There is a growing awareness about buying health insurance plans, yet, a lot of doubts remain.
Let us have a quick look at the list of top 10 FAQs to attain a better understanding of health insurance concept:
- Q. 1) Can I claim for health insurance from mine and my spouse’s company if we both have media claim plans?
- Q. 2) Will health insurance cover only surgery or all kinds of hospitalisation expenses?
- Q. 3) Is there a guarantee that claims will be approved?
- Q. 4) How to study policy documents?
- Q. 5) Can premium change over the years?
- Q. 6) Do I require one health policy or more?
- Q. 7) Can I get treatment from different hospitals?
- Q. 8) What should I do if there is any dispute with the insurance company?
- Q. 9) What is Critical Illness and Why is it Important?
- Q. 10) Can I be denied cashless hospitalisation?
Yes, you can do so! If you’re covered by your employer for an amount of Rs. 2 lakhs and also have coverage under your spouse’s plan from his/her employer for another Rs. 1 lakh, then you can file for reimbursement to a maximum of Rs. 3 lakhs. The only thing to be kept in mind is that you should first file a claim with your company and then with the spouse’s company.
A health plan provides cover for accidents, surgeries and even normal hospitalisation for any treatment. The only requisite is that the insured needs to be hospitalised for a specified number of hours.
The claims will be approved provided you have given complete and accurate information to the insurer at the time of buying the policy. Also, at the time of hospitalisation whether it is planned or in an emergency, do update the insurer and provide all necessary documentation. If everything is according to the policy documents and meets the required terms and conditions, the claims will be approved.
You must be aware of policy details. The things to look out for are: check what is not covered in your health plan, what are the limits set by the insurer on various kinds of treatments like cataract surgery, maternity benefits, room rents, etc. This will ensure you don’t get any nasty surprises at the time of filing a claim.
Yes, the premium is subject to change depending on the claims you have filed. Even if no claims are filed, based on age the insurers charge different premium amounts. The good part is they have age brackets like 25-30 years, 30-35 years and so on and so forth. So if everything else remains same and you belong to a particular age bracket, the premium will only increase if you move on to the next age bracket.
One is enough if you have an adequate sum assured with it. Having 2 separate policies is a wise idea if you want to separate the risks. For example, you can have one with you, your spouse and children and another with your parents. But only if the health plans are offering substantial benefits and are affordable.
Ideally, you should select the best network hospital to get treatment from, but for some reason you have to change hospitals, you can still health insurance benefits. However, it would be subject to approval from the third party administrators (TPA), who would evaluate your situation and will check if you meet the terms and conditions of the plan.
For all disputes, you can firstly approach the customer complaints cell of Insurance Regulatory and Development Authority of India (IRDAI), and if you don’t get a solution there, you can then approach the Grievance Redressal Cell of IRDAI.
Critical illness covers life-threatening diseases like cancer, bypass surgeries, kidney aliments, stroke, etc. and their treatment is very expensive. Having a critical illness rider or a standalone critical illness policy helps you to cover the financial risks associated with these diseases. The insurer pays the lump sum amount at the time of diagnosis of any of such diseases instead of waiting for hospitalisation.
If you are admitted to a non-network hospital of the insurance provider or if your ailment is not covered as per the terms of the policy, the insurance provider can deny you the cashless benefits. Therefore, it is important to read the terms and conditions carefully to be aware of such details.
Hope these Health insurance FAQs helped you clear a lot of doubts.