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Health Insurance FAQs

What is Health Insurance?

Health Insurance is an insurance policy which covers you and your family against any medical contingency. In short Health Insurance is a protection against medical costs. It is a contract between an insurer and an individual /group in which the insurer agrees to provide specified health insurance cover at a particular premium. The health insurer usually provides either direct payment or reimburses the expenses associated with illnesses and injuries.

Why do I need Health Insurance?

Illness is unforeseen, and cannot be predicted so Health Insurance comes to your rescue and finances your medical expenses. Moreover the Healthcare expenditure in our country is expensive which, vast majority of people can’t afford, and So Health Insurance is a tool to finance your sudden healthcare expenses.

How is premium determined in Health Insurance?

Premium depends on several factors:
1). Your age: Age is the most important factor for determining the premium since health risk increases with age and premium as well.
2). Amount of coverage required.
3). Number of family members covered.
4). Your income \ earning.
5). Other additional benefits.

Why is it important to disclose health details when I buy a policy?

You must disclose every detail about any disease or illness you have or any treatment you are undergoing while taking the policy. An insurance contract works on the principal of “utmost good faith”, so not disclosing your health details will not be correct. Furthermore, non-disclosure can also lead to rejection of your claim.

Can I apply for a Health insurance policy when I am already diagnosed with some disease or ailment?

Yes, you can apply for a Health Insurance . But the policy will be issued excluding the diagnosed disease and other diseases pre-existing at the time of inception of the cover.

Will Mediclaim reimburse my expenses related to the disease which I am already suffering before the inception of the plan?

Insurance company will not cover any illness/ailment which already existed at the time of first obtaining the insurance cover. However, some companies cover such conditions after, two or four continuous renewals; they start covering the pre-existing illness after that.

What is Mediclaim Policy and what does it cover?

The policy provides for reimbursement of hospitalization/ domiciliary hospitalization expenses for illness/diseases suffered or accidental injuries sustained by the insured during the policy period.

Does Mediclaim cover any expenses besides hospitalization costs?

Mediclaim covers pre-hospitalisation (30 days) and post-hospitalisation (60days) expenses also if they are connected with the sickness / accident for which the hospitalisation takes place.

What is considered as "domiciliary hospitalization" under Mediclaim?

It is that condition of the patient in which he cannot be moved to the hospital or if there is no bed available in any of the hospitals, then the treatment is taken at home and if it is given like the treatment given at the hospital, then in such situation, it is reimbursable.

What is a Cashless Facility?

Cashless Facility is a service wherein the insured can get admitted and can settle all hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the insurance company, that's why it's a cashless facility where you are provided with the claim there and then at the time of settling the bills, the hospital directly contacts with the insurance company and settle the claim.

What is a Health Card?

A Health Card is that card which comes along with the policy which would entitle you to get cashless claim at any of the company’s network hospitals.

Am I entitled for cover immediately after I take my policy?

For the first 30 days after your policy is activated, you would not be entitled for any cover for sickness but you can avail of accidental cover immediately.

Do I have to undergo medical Check up while taking health insurance policy?

Medical tests is required after 45 years of age.

Is a Medical check up again required at the time of renewal of the policy?

No, the medical check up has to be taken only once, during the inception of taking a policy and only if you are 46 years of age or above.

What is the Critical Illness policy? And what does it cover?

It is that policy which covers Illness; it is complimentary to a mediclaim policy, being an additional policy which can be taken along with Mediclaim.
The Critical Illness policy covers five major illnesses
1). Cancer.
2). Kidney failure.
3). Organ transplant.
4). Multiple sclerosis and.
5). Coronary artery surgery (20 percent of Sum Insured)

When does the Critical Illness policy cover all the five illnesses?

As long as the policyholder was not suffering from any of the illnesses, the pre-existing illness exclusion applies to the Critical Illness policy also.

What is a Floater Policy?

A floater Policy is issued with a single sum insured covering number of individuals. The family is covered for a fixed amount and anyone in the family can avail of the benefit till the limit is exhausted. In short, it is one single policy which takes care of the hospitalization expenses of your entire family.

Do I get a No Claim Bonus under my health insurance if I do not make a claim?

Yes, some plans offer a discount in premium. Others offer an increase in your benefit amount for every claim-free year.

What are the benefits of renewing my health insurance policy?

There should be continuous renewal of the policies. If there is a break in insurance, the insured would lose the benefits of insurance in the event of any contingency. You will be prevented from the benefits of No claim Bonus in a claim free year. Moreover you will not be covered for Pre-existing diseases.

Why should I take Individual health plan or a Family Floater plan if I already have health insurance from my employer?

You are covered with the health insurance policy as long as you are in the employer’s services. If tomorrow, you change your job, then you and your family will be barred of any medical emergency arises when you have not arranged for an alternative health insurance policy. It is at this point of time that an Individual or Family Floater Health Insurance policy will come to your rescue.
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