Health Insurance

STAY PROTECTED WITH HEALTH INSURANCE ON YOUR SIDE

HEALTH INSURANCE DEMYSTIFIED

With Health insurance by your side every coverage offered by an insurance company depends on the type of policy and insurer. An ideal Health Insurance policy is the one that suits your health needs the best possible ways. Here are some common coverages your insurance company may offer:

  • In-Patient/ Out-Patient Hospitalization expenses
  • Coverage against Pre-existing illnesses
  • Coverage on Pre & Post Hospitalization
  • Regular Health check-ups
  • Ambulance charges
  • Maternity cover
  • Room Rent
  • Operation Theatre charges

Health Insurance can offer the validity to enhance your protection by choosing a rider & add-on features by paying more premium for the same.

Health Insurance package varies from one company to another. Every health plan is customised to supplement your basic health needs; but there are some which may not be covered by your insurance provider. Here are some basic coverage exclusions which your insurance company may not have in offer for you:

  • No reimbursement or coverage on waiting period in initial 30 days of the policy purchase.
  • Coverage on critical or pre-existing illness.
  • Injuries due to war/ terrorism/ suicide attempt.
  • Terminal illnesses or AIDS
  • Common illnesses, bed rest etc.
  • Other non-listed expenses incurred on maternity

Cashless Hospitalization is a huge relief to policy holders introduced by insurance companies. It is a facility offered by companies where a patient can holding a health insurance policy can use when the need of undergoing an expensive treatment or medical admission occurs without having to pay cash to the hospital, since the cover is offered and managed by the hospital and the insurer directly.

Health Insurance companies’ tie-up with numerous hospitals to offer some listed cashless services facility against certain ailments. The hospitals listed by that insurance company is termed as Network Hospitals. Cashless facility can be availed only in these listed network hospitals only. Third Party Administrators play a vital role co-ordinating with the hospital and the insurance company to complete the process of health claim for cashless hospitalisation when in time of need.

Just fill in your pre-authorisation form duly in the presence of an authority and send the same to your TPA who would then specify whether the claim should be approved or rejected.

Today, there are a range of health insurance plans to choose from. A mix of different insurance plans, varying premium amounts, the associated jargons and clauses leads to a lot of confusion and makes it difficult to determine which health insurance plan is best for you. Given this, it is best to compare from available alternatives online and then go for the best plan based on your individual requirement. The broad approach should be:

  • Short-list a few insurance policies based on factors such as claim-settlement ratio, premium, hospital network in your locality, policy features, etc.
  • Read user reviews to get a perspective from existing customers
  • Do a side-by-side comparison at All Risk Cover to understand what’s on offer.

FAQS

What does health insurance cover?

A health insurance plan cover nearly all hospitalisation expenses when the insured is hospitalised for 24 hours or more. The cover includes cost of treatment, medicines, surgery, doctors’ fees, room rent, etc. Some insurance policies also cover costs incurred in day-care procedures. Insurers have varying policies and it is important to go through the policy document carefully to learn what is covered, what is not covered, the available hospital network in your location and other such details pertaining to your health insurance plan.

My Employer has already offered health insurance as part of my employment. Should I still go for a separate health insurance plan?

It is always advisable to go for a separate health insurance cover besides what your employer offers for the following reasons:

  • Employer provided health insurance ceases to exist if you retire or switch jobs.
  • If you switch jobs, you are without any health cover during the interim period before joining the new company.
  • It is possible that your new employer does not offer health insurance
  • Health insurance premium increases with age. Therefore, the more you delay your decision, the higher your insurance premium.
  • Group health insurance does not offer benefits such as No Claim Bonus, etc., which is extended in personal health insurance plans.

What is the upper age limit at entry?

Most health insurance companies restrict the upper-limit at entry between 55 – 60 years. The policies vary from company to company.

What is waiting period?

Waiting period is the duration during which a policyholder cannot initiate a claim. If you buy a health insurance policy, you cannot claim insurance the moment you buy the policy. There is a “waiting period” of 30 days during which you cannot initiate any claim except in the event of an accident. Also, depending on the type of illness for which coverage is sought, the waiting period ranges anywhere between 1 – 6 years. For instance, for cataract surgery, most companies specify a waiting period of one year.

What is the procedure for initiating a claim?

You can make a claim by initiating the claims process. The claims process involves the following:

  • Claim intimation (For instance, intimation to the Third-Party Administrator desk)
  • Claim processing
  • Claim settlement – Payment/Rejection

Do I need to physically intimate the insurer to initiate claim?

No. You can intimate the insurer through various channels including the following:

  • Third-Party Administrator (TPA) desk
  • Call-centre
  • Online
  • Emil
  • Fax
  • Others

What is the procedure for availing cashless claim?

In order to avail cashless claim, you (or your family member as the case may be) should intimate the Third-Party Administrator (TPA) desk at the network hospital and complete the documentation as required. The insurer will examine the Pre-Authorisation request against the sum insured per the health plan and communicate as appropriate (approve/part approve/reject).

What is the maximum number of claims allowed over a year?

There is no cap on the number of claims made during a policy period. However, the sum assured specified in your policy is the maximum limit under the policy.

Can I renew my health insurance policy after the expiry of the due date?

It is advisable to renew your health insurance before the expiry of the policy tenure. This is to ensure that you do not lose out on any benefits – such as No Claim Bonus, etc. Your insurer usually send a renewal notice intimating you of the upcoming renewal. However, the insurer is not obligated to intimate you of the same.

Can I renew my health insurance policy online?

Yes. You can renew your health insurance plan online. You can renew your policy online even if you haven’t purchased on online.

What is a family floater plan?

A family floater plan, unlike an individual health insurance plan, covers more than one member of the immediate family. You can get insurance coverage for all the immediate family members with a single plan. A family floater policy cover self and spouse, or self, spouse and children as the case may be. This plan is cost-effective in comparison to an individual cover because the cost of premium paid for taking health insurance for all members individually works out to be more expensive than going for a family floater plan.

What are exclusions?

Insurance companies list certain cases as exclusions for which there is no medi-claim. Exclusions vary from one insurer to the other and it is important that you go over the policy document to know this better. Depending on the type of health insurance you have opted for, OPD costs, ambulance costs, etc., may or may not be covered. There are certain other items which are generally excluded:

  • Expenses incurred towards beauty treatment and cosmetic surgery.
  • Cost of Dental implants.
  • Cost of purchasing contact lenses and spectacles.
  • Treatment cost related to HIV/AIDS.
  • Hospitalisation resulting from war – nuclear, chemical, biological warfare.
  • Cost of treatment using alternative medicine such as naturopathy, ayurvedha, siddha, etc.

What is Co-payment?

Certain health insurance plans come with a co-payment option. Co-payment essentially means that you agree to pay a part of the treatment expenses from your pocket. The percentage varies from insurer to insurer. You can opt for co-payment if you are looking to lower your insurance premium. But do remember that while this results in a lower premium outgo, it can burn a hole if the medical bills are high in case of hospitalisation.

What are add-ons?

Health insurance providers allow you the ability to customise your health insurance plan based on your individual requirements. You can customise your plan using add-ons to your policy. These add-ons help cover certain illnesses that are otherwise not covered as part of your regular plan. For instance, you can obtain cancer-care as an add-on. Similarly, critical illness cover, personal accident cover, etc., are all add-ons. Opting for add-ons increases your premium outgo but at the same time offers additional security.

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