FAQs

Health Insurance is a type of insurance plan wherein an insurance company promised to compensate the policyholder(s) for the expenses incurred on medical treatment subject to the sum insured mentioned in the policy.

Health insurance policies have a free-look period of 15 days, which gives you an opportunity to analyze the policy and go through all the terms and conditions to check if it suits your requirements else you can get it cancelled within this period and the insurance company will refund the premium amount paid by you.

Grace period is like an extension provided to you by the insurance company, in case you forget to pay your insurance premium on time. The grace period is generally of 30 days. You will not get coverage during these 30 days and you will also not be able to register any claim unless you renew health insurance on time.

Waiting period in health insurance is the specified amount of time for which your health insurance policy will not cover you for any diseases or pre-existing diseases that you might have mentioned in your proposal form while purchasing the health insurance policy. The waiting period differs from company to company. During this period, if the insured files a claim; the insurance company has the right to reject this claim unless it is an accident emergency.

Specified diseases are the ones that are listed by the insurance companies along with their health insurance policies and there is a time bound exclusion applicable, before you start getting coverage for them.

Pre-existing diseases are the ones which you suffer from before taking the policy and which must be declared by you to your insurance company at the time of buying the medical insurance plan. The coverage for the pre-existing diseases starts after a certain waiting period as mentioned in your health insurance policy document.

Arogya Sanjeevani Policy is a Standard Health Insurance Product which is offered by all health insurance companies with exactly the same benefits.

A claim settlement ratio refers to the percentage of claims settled by a health insurance company out of the total claims received by it during a financial year. The higher the claim settlement ratio, the better it is.

Suppose you take a cover for Rs 10 lakh as the sum insured. At the time of making a claim, if you use only Rs 5 lakh of that cover, then the remaining Rs 5 lakh can still be used by you during the remaining policy period. The amount of cover on your policy is sum insured. It is the maximum amount up to which you can get insured and avail benefits in the event of a medical claim during a single policy year.

The compensation for expenses incurred prior to hospitalisation for a treatment as well as for the recovery treatment after discharge. These are for consultations, medicines, investigations or any other factors related to the illness for which hospitalisation has occurred.

Network hospital is a hospital that has an agreement signed with your health insurance company. This tie-up between the hospital and your health insurance provider allows you to avail the benefit of cashless health insurance claims. It is necessary that the insurance company is informed of the hospitalisation so that they can authorise the hospital to not charge the customer. You can relax when the payment of your medical bill is taken care by your health insurance provider. You get the required care during hospitalization as well as for pre & post hospitalization treatments.

There are a few documents that you must be able to show to buy a health insurance policy. These are-
Age proof (Any One): Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter’s ID, etc.
Identity proof (Any One): Passport, Driving License, Voter ID, PAN Card, Aadhar Card, which proves one’s citizenship.
Address proof (Any One): Electricity bill, Ration Card, Telephone Bill, Passport, Driving License with your permanent address clearly mentioned on it.
Medical check-up: Some plans require health check-up to ensure that the person is not suffering from any chronic illness.

The insurance company’s own claim settlement team is called an In-house claim team, while Third Party Administrator (TPA) refers to the third-party/outsourced claims team. An in-house claims team enables the insurance company to directly deal with health insurance claims and provide the customer with faster and better service.

Certain surgical procedures do not require 24 hours of hospitalisation due to growing medical advancement. Daycare procedures are covered in polices these days.

Co-payment or co-pay refers to the share of claim amount borne by the policyholder at the time of claim settlement. However, a co-payment does not reduce the sum insured. Eg, if your medical insurance plan has a 10% co-pay clause and your claim amount is Rs 2 lakh, you have to pay Rs 20,000, while we will pay Rs 180,000.

This additional benefit compensates you for the charges that you incur when availing an ambulance service in case of an emergency to take the patient from home to hospital or from one hospital to another. The amount of cover provided differs from policy to policy.

If you visit a network hospital for treatment you can avail the benefit of cashless treatment. This means that you don’t have to arrange for funds from your pocket while hospitalization. All you need to do it inform the insurance desk in the network hospital about your policy detail. They will arrange for the pre-authorization letter from your insurance company, and the hospital bill settlement will be taken care of by the hospital and your health insurance company.

If you have a health insurance policy, then you can get the benefit of daily hospital cash. This means that your insurance company will pay you a certain fixed sum of money daily up to a limited number of days.

This additional benefit in your health insurance policy provides you a Free Health Check-up every year. You can regularly undertake heath check-ups without having to worry about paying medical bills.

If you renew your health insurance policy without any break and there has been no claim in the preceding year, then your Sum Insured (SI) is increased by certain percentage like 10% every successful claim free policy renewal. This increment in Sum Insured is mentioned in your document. This percentage differs from policy to policy.

You can get a tax benefit by paying premium towards your health insurance plans in India. Whether you buy a health insurance for yourself or your family, you can get tax exemption as per section 80D of the Income Tax Act. You can claim tax deduction up to INR 25,000 per year for the health insurance premium paid for yourself, if your age is less than 60 years and up to INR 50,000 if you are a senior citizen.