Health Insurance

Question 1 

Does health insurance policy cover pre-existing illness?


A pre-existing condition is one for which the policyholder is already receiving treatment when they get health insurance. There may be a waiting period before you begin to receive coverage for a pre-existing condition, even though your health insurance company may provide you coverage for it. The waiting period is what it is called. In some circumstances, the waiting time may be up to four years.

Question 2 

How are health insurance claims usually settled? 


Health insurance claims are either reimbursed or handled without the use of cash. In a cashless setting, your health insurance company will pay your hospital bill on your behalf. You will only be responsible for paying any differences that your health insurance does not cover. However, the cashless facility is only accessible in network hospitals. In the event of reimbursement, you pay your hospital’s outstanding balance before filing a claim with your health insurance company. Your health insurance company reimburses you for the claimed amount, less any applicable exclusions.

Question 3

Can the sum insured be increased on existing health insurance plans? 


When your health insurance plan is renewed, you can raise the maximum amount insured. Before purchasing a health insurance plan, be sure to carefully study the policy wordings as this depends on the indemnification policies of the firm.

Question 4

Can someone have more than one health insurance policy? 


You are permitted to have multiple health insurance policies, whether they are offered by the same company or different ones. In accordance with your sum covered, you can also divide your claim among the several health insurance policies.

Question 5

What is a cashless facility? 


The term “cashless” refers to the benefit when your health insurance company pays your hospital costs immediately. Today, the majority of health insurance providers offer it.

Question 6

What is Family Health Insurance?


A family health insurance plan is a kind of medical insurance that covers all your family members in a single health insurance policy. Under this plan, a fixed sum insured is shared by all family members with an assumption that not everyone will get sick at the same time. Most family health insurance plans offer cashless hospitalisation facilities, maternity benefits and cover pre & post hospitalisation as well.

Question 7

How many people are covered under a family health insurance plan?


Family health insurance plans allow you to cover up to 6 family members under one medi-claim policy. It is a type of health insurance plan for which you pay a single premium amount for a family floater plan and the sum insured splits among all the covered members.

Question 8

What is not covered in a Family Health Insurance Plan? 


Following medical expenses are generally not covered by family health insurance plans in India:

  • OPD treatments and routine medical check-ups
  • Expenses incurred on any aesthetic treatment or plastic surgeries
  • Expenses incurred on life-support machines
  • Treatment that was taken overseas unless it is included in the plan
  • Any illness or injury resulting due to war conditions, nuclear reaction, rebellion, acts of foreign enemies, etc.
  • Injury or illness due to participation in unethical or criminal activities
  • Pregnancy or childbirth-related complications (unless mentioned in the plan)like voluntary termination of pregnancy, miscarriage or abortion, etc. 
  • Any pre-existing medical condition is not covered until the completion of the waiting period

Question 9

Which documents are required to raise a reimbursement claim under family health insurance? 


The following documents are required to be submitted to raise a family health insurance claim:

  • Duly filled health insurance claim form
  • Policy document
  • Hospital discharge report
  • Consultation report and investigation results
  • Hospital bills
  • Bill payment receipts

Question 10

Is a family health insurance plan better than an individual health plan? 


If you need health insurance for your entire family, buying a family health insurance plan is any day better than buying an individual policy. A health insurance policy for a family will cover all the members of your family for a single sum insured and only a single premium needs to be paid to the insurance company. 

On the flip side, an individual health plan covers only one person. So, you will need to buy a separate health plan for each family member with a different premium. The combined premium for multiple individual policies will be significantly higher than that of a family health plan.