Common Questions Related to Health Insurance

Post Covid the one type of insurance that is most sought after is health insurance. The steep rise in medical care expenses over time has made it difficult for many people to access high-quality healthcare. With health insurance, you can protect your finances that would otherwise be used for emergency medical care. However, there are Common Questions Related to Health Insurance that prospective purchasers may have while buying medical insurance. This post will clarify the Frequently Asked Questions (FAQ’s) if you are looking to buy a health insurance plan.

Common Questions Related to Health Insurance

What types of health insurance are offered?

• Although there are now several products available that give a range of health covers, based on the need and preference of the insured, hospitalisation costs are still covered by the most common type of health insurance policies in India.
• The health insurer typically pays the hospital directly (cashless facility), reimburses the costs of illnesses and injuries, or pays out a set benefit when a disease manifests itself.
• The health plan makes clear in advance what kinds and how much of a person’s medical expenses would be covered.

What elements affect the cost of health insurance?

• Age is a significant component in determining the premium; as you get older, your risk of contracting illnesses increases.
• Another important issue that affects the premium is prior medical history. The premium will be reduced by default if there is no medical history.
• Years without a claim may also affect how much the premium will cost because you may be eligible for a discount. Your premium will automatically be reduced as a result.

What is excluded from a health insurance policy?

• You must read the prospectus or policy to comprehend what is and is not covered.
• Pre-existing conditions are typically not covered by health insurance policies.
• Additionally, the policy would often impose a waiting time and exclude some disorders from coverage during the first year.
• The cost of eyeglasses, contact lenses, and hearing aids would not be covered, nor would dental treatment or surgery (unless hospitalisation was required), convalescence, general debility, congenital external defects, venereal disease, intentional self-harm, use of intoxicating substances such as alcohol or drugs, AIDS, costs for diagnosis, x-rays, or laboratory tests that were not consistent with the disease necessitating hospitalisation, treatment-related expenses, etc.

What age group is allowed to purchase health insurance?

• Although the minimum age for purchasing health insurance varies, the usual minimum age for people is 18 and the maximum is 65.
• Children must be between 90 days and 18 years old to qualify.

Recent medical tests have revealed that I have a condition. Do you allow me to have health insurance?

• A medical issue will be regarded as pre-existing if you already have a diagnosis for it.
• In this situation, you might have to wait a set amount of time (the waiting period) before being permitted coverage.
• You can be compelled to pay a higher premium or have your insurance denied depending on your insurer.

Is my policy operative throughout India?

• The fact that medical emergencies can occur anywhere makes this one of the most crucial health insurance topics to think about.
• Typically, health insurance covers medical care everywhere in India, but you should double-check this provision.
• Find out if your policy’s claim settlement has any regional restrictions. Some medical insurance policies also provide coverage for travel abroad.

Who do I contact if I need to be hospitalised immediately?

• You don’t need the added stress of learning about the claim settlement process during an emergency circumstance, which already involves a lot of stress.
• Find out the policy for emergency hospitalisation whether your coverage allows for the cashless payment of claims.
• Inquire about the paperwork and, more significantly, who you should call in case of such an emergency hospitalisation.
• A good broker will have a customer care desk or a designated representative who can assist with a claim.

How Do I File a Claim If I Need Treatment at a Hospital That Is Not in the Network?

• In this situation, individuals may submit a claim for payment after their treatment is finished.
• When an insured person might not be able to get to a network hospital for emergency care, a reimbursement claim is intended.
• In this situation, individuals have the option to seek treatment, pay for it, and then submit a claim for reimbursement.
• All costs that are covered by the policy overage, barring any that are not, will be covered by such a claim.
• Inquire with your insurance about the paperwork you need to provide in order to submit a reimbursement claim.

What procedure does the organisation use to process claims?

• Your health plan will really be put to the test during the claim settlement phase.
• To determine whether the procedure is clear-cut or complicated, you should inquire about the company’s claim settlement procedure.
• Additionally, pay close attention to whether the company reimburses customers or uses a cashless option to settle grievances.
• Your best option for avoiding any financial pressure from medical costs is a cashless facility.

Will my Health Insurance coverage start on the first day?

• You will have to wait for a period of 30 days (waiting period) before your policy starts protecting you.
• There won’t be a waiting time if you have health insurance that includes accident coverage.
• Additionally, depending on the plan, you may need to wait to use the coverage if you have a pre-existing condition or a certain sickness.

Can my Health Insurance coverage be transferred from one health insurance provider to another?

• Yes, you are permitted to move my health insurance coverage from one insurer to another for a variety of reasons.
• Some of these include receiving better estimates from a new insurance provider, receiving better services, having a different insurer cover more medical bills, etc.
• The Insurance Regulatory and Development Authority of India (IRDAI) had issued a circular in which the insurance companies were required to permit the insured to switch from one health insurance plan to another or from one insurance company to another without causing the insured to forfeit any accrued benefits, such as renewal credits for pre-existing conditions.

We hope these Common Questions Related to Health Insurance have helped you to get a clear understanding.