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Q:1)Why do I need health insurance?

The need for health insurance plans has increased due to substantial changes in our personal and professional lives that lead to dwindling health. We look at the following reasons to understand the reasons for buying health plans:
1) Deteriorating Lifestyle
Accumulation of items of luxury that doesn’t involve much of movement, increased stressed levels at work, sedentary lifestyle and least amount of exercises is leading to poor lifestyles. It directly impacts our health and leads to complications. The treatment for such ailments require substantial amount of money that only health plans can provide for.
2) Reign of Lifestyle Diseases
Obesity, diabetes, heart complications and the likes are all a result of poor lifestyle choices. Eating junk food, not sleeping on time and hardly any or nil physical activity leads to such diseases that require lifelong management along with immediate hospitalisation. To meet sky-rocketing expenses for treating such diseases, health insurance policy comes handy.
3) Prevention Is Better Than Cure
Health risks are unforeseen and sudden. Instead of scrambling for money when a health tragedy strikes, it is better to be prepared. Most people are devoid of adequate medical care because they don’t have enough funds to pay for correct medical treatment. These treatments can sometimes be only availed at private medical establishments where the cost of medical care is beyond a common man’s budget. It is not always possible to beg or borrow to pay for such expenses; hence a health plan is of utmost requirement.
4) Financial Discipline
Saving money on a regular basis to pay premiums towards health plans inculcates a sound financial discipline. These small savings go a long way in providing the right medical cover when you actually need it.

Q: 2) Why should I take a Health Policy if I already have health insurance from my employer, or if my family and I are already covered by my corporate?

Your employer will cover your medical expenses only as long as you are in his services. Tomorrow, you may change your job, retire, or even start something on your own. In all such cases you and your family will be stranded if a medical emergency arises and you have not arranged for an alternative health insurance policy. It is at this point of time that Health Insurance policy will come to your rescue.  Health Insurance policy can also act as a supplement to your existing medical cover in case the cost of medical treatment is higher than your existing cover level.

Q:3) What is the maximum number of claims allowed over a year?

Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.

Q:4) What is the right time to buy health policy?

A: ASAP- As soon as possible is the perfect answer to this question. By buying at a younger age, you can enjoy low premium rates. Moreover, for critical illnesses, every firm has its own waiting period. By buying it at young age means you get access to health inclusion when the need actually arises. So don’t wait for any accident or a medical condition to occur before you hit a panic button and buy a health insurance policy.

Q:5) What is the importance of Health Insurance?

Maintaining health doesn’t cost a lot of money. However, once it is spoiled, the medical treatments and regaining process can put a massive hole in your pocket. On the list of priorities in our life, health insurance must be amongst the top ones. Here are the reasons why a health plan is absolutely necessary:
1) Protection Of Health
Health insurance policies not only come to your aid at the time of hospitalisation, but some of them also help you in getting free medical check-ups and timely medical care. Most people are inclined to get counselling when they know they won’t have to bear the expenses. With expensive doctor visits and prohibitive costs of medical tests, it is obvious that health plan covering such expenses comes as a saviour!
2) Financial Support during Emergencies
Almost every health plan comes with the feature of cashless hospitalisation in their network hospitals. During emergencies, it really helps in getting adequate and timely treatment without the dependants of the insured having to scramble for funds.
3) Protection against Rising Health Expenses
While advancement in science and technology has helped in getting better medical care, the cost of such treatments has also gone through the roof. An adequate sum assured with a health plan can help you to get proper medical care, no matter what your financial status is! The insurer takes care of money matters while you can focus on getting the right treatment.
4) Productive Utilization Of Own Savings
We save money to pay yearly premiums for health insurance policies. We may not need to use the health policy benefits every year and it may look like waste of money in the short-term. But the day you need to be hospitalised, all these indirect savings will come to your aid by saving your life and getting you satisfactory medical treatment.
5) Source of Credit
Not everyone has enough of a bank balance or sufficient cash at home to face medical emergencies. Health insurance can help you buy time to make hospitalisation payments. Even if you have to somehow pay from your own pocket initially, due to any reason, you can always claim it back.

Q:6) Types of health insurance policies/ cover?

Just like everyone is different in their own way, the insurers have also come up with different kinds of health plans catering to individual health requirements and lifestyle needs. Following are the various types of health plans for you to select from:
1) Individual Policy
As the name states, you can buy it for yourself and covers only your health related expenses. The plan can be customised based on your age; lifestyle habits etc. and help you during hospitalisation.
2) Family Floater Policies
These polices cater to entire families including spouse and children and in some cases it includes parents too. These are comparatively cheaper than individual plans, but come with their own set of restrictions. -
3) Critical Illnesses Plan
This plan is to provide health benefits for critical illnesses like cancer, paralysis, stroke, heart-related ailments and the likes. Under these plans, the insured is paid the entire sum insured at the time of diagnosis itself rather than waiting for the treatment to get over. However there is a waiting period of 90 days from the date of commencement of the policy before one can avail the benefits of the plan. Also, there is a 30 days survival waiting period that means that the insured has to survive for more than 30 days after the diagnosis of the critical illness for the plan to kick in.
4) Maternity Policies
These are the plans that take care of maternity related expenses including hospitalisation, delivery charges and in some cases cover even the new born baby for a certain period of time.
5) Senior Citizen Plan
Senior citizens are the most vulnerable lot, who require expansive medical care that results in massive expenses too. Senior citizen plan can help them get adequate care without burning a hole in the pocket.
6) Cardiac Care Plan
These are cardiac special health insurance plans since the cost of heart-related treatment has risen drastically in last few years. These plans cover patients, who have undergone either angioplasty or by-pass surgery once prior to buying the plan and meet the insurer’s waiting period guidelines. The insured are covered for future cardiac ailments, surgeries and cardiac medical management.
7) Diabetes Plan
These plans cover the insured for diabetes and its related complications. But, the cover starts only after a waiting period of 1 to 30 days, that too depending from insurer to insurer, based on pre-screening of the disease. There are only a handful of players in the market providing such coverage so choose carefully.
8) Dengue Care Plan
Dengue comes back as an epidemic every year and the cost of treatment is extremely high as well. With such plans one can manage the disease if it strikes despite all precautions. The plan comes into effect almost immediately or at the most after 15 days of the initiation of the policy. The premiums are extremely low and some insurers also offer OPD coverage since most patients get treated via outpatient treatment only.
9) Personal Accident Plan
An accident can happen anywhere, anytime. The result could be disability, partial disability and long periods of recovery and rehabilitations. The personal accident plan helps to cope up with expenses during this period including hospitalisation expenses and routine household expenses.
10) Top-up Plans
This plan offers financial coverage for hospitalisation expenses after the basic sum insured is exhausted in a given policy year subject to a capped limit. However, it can be used only once in a year.
11) Super Top-up Plans
These plans come into effect after the basic sum insured is exhausted and can be used multiple times in a year for hospitalisation. It covers all the medical bills generated in a year due to hospitalisation subject to the financial limit of the plan. For example, if an insured has a basic plan with coverage of Rs. 5lakhs and super top up plan with coverage of Rs. 10lakhs, the patient can file for claims up to a maximum of Rs. 15lakhs in a policy year spread across single or multiple hospitalisation events.
12) Cancer Care Plans
Even though cancer is part of critical illnesses plan, a health policy dedicated only for cancer is more beneficial if the insured has a genetic history of the said disease. This way one can have access to substantial amount of funds for managing and treating the disease.
13) Extended Family Plans
Certain insurers also provide health insurance coverage to siblings and extended family including family of spouse etc. This gives comprehensive health coverage to entire family.
14) Worldwide Emergency Cover Plan
For those travelling frequently all over the world for business or leisure purposes can avail such plans to take care of the medical expenses in a foreign country.
15) OPD Cover Plans
These plans provide health coverage for expenses incurred on getting counselling, tests and medications from an Out Patient Department (OPD).
16) Without Pre-policy Medical Check-up Plan
Many insurers, to woo customers, offer health plans in which you don’t have to undergo any medical tests. You can buy them online by furbishing only the basic health information about yourself.
17) AYUSH Cover Plans
AYUSH stands for: Ayurveda, Siddha, Unani and Homeopathy. These alternative modes of treatment are also covered by certain health plans offered by the mainstream insurance companies.

Q:7) What is a ‘cashless’ claim?

In a cashless claim the insured is required to intimate the TPA to avail cashless facility. After authorizing it, the TPA directly settles the claim to the network hospital and the insured is not required to pay any charges except non-medical expenses and other expenses not covered under the policy. Insured person is entitled for cashless only in our network hospitals. 

Q:8) What is a reimbursement claim?

In a reimbursement claim the insured has to pay upfront for the services of the provider and seek reimbursement from the Insurer for the covered services

Q:9)What is Pre-Authorization?

In a pre-authorization process, the insured or the service provider seeks an approval and guarantee of payment from the insurer or it’s TPA for the covered services before the Hospitalization / service for planned treatment and during the course of Hospitalization / service for emergency treatment

Q:10) Is cashless facility available across all hospitals?

The cashless facility is available only at the hospitals which are in Insurance Company network.

Q:11) What do you mean by network/ non network hospitalization?

A Hospital, which has an agreement with insurance companies for providing Cashless treatment, is referred to as a 'Network Hospital'. Cashless facility is provided ONLY at the network hospitals. Non-network hospitals are those with whom insurance companies do not have any agreement and any policyholder seeking treatment in these hospitals will have to pay for the treatment and later claim as per reimbursement procedure.

Q:12) Will I get cashless at government institutions like AIIMS/TMH/ARMY Referral hospitals?

No, this facility does not extend to government hospitals.

Q:13) How long is the policy valid for?

Insurance Companies offer policies with option of 1, 2 and 3 years policy period which can be renewed every year till lifetime.

Q: 14) My wife & children are residing at Chandigarh while I am in Delhi. Can I cover all of us in one policy.

Yes, you can cover the entire family under one policy. Your health insurance policy is in force across India.

Q: 15) Does health insurance cover diagnostic charges like X-rays, MRI or ultrasound?

Health Insurance covers all diagnostic test like X- ray, MRI, blood tests etc as long they are associated with the patients stay in the hospital for at least 24 hours. Any diagnostic tests which do not lead to treatment or which have been prescribed as Outpatient are generally not covered.

Q:16) What is health cashless card?

A health cashless card is a card that comes along with the Health Policy. It is similar to an Identity card. This card would entitle you to avail cashless hospitalization facility at any of our network hospitals. A health card mentions the contact details and the contact numbers of the TPA. In case of a medical emergency, you can call on these numbers for queries, clarifications and for seeking any kind of assistance. Moreover, you need to display your health card at the time of admission into the hospital

Q:17) Is the premium exempted from Income Tax?

Yes, the premium paid for health insurance policies qualifies for deduction under Section 80D of the Income Tax Act. An person is entitled to a deduction of Rs. 25000 in respect of medical insurance premium paid on the health of himself, his spouse and children. In addition thereto, if he pays health insurance premium on the health of his parents( senior Citizen), he will be entitled to additional deduction of Rs. 30000/- The health insurance premium that you pay must be from the taxable income applicable for the year you claim. Premium should not be from gifts received by you. The premium may be paid by any mode of payment, other than cash.

Q: 18) What do you mean by pre-existing disease or conditions?

By Pre-existing Condition we mean any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer.

Q: 19) Does any health insurance cover the treatment of pre-existing cover?


Q: 20) What is a waiting period?

A waiting period is the length of time the insured have to wait before being eligible for Health Policy benefits.

Q:21) What is room rent capping?

Hospital charges rent on the room that one takes at the time of hospitalization. Some insurance companies put a cap or a limit on how much a person is eligible for the room rent per day at the hospital. One needs to compare it with the rates of the hospitals one visits. These norms vary for each Health Insurance company. 

Q: 22) What is Capping in health Insurance?

Capping is the maximum amount one can avail under different heads covered in the health insurance plan, like room rent and ICU charges. If expenses come out to be more than the specified limit, then these are to be borne by a policyholder. 

Q: 23) During the course of treatment can I change my hospital?

Yes, you are allowed to change the hospital on the grounds of better treatment and services, but you need to first inform your TPA who will evaluate your case on the basis of Policy terms and conditions. 

Q: 24) Is medical checkup is necessary before buying a policy?

A: Pre Policy medical checkup is mostly on higher age bracket or people having past medical history and opting for high sum insured option. However, it is in our best interests to undergo medical test at the time of buying policy to ensure the fast and efficient claim settlement.

Q: 25) What do you mean by Pre and Post hospitalization?

Pre- and Post-hospitalization expenses cover all medical expenses incurred within 30 days prior to hospitalization and expenses incurred within 60 days post hospitalization provided the expenses were incurred for the same condition for which the Insured Person’s hospitalization was required.  For Example: A person may be required to undergo certain tests to confirm the disease for which he is eventually hospitalized. The Doctor's consultation fees for this, the expenses for tests and medicines 30 days prior to hospitalization for that particular disease are covered. Medical expenses for 60 days post-hospitalization after being discharged from the hospital, e.g. the subsequent follow-up consultations with specialists, medicines and test expenses are covered.

Q: 26) What is Co-Payment?

Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured; however it reduces the premium payable by the insured to the insurer.

Q:27) Why should I buy a critical illness cover?

With rapidly changing demographics and lifestyles prevalence of critical illness is on the rise in India. With rise in life expectancy and chronic nature of critical illness there is a requirement of additional funds to afford high medical costs for treating such critical illnesses. Our policy covers 8 most common critical illnesses were an insured member is compensated by a lump sum payment.

Q:28) What is TPA?

TPA stands for Third Party Administrator.  TPA means the third party administrator that we appoint from time to time as specified in your schedule. All claims under the policy will be processed and settled by specified Third Party Administrator (TPA) licensed by IRDA.

Q: 29) What is Convalescence Benefit?

After a long period of hospitalization, a policyholder may not be able to get back to work immediately. This means there may be a loss of income. At this point of time, he/she may need extra funds to take care of the household expenses, medicines, etc. Convalescence benefit is an additional benefit offered with health insurance to take care of such expenses. 

Q: 30) What are riders and add-ons ?

To cater to specific requirements of individuals and families most Health Insurance companies provide customization of a medical Policy by giving Riders or add-on benefits like critical care policy or personal accidental benefit to the main policy. Opting for these adds to the Premium cost but at the same time adds to the sum Assured in critical situations. 

Q: 31) What is Maternity Insurance?

While the anxiety about parenthood will take days to settle, one thing you don't need to worry as much are the hospitalization expenses if you have adequate maternity cover. While there are numerous other factors that the couple should consider before and after conceiving to ensure a safe and healthy pregnancy, one cannot overlook the cost involved. With high-end hospitals spreading their web across the country, the cost of a normal delivery clubbed with the hospitalization in a decent hospital in any metro city could range anywhere between Rs.60,000 to Rs.2 Lakhs. These shocking figures only suggest a need for proper planning of finances towards the expenses that will incur. Hence, a Maternity cover offered by several Health Insurance companies is one modern approach to tackle these costs.

Q: 32) Who should choose maternity benefit in their policy?

Maternity benefits may be an important feature in your health insurance policy if you are availing it as a couple (family floater) and are planning to conceive within 2-4 years. Remember, you must choose the policy, in which the waiting period (usually 2-4 years) .

Q: 33) Why Do You Need Maternity Insurance?

As a responsible parent, you must prepare suitably for the cost related to pregnancy and the delivery of the baby. With the medical costs soaring high, one has to be well prepared for all expected and unexpected expenses. And this is why you should consider a Maternity cover in your health insurance plan Covers Your Maternity Expenses: Most regular-joe medical health insurance policies does not cover maternity costs and thus are of no use when the time comes for the baby’s delivery. Safeguard Against the Rising Healthcare Costs: With healthcare inflation about 15-18% each year, the cost of hospitalization will be more than twice within the next five years.

Q: 34) What Does Maternity Cover Include?

Includes expenses for hospitalization and the costs for the delivery of the baby (normal or caesarean) Covers costs that are related to pre and post hospitalization, as well as pre & post-natal care Covers the new-born baby as well, up to a particular time limit Includes the ambulance charges for ferrying the to-be mom to the nearest network hospital of your choice

Q: 35)What is Portability?

Under Portability the health insurance customer can switch from one Insurer to another insurer, the credit on continuity of the coverage would be passed on from the previous insurance policy to the new insurance policy

Q: 36) Is portability applicable for all the health products?

Continuity can be passed on from products with similar risk covered, for e:g Portability can be opted from Hospitalization policies popularly known as mediclaim Policies to mediclaim policies

Q: 37) Is there any age criterion to be eligible for portability?

The entry age depends on the new policy terms & conditions & guidelines

Q: 38) What continuity do I get under portability?

After the UW process if the proposal is accepted continuity would be given for all the waiting periods under the policy, including the waiting period for pre-existing illnesses & The continuity would also be given on the time bound exclusions, for e:g most of the policies exclude the joint replacement surgeries for a period of 3-4 years, with portability the continuity would be considered for these conditions also

Q: 39) Under what conditions I should port my health policy?

Study your existing health insurance policy & also the company records If you are not satisfied wither with the services / coverage’s, think of porting the policy You will have to initiate the process at least 2 – 3 months prior to the policy expiry date.

Q: 40) Will I need to undergo medicals again?

This depends on the Underwriting guidelines of the new insurer, if so the insurer Will inform you accordingly

Q: 41) If I want to port my policy to your company what documents I need to submit?

The documents required are a) Previous policies (The no. of years continuity will be subject to the policies submitted) b) Claim experience in detail c) Proposal form d) Age proof e) If any positive declarations – discharge card, investigation reports, latest prescriptions & the clinical condition
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