Six frequently asked questions on health insurance
Large number of Indians have realised the importance of health insurance and now many even set aside a decent budget to invest in a comprehensive health cover. However there are a few questions and doubts due to which the buying decision is put on hold. People evaluate health plans for months together and yet donít buy it. Letís quickly take a look at some of the frequently asked questions -

What will the health insurance policy pay for and when?

A health insurance policy ideally covers -
In-patient Treatment - Covers hospitalisation expenses due to an illness or accident. Pays for medical expenses incurred for room rent, boarding expenses, nursing, intensive care unit, medical practitioner, medicines or drugs and other related expenses

Pre-Hospitalisation- Pays for medical expenses incurred due to an illness immediately before hospitalisation

Post-Hospitalisation- Pays for medical expenses incurred immediately after the discharge post hospitalisation

Day care procedures- Pays for medical expenses which do not require 24 hours hospitalisation
Will the premium increase every year or remain constant? What happens to the renewal premium if I make a claim in the existing year and what happens if I do not make a claim?

The premiums charged by the health insurance company is usually the same for specific age groups such as 0 18, 19 30, 31 45, 46 -55, 56 60 and 60+. The premium usually remains constant as long as you are in the same age bracket. But once you shift from one age bracket to another the premium will increase.

If you make a claim in the existing year, then chances are your renewal premium will be increased. The increase in premium is called load premium which can be looked at as an extra cost for the additional risk the insurance company is covering. But nowadays insurance companies state on their policy document that they will not load your premium for first five years irrespective of your claim history.

If you do not make a claim in the existing year, then the insurance company usually offers you a bonus. This bonus could be in the form of discount in premium or increase in sum assured amount.
What are the important things to check in the policy?
1. Check the list of hospitals that are tied up with the insurance company.

2. Check the waiting period for pre-existing diseases. Usually an insurance company covers the expenses on pre-existing diseases after a period of 3 years.
3. Check if there is a clause of co-payment (means that the policyholder has to bear some percentage of expense of the claim). The co-pay clause is usually a feature in senior citizen health insurance policies.

4. Check the exclusions in the policy. This is important as one should be aware of the limitations in your policy and therefore avoid any chaos at the time of a claim.

Can I take 2 health insurance policies? How will I make a claim in that scenario?

Yes you can take multiple health insurance plans from the same company or different company. In fact it is a good idea to take two health plans from different companies and diversify. There are many ways in which you can make a claim in multiple policies but the most practiced approach is splitting it between the companies in proportion of the sum assured availed.

So letís say, you have a policy from Company A of 3 lacs and from Company B of 6 lacs. Now the claim amount is 3 lacs then you can submit a claim to Company A for 1 lac and Company B for 2 lacs. However, once the new guidelines come into effect, chances are that you will be allowed to file a claim for the entire amount with the company you wish to.

Does everyone offer cashless facility or we have to ask for it?
Yes, cashless service has become an inherent part of a health insurance policy. The public sector general insurance companies offer a discount in premium if you opt out of the cashless service but not many people avail the same.

What if the insurance company refused to settle my claim and I want to file a complaint against them? Also say they do process the claim but I am unhappy with the amount approved by them, then what can I do?

To monitor policyholderís grievances and turn around times, IRDA has implemented the Integrated Grievance Management System (IGMS). IGMS provides a gateway for policyholders to register complaints with insurance companies first and if need be escalate them to the IRDA Grievance Cells. IRDA Grievance Call Centre (IGCC) can be accessed through.
15 April 2013
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