Health Insurance FAQ India

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List of FAQ –

Q.What is health insurance?

The term ‘health insurance‘ refers to the type of insurance that covers your medical expenses. The health insurance policy is a contract between an insurer and the person/group in which the insurer agrees to provide a specified health insurance coverage on a fixed premium.

Q.What type of health insurance is available?

The most common type of health insurance policies in India covers hospitalization expenses, while now a number of products are available which provide a full range of health cover based on the need and choice of the insured.

The health insurer is either given the facility of direct payment to the hospital (cashless facility) or reimbursement of expenses related to illnesses and injuries or reimburses a fixed benefit (amount) on any illness. The type and quantity of health care costs covered in the health insurance plan are already specified.

Q.Why is health insurance important?

All of us must purchase health insurance according to the requirements for all of our family members. Buying health insurance protects us from sudden, unexpected costs of hospitalization (or other covered health events, such as critical illness), which could otherwise have a big impact on household savings or even make debtors.

Each of us is sensitive to health risks and medical emergencies can come from any of us without any warning. With the technological advancement, new procedures and more effective medicines, healthcare are becoming increasingly expensive day by day due to the cost of healthcare. Where these high costs of treatment can get out of reach of many people while taking the protection of health insurance is far more economical.

Q.What kind of health insurance plans are available?

Health insurance policies, under micro-insurance policies, From the sum insured of 5000 to some critical illness plans, Rs. Available with a sum insured of 50 lakh or more. Most insurers offer policies with the insured amount up to Rs 1 lakh to Rs 5 lakh.

Since the rent and other expenses of the rooms payable by the insurer are now being added as an option with the sum insured, it can be advised that it would be better to take adequate cover from the earliest age, especially because someone Increasing the amount insured after claiming is not easy. Also, where most non-life insurance companies offer health insurance policies for a period of one year, there are also policies that are issued for two, three, four and five years.

There are also plans for life insurance companies whose duration can be extended. During the policy period in the hospitalization policy, the actual cost of treatment is admitted in the hospital or covered partially or partially. This is a comprehensive form of coverage which is applicable to various expenses incurred during hospitalization and includes expenses incurred before and after a certain period of time before recruitment to the hospital.

Such policies are available on the basis of the individual insured amount or on a family floater basis, in which the sum insured is divided on all the members of the family. Hospital Daily Cash Benefit Policy is another type of product, which provides a fixed sum insured for each day during hospitalization. In case of recruitment to ICU or specified diseases or injuries, coverage for higher daily gain can also be given.

In the Critical Illness Benefit Policy, the insured person gets a fixed lump sum if he is diagnosed with a specific illness or if he has any special procedure. This amount is helpful in reducing various direct and indirect economic effects due to a serious illness. Usually, once the lump sum amount is paid, the plan is no longer effective.

There are also other types of products in which there is a one-time payment (Surgical Cash Benefit) on the basis of having a specific surgery and some other products which meet the needs of specified targeted classes such as senior citizens.

Q. What is the cashless facility?

Insurance companies have entered the country by signing contracts with many hospitals in the country. Under the health insurance policy offering a cashless facility, if the policyholder is treated in a hospital in this network, then he does not have to pay the hospital bills in cash because the hospital is paid by the third party administrator on behalf of the insurance company.

However, the expenses incurred by the insurance company, the excess of the limitations or sub-limits, or the type of expenses not covered under the policy, is to be paid by the insured directly to the hospital. However, if you get treatment in a hospital outside the network, then the benefit of the cashless facility is not obtained.

Q.What tax benefits will I get if I choose health insurance?

Health insurance offers attractive tax benefits as additional incentives. There is a special section 80D of Income Tax Act which provides tax benefits for health insurance and it is exempt from section 80C which is applicable on life insurance and some other types of investments/expenses are also exempted.

At present, such customers of health insurance who have purchased the policy by any other form of payment other than cash, they will be able to pay the annual income of their annual income from their taxable income in respect of payment of health insurance premium for their spouse and dependent children. Can cut 15,000. For senior citizens, this deduction is high, which is Rs.20,000 In addition, additional Rs. Payment of 15,000 also comes under the tax exemption, which is paid by the parents on health insurance premium, and if the parent is a senior citizen, then the deductible amount is Rs. 20,000

Q.What are the factors affecting health insurance premiums?

Age is a major factor on which the premium is determined. The more you are, the cost of the premium will be as high as you are more vulnerable to more diseases. Pre-medical history is another factor in determining premiums. If there is no pre-medical history, then the premium will be reduced automatically.

The unclaimed year is also a major factor in determining premium because it can give you a certain percentage discount. This will help you reduce your premium automatically.

Q.What is not covered in health insurance policy?

You must read the description/policy and understand what is not covered in it. Commonly pre-existing diseases (read the policy to understand what is present in the disease) are kept excluded under health insurance policy. In addition, certain diseases are also excluded during the first year of coverage and a waiting period is applied.

There are also certain standard exclusions such as the prices of glasses, contact lenses and hearing aids are not covered, teeth treatment/surgery (if hospitalization is not recruited) is covered, health benefits , General disability, external disorders of genitalia, sexual dysfunction, deliberate self-injury injury, drug use / alcohol use, aids, diagnosis, X-ray or laboratory examination Not such expenses incurred on issues which are relevant to the disease requiring hospitalization which does not cover the expenses related to pregnancy or childbirth and caesarean section, naturopathy treatment etc.

Q. Is there a waiting period for a claim under a policy?

Yes, when you receive a new policy, there is usually a waiting period of 30 days, which is applicable from the date of commencement of the policy, and during this period, any expenses related to hospitalization are not paid by the insurance company. However, due to an accident, this provision does not apply when hospitalization is due to occur in an emergency. This waiting period does not apply to subsequent policies after renewal.

Q.What are the pre-existing conditions for a health insurance policy?

It is a medical condition that can be present before you take a health insurance policy and it is important because insurance companies do not cover such pre-existing condition for 48 months before the first policy. This means that only 48 months of continuous insurance cover is considered for payment for pre-existing conditions.

Q.If my policy is not renewed before the expiry date, can I be denied from renewal?

If the premium is paid by you within 15 days of termination (it is called grace period) then the policy will be renewable. However, coverage will not be applicable till the period until the premium is received by the insurance company. If the premium is not paid within the grace period, the policy will have lapsed.

Q. Can I transfer my policy from one insurer to another without leaving the renewal benefits?

Yes, the Insurance Regulatory and Development Authority (IRDA) has issued a circular which is effective from October 1, 2011 and it directs the insurers that they are from an insurance company and from a plan In others, allow the insured to move without the expiry of the renewal benefits of pre-existing conditions, which have been benefiting from the previous policy. However, this benefit will be limited to the sum insured (including bonus) under the previous policy. You can get information from your insurance company for details.

Q.What will be the policy coverage after submitting a claim?

After a claim is submitted and settled, the policy coverage is reduced to that amount, which has been paid on settlement. For example, consider that in January you have to pay Rs. Launched a policy with 5 million annual coverage, and in April you will get Rs. Claimed 2 million. Now from May to December, you will have a balance of Rs. Coverage of 3 lakhs will be available

Q.What does ‘anyone disease’ mean?

‘One disease’ means the continuous period of the disease, which includes re-emergence within certain days. Often this period lasts for 45 days.

Q.Maximum number of claims allowed in a year?

Any number of claims can be allowed during the policy term if no specified overrun has been fixed in any policy. Although the sum insured is the maximum limit under the policy.

Q.What is the ‘health check’ facility?

Some health insurance policies pay the specified expenses for general health check once in a few years. Generally, it is done once in four years.

Q.What do you mean by Family Floater Policy?

Family Floater is a single policy in which your entire family hospitalization expenses are covered. There is a single sum insured in this policy, which can be used by any / all members of the family to any ratio or amount, which is subject to the maximum overall limit of the policy sum insured. Instead of taking individual personal policies, it is often better to take a family floater plan. Family floaters cover all medical expenses arising due to plans, accidental illness, surgery, and accidents.