Yes. You will need insurance. Even if you're young, healthy and haven't had to see a doctor in years, you will need coverage against unexpected events like accidents or an emergency. While your health insurance coverage may/may not (depending on the policy taken) pay for things that aren't too costly like routine doctor's visits, the main reason to have coverage is to have protection against the large treatment expenses of serious illness or injury.

2. Is Health Insurance the same as Life Insurance?

No. Life Insurance protects your family (or dependents) from financial loss that may arise in the event of your untimely death/or if something happens to you. The payout is made only post the death of the person insured or at the maturity of the policy. Health Insurance protects you against ill health/diseases by covering the expenses you might incur (for treatment, diagnosis etc.) in case you are affected by disease or injury. There is no payout made at maturity. Health insurance also needs to be renewed annually.

3. My employer provides me with health insurance coverage. Is it advisable to take another policy on my own?

It is strongly advised to have health insurance on your own as well because of reasons of continuity. Firstly, if you change your job, you might not necessarily get health insurance from your new employer.
In any case you will be exposed to health costs in the transition period between jobs.Secondly, the track record that you have built in health insurance at your old employer will not transfer to the new company policy.
Covering pre-existing diseases might be a problem. In most policies pre-existing diseases are covered only from the 5th year onwards.

4. Are Maternity/Pregnancy related expenses covered under Health Insurance plans?

Yes. Maternity/Pregnancy related expenses are covered by some insurance providers. However, employer provided group insurance plans often cover maternity related expenses

5. Is there any tax benefit that one can avail of while purchasing Health Insurance ?

Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment of Health Insurance premium for self and dependants. For senior citizens, this deduction is Rs. 20,000. Please note that you will have to show the proof for payment of premium. (Section 80D benefit is different from the Rs 1,00,000 exemption under Section 80 C)

6. Is a medical checkup necessary before buying a policy

A medical checkup is necessary for a new health insurance policy for customers above the age of 40 or 45 years depending on the health insurer's norms.
Medical checkups are usually not needed for renewal of policies

7. What are the minimum and maximum policy durations?

Health insurance policies are general insurance policies usually issued for a period of 1 year only. However, some companies also issue a two year policy. At the end of your insurance period you must renew your policy.

8. What is coverage amount ?

Coverage amount is the maximum amount payable in the event of a claim. It is also known as “sum insured” and “sum assured”. The premium of the policy is dependent on the coverage amount chosen by you

9. My wife and children are residing at Mysore while I am here in Bangalore. 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. You must check whether there are any network hospital near to your as well as your family's place of residence. You must check if your insurer has a network hospital close to you or where the rest of your family resides. Network Hospitals are the hospitals that have tied up with the TPA(Third Party Administrator) for cashless settlement for expenses incurred there.

10. Are naturopathy and homeopathy treatments covered under a health policy ?

Naturopathy and Homeopathy treatments are not covered under a standard health policy. The coverage is available only for allopathic treatments in recognized hospitals and nursing homes

11. Does health insurance cover diagnostic charges like X- ray, 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 one night. Any diagnostic tests which have been prescribed in the OPD are generally not covered.

12. Who is a Third Party Administrator?

A Third Party Administrator (commonly referred to as TPA) is an IRDA (Insurance Regulatory and Development Authority) approved specialized health care service provider. A TPA provides the insurance company with a variety of services like networking with hospitals, arranging for cashless hospitalization as well as claims processing & timely settlement

13. What do you mean by Cashless Hospitalization?

In the event of hospitalization, the patient or their family will have a bill to pay the hospital. Under Cashless Hospitalization the patient does not settle the hospitalization expenses at the time of discharge from hospital.
The settlement is done directly by the Third-Party Administrator (TPA) on behalf of the health insurer. This is for your convenience.
However, prior approval is required from the TPA before the patient is admitted into the hospital. In case of emergency hospitalization, approval can be obtained post-admission. Please note that this facility is available only at the network hospitals of the TPA

14. Are there any waiting periods when my expenses will not be settled, in case of a contingency?

When you get a new health insurance policy, there will be a 30 day waiting period starting from the policy start date, during which period any hospitalization charges will not be payable. However, this is not applicable to any emergency hospitalization occurring due to an accident. This 30 day waiting period is not applicable when the policy is renewed.

15. What happens to the policy coverage after a claim is filed?

After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement.

For Example: In January you start a policy with a coverage of Rs 3 Lakh for the year. In April, you make a claim of Rs 1 lakh.
The coverage available to you for the May to December will be the balance of Rs.2 lakh

16. 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.

17. What are the factors which determine the premium payable for health insurance ?

Under health insurance, the age and the amount of cover are the factors that decide the premium. Usually, younger people are considered more healthy and thus pay lower annual premium. Older, people pay a higher health insurance premium as their risk of health problems or illness is higher.

18. Who will receive the claim amount under health insurance if the policyholder dies during the time of

In cashless mediclaim settlement, it is settled directly with the network hospital. In cases where this is no cashless settlement, the claim amount is paid to the nominee of the policyholder.
In case there is no nominee made under the policy, then the insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount.
Alternatively, the insurers can deposit the claim amount in the court for disbursement to the next legal heirs of the deceased.

19. Is mediclaim the same as health insurance?

Yes, it is the same.

20. What is the difference between Health Insurance & Critical Illness policies or Critical Illness Ride

A Health Insurance policy is a reimbursement of the medical expenses. A critical illness insurance is a benefit policy.
Under a benefit policy upon the occurrence of an event, the insurance company pays the policyholder a lump sum amount. Under a Critical Illness policy, if the insured is diagnosed with any critical illness as specified in the policy.
The insurance company will pay the policyholder a lumpsum. Whether the client spends the amount received on the medical treatment or not depends on the client's own discretion.

21. How does the insurance company decide whether a disease was a pre-existing one or not?

While filling up the proposal form for insurance you need to provide details of the illnesses you have suffered during your lifetime. At the time of insurance, you should be aware whether you have any disease and whether you are undergoing any treatment. The insurers refer such health issues to their medical panel to differentiate between pre-existing and newly contracted illnesses.
Note: It is important to disclose any disease you might be suffering with before buying the health insurance policy. Insurance is a contract based on good faith and any willful non disclosure of facts might lead to problems in future.

22. Can I seek treatment at home and be reimbursed for it under health insurance?

Most policies offer the benefit of treatment at home:
a) When the condition of the patient is such that he cannot be moved to the hospital or
b) When there is no bed available in any of the hospitals and only if it is like the treatment given at the hospital / nursing home which is reimbursable under the policy.
This is called “domiciliary hospitalization” and is subject to certain restrictions both in terms of the amount which is reimbursable as well as the disease coverage.

23. What do I have to carry when I go in for Cashless Hospitalization?

All you need to carry for Cashless Hospitalization is your Health ID Card, a photo Identity proof (like Passport, Voter ID etc).

24. What happens to our Floater cover limit after a claim?

The Floater limit reduces to the extent of the claim every time a claim is made by any of the, family members covered under the floater.
However, the next year the limit is restored back to its original value.

25. Can I get hospitalized in any other town ?

Yes, you can get hospitalized in any town in India. Cashless service is available pan India in all the network hospitals of the insurer.
The list of hospital network is provided along with the policy. For all hospitals which are not in the network list you will have to pay first and then seek a reimbursement from the insurer.

26. What is a Pre-Existing disease?

A Pre-Existing disease is any disease that you or your family member is already suffering from at the time of applying for the policy for the first time e.g., Hypertension, Diabetes

27. Are any PreExisting diseases covered?

Most insurers cover Pre-Existing diseases from 5th renewal onwards if you continuously renew the policy with the same insurer.

28. What if the hospitalization is for less than 24 hours (e.g., For kidney stone removal)?

Insurers cover all advanced technological surgeries such as kidney stone removal, catheterization, chemotherapy etc. under day care treatment and do not insist on 24 hours hospitalization in case of these procedures. The list of such procedures is mentioned in the policy issued by the insurer.

29. Are accidental injuries covered?

Yes, this policy covers accidental injuries, which require hospitalization for a period of at least 24 hours or more, from the first day of the policy coverage period.

30. Is a medical checkup compulsory for enrolling?

Individuals and family members who are more than a certain age are required to submit medical tests before the policy is accepted by the insurer.

31. What is the difference in a co-pay and co-insurance?

Co-insurance is the portion of costs that are shared between the insured and the insurer. It is common for an insurance company to pay 80% with the insured being responsible for the remaining 20%. Co-pay is a predetermined amount of money that the insured pays out for certain services.
For example, if you have a Rs200 co-pay on doctor's visits, you would pay the doctor Rs200 for every visit and the insurance would pay the rest of the doctor's fee for that visit.
Special services, like x-rays or lab work, aren't usually covered under the co-pay for the doctor's visit.

32. What is the difference between in-network and out-network providers?

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-network provider is one not contracted with the health insurance plan.
To make a point, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers.

33. What is critical care insurance policy?

A new and first of its kind, a health insurance plan called critical care provides lump sum benefits on diagnose of critical diseases/illnesses.
It's targeted towards health-conscious individuals. Some insurance company's critical plan also provides an additional cover against personal accident, permanent total disablement and a second opinion on the first diagnose of the critical illness (pls refer the product brochure for more details on coverage, terms and exclusions).
An individual opting for this should not have suffered from any per-existing disease, 90 days prior the policy start date.

34. What is TPA? DO I need to approach a TPA for settling my claims?

TPA is a Third Party Administrator. A TPA is a specialized health service provider rendering a variety of services like networking with hospitals, arranging for hospitalization, claim processing and documentation.
All insurance claims are settled by third party administrator. In case of hospitalization, the charges would be directly paid to the hospital, for that you would need to call on a help line number of a TPA and they will also arrange for cash less facility.
This number will be given to you at the time of purchase of the policy.

35. How to prevent rejection of claims?

Only claim for hospitalization, which confirms existence of an illness/ailment, which needs hospitalization.
Make sure you declare all the PreExisting diseases at the time of applying for a policy. And the best way to avoid rejection of a claim is to read the policy wordings very carefully.

36. What is Cashless access/Cashless Facility?

This means you can walk into any of the network hospitals across the country and get treated without having to pay for your hospital bills.
If you do not get admitted to a networked hospital, your expenses will be reimbursed by the insurance company only on receipt of complete documents from you

37. What documents should one obtain before discharge from the hospital in case of cash less facility availed?

All bills in original and a discharge certificate are to be left with the hospital providing cashless treatment. The patient has to countersign all bills and fill the claim form and also leave the same with the hospital at the time of discharge.
A copy of the bills & Discharge Summary can be carried by the patient for his records and for submission along with Pre & Post Hospitalization bills.

38. I am not keen to avail of Cash less facility. Can I go in for reimbursement?

Yes. Under the Mediclaim Policy, you can opt for Cash Less as well as Reimbursement. We would advise that in case you are taking treatment from a network hospital, then you should avail of the Cash less facility.
This will give you the financial advantage of not paying for your hospital treatment and also gives you more cushion to meet your post-hospitalization expenses

39. What is the benefit of carrying a health card?

The benefit of carrying the Health Card is that you and your family members get access to the cash less facility from the TPA's network of hospitals. This means you can walk into any of the networked hospitals across the country and get treated without having to pay for your bills first and then claim form us.
If you do not get admitted to a networked hospital, your expenses will be reimbursed within 7 days of receipt of complete documents from you. Also in the event of any unforeseen accident a third party can identify your Insurance Company and your family can be intimated.

40. Why do I need Travel Insurance?

One usually travels abroad for various reasons- a pleasure trip, a business trip, a study trip etc. You do not want anything to ruin your hard earned holiday, foreign study or your crucial business meeting.
But there is a possibility of some unexpected occurrence no matter how perfect the planning is. Unfortunate events such as baggage loss, passport loss, a medical emergency or an accident can affect you.
Having Overseas Travel Insurance protects you from all such perils. It ensures that in the unknown foreign land. You are not left stranded in any kind of an emergency.

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Frequently asked Questions

1. I am young and healthy. Do I really need health insurance?