Retail Health Insurance FAQs:

 

1)      What is Health Insurance?

 

Health insurance is a contract between the insurance company and the insured customer in which the health insurance policy promises to settle the health insurance claims of the customer during the policy period up to the limit of sum insured, in return for a considerable amount known as “Premium”. Health insurance policy can be divided into two types: Retail health insurance and Group health insurance. Retail health insurance is a type of health insurance which covers the Self and Family of the proposer while the Group health insurance is taken by the Employer for their employees.

 

2)      What is the need for Health Insurance?

 

Health insurance is the most sought after insurance in India after the outbreak of Covid-19 pandemic. As per the report of Niti Ayog, at least 30% of Indian population, or 40 Crore individuals are devoid of any health insurance protection in India. Central and State Sponsored schemes cover the bottom 50% of the population, or 70 crore individuals.

 

3)      What is covered in a Health insurance policy?

 

Health insurance policy covers the hospitalization and other allied expenses made by the insured customer. Health insurance policy covers the illness or diseases or accident related hospitalization of the insured customer up to the limit of sum insured mentioned under the policy. All the treatment related expenses are covered under the health insurance policy subject to the terms and conditions mentioned under the policy.

 

4)      What is In patient hospitalization in a Health insurance policy?

 

If a patient is admitted to the hospital for more than 24 hours for any kind of treatment, then it is known as in patient hospitalization. In patient hospitalization is when the insured is admitted to the hospital for more than 24 hours during the course of treatment. For any in-patient claim to be admissible under the health insurance policy, the insured customer needs to undergo treatment for more than 24 hours in the hospital as an in-patient.

 

5)      What is the difference between health insurance and medicare insurance policy?

 

Medicare insurance and health insurance are almost similar and are used interchangeably in India. Medicare insurance is a terminology used in the West while health insurance is the terminology used in India. Some define medicare insurance as insurance coverage to the employee only and health insurance is the coverage for Employee as well as his/her family. Medicare is the coverage provided by the state while health insurance is the insurance taken by the individuals to cover their health expenses from insurance companies.

 

6)      Is accident related hospitalization covered in health insurance?

 

Hospitalization due to accidents is covered under your health insurance policy from day 1 without any waiting period. There is no waiting period of accident related hospitalizations under your health insurance policy. Since the accidents can happen anytime, there is no waiting period under the health insurance policy,

 

7)      Does my health insurance policy cover Cancer and Heart attack?

 

The hospitalization expenses incurred as a result of Cancer or Heart attack are covered under your health insurance policy subject to the terms and conditions under the policy up to the sum insured mentioned under the policy. Cancer and heart attack are known as Critical illnesses which are life threatening and require a high degree of health insurance coverage. Therefore a health insurance policy has separate sum insured for critical illnesses in addition to the basic health insurance coverage.

 

8)      What is the waiting period in a health insurance policy?

 

Waiting period is the time period during which the insured customer cannot make a claim under the health insurance policy. Every health insurance policy would have a waiting period after which the claims would be settled. The waiting period under any health insurance policy would range from 30 days to 4 years depending on the type of health insurance policy and the insurance company.

 

9)      What is day care procedure in health insurance?

 

A day care procedure does not require admission in the hospital for more than 24 hours. Due to the advancement in technology most of the treatments do not require for the patients to get admitted in the hospital for more than 24 hours.

 

10)  Is there any age limit to purchase a health insurance policy?

 

The minimum age limit to purchase a health insurance policy as Proposer is 18 years and the maximum limit is 70 years for most of the insurance companies. Children under 18 years of age can be added in the health insurance policy with at least 1 adult being present in the policy. The entry age would be decided by the insurance companies for their retail health insurance policies.

 

11)  Can I claim immediately after taking a health insurance policy?

 

Yes, you can claim immediately after taking the health insurance policy only for accident related hospitalization. For every other disease or illness there would be a waiting period specified in the health insurance policy. The waiting period would range from 30 days to 4 years. There are different waiting periods under a retail health insurance policy. 

 

12)  What is Cashless hospitalization in a health insurance policy?

 

Cashless hospitalization is the process of claim settlement in which the insurance claim would be settled by the insurance company directly to the hospital so that the customer need not pay the claim from his/her pocket.

 

13)  My preferred hospital is not in the network hospital list, how to claim now?

 

If your preferred hospital is not in the network hospital list provided by your insurance company, then you can opt for Reimbursement of health insurance claim. In the reimbursement process, the customer has to pay the medical bills and then submit the original bills and other treatment related documents to the insurance company to process the claim and settle the amount. The reimbursement process would take around 10-15 days for the claim amount to be settled.

 

14)  Will my entire hospital bill be settled by the insurance company?

 

In most of the cases the entire hospital bill would be covered by your insurance company subject to the maximum sum insured available under your health insurance policy. If the hospital bill is over and above the sum insured mentioned under the policy, then the difference amount has to be borne by the customer. It is important to note that all the treatment related expenses are paid by your insurance company subject to the sum insured available under the policy.