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Health Insurance FAQ

In India, a health insurance is something that pays for hospitalizations, medical expenses incurred for an
in-patient, sometimes out-patient and for the treatment through alternative modes like Ayurveda, etc.

  • The first health policies in India were Mediclaim Policies.

Health insurance premiums are determined after taking into consideration factors like age, family medical
history, pre-existing medical conditions, body mass index and smoking habits, among others. Additionally, the
type of coverage, sum insured and members covered under a policy have an impact of the premiums payable.

To encounter such financial hardships to treat critical illnesses, it is essential to introduce something called as
‘Fixed Benefit Health Insurance Plans’. These plans take care of two major expenses such as hospital room
charges as well as the entire cost of the surgery. But, remember these plans do not pay the expenses that
include pathology, radiology and medical consultation.

Co-Pay is a clause in the Health Insurance Policy that underlines that the insured will have to share the Claim
Burden and Co-Pay a pre-determined amount.

Yes, maternity is covered under health insurance plans. In fact there are special health insurance plans by many
insurers that take care of medical expenses related to maternity.

Overseas Health Insurance is covered under International Travel Plans. These plans usually cover bodily injuries caused, medical illnesses or diseases contracted during an international journey.

Yes. Mostly, health care and health insurance is referred to as the same thing.

According to the current law, your health insurance plan can cover your dependent children. You can now add
or keep your dependent children included in your policy, until they turn 21 years old.

A health insurance policy covers expenses that incurred due to the medical treatment/surgery. In order to get
the benefits of the health plan, the policyholder has to go for at least 24 hours of continuous hospitalization.
There are some day-care procedures (less than 24 hours) that are also covered under a health plan, but you also
need to get hospitalized to avail benefits. It is suggested to go through your policy document to ascertain what
is included and excluded under your policy.

Yes, it’s always advisable to buy a health insurance policy of adequate sum insured when you are young and in
good health as the possibility of becoming sick in younger age is comparatively lesser so you can get a health
insurance policy of adequate sum insured at best premium rate and the most important reason is- ‘peace of
mind’. Having a health insurance policy, you won’t have to worry about the doctor’s fee and other medical
expenses.

Please note that the possibility of any mishap or accident or sickness cannot be ruled out; it can happen to
anybody, anywhere, anytime. There are many reasons to opt for a health insurance policy at a young age.

There are manifold advantages to it as listed below:

  1. Waiting period:

    In most cases, health insurance policies have a waiting period ranging from 30 to 90 days, during which
    you cannot make any claims even if you have a medical emergency. There is a waiting period for many
    ailments such as cataract, urinary tract stones, knee replacements, arthritis and so forth. Most insurance
    providers declare at least 10 to 15 ailments which have a waiting period of 1 year or 2 years. Individuals
    above 60 years have even longer waiting period in some cases. Buying a health insurance policy at a young age is, therefore, a big advantage in this context, as you would exhaust the waiting period without any
    concerns.

  2. Comprehensive:

    If you make the wise decision of buying a health insurance policy when young, you can enjoy the benefit of comprehensive and holistic coverage. You will, therefore, enjoy greater security during employment and
    even after retirement.

  3. Low premium:

    In most cases, the premium amount charged by an insurance provider depends on your current age. If you opt for a policy at a young age, you can avail of a lower premium.

  4. Duration:

    It is important to note that most health insurance policies on offer come with a ceiling on upper age. If you buy a health insurance policy at a young age, you will not have to worry about age limits and thereby
    enjoying the benefit of health insurance for a longer duration.

  5. Tax benefit:

    Buying a health insurance policy at a young age will allow you to enjoy tax benefits for a longer period in
    that you can claim the premium you pay as deduction from your total income under 80D of the Income Tax Act, 1961.

  6. Coverage:

    Taking a health insurance policy at a young age ensures that you have greater coverage. Many latest
    health plans offer wide coverage from day care procedures and vector borne diseases to maternity
    benefits and OPD expenses among others. In short, your coverage costs will only increase as you grow
    older owing to possibility of more medical complications.

  7. Pre-existing conditions:

    Buying a health insurance policy in your late 40s will only increase your financial burden with reduced
    benefits. Many health insurance providers exclude many pre-existing conditions from getting covered
    which defeat the purpose of opting for a health insurance policy.

  8. Bonus:

    Most insurance companies offer a ‘no claims Bonus’ in the absence of any claims in the preceding year of a policy term. If you buy a health insurance policy at a young age, you can avail of cumulative bonus as you
    will most likely renew your policy every year. As a result, the bonus accumulated increases your coverage amount which will prove to be an advantage at later stages of life when you are old and grey. No claims
    bonus may range from 5% to 50% and in some cases 100% of sum insured.

  9. Wider options:

    You will be in a better position to choose from a wide variety of health insurance plans at a young age
    rather than in your late 40s. You have the freedom to opt or a plan which best suites your requirements by analysing all the important parameters.

  10. Lifelong renewal:

    You can opt for lifetime renewal of your health insurance plan and thereby, avail of extended coverage.
    Consequently, you can enjoy healthcare benefits for your entire life by opting for renewal of your policy.

  11. Lower chances of rejection:

    When you are young, you have many productive years ahead of you and less health complications. As a
    result, chances of your health insurance policy getting rejected are miniscule.

  12. Financial planning:

    Buying a health insurance policy at a young age not only gives you greater coverage but also helps you
    plan your finances in a better way. When you have adequate medical cover to take care of any health
    emergencies, you can focus on making other long-term investments.

  13. Personal health insurance:

    In this day and age of an exponential increase in medical expenses, the importance of a health insurance
    policy cannot be over emphasized. The coverage provided by your employer may not suffice to cover your costs. Furthermore, you will run the risk of being uninsured at the time of any job change or loss of
    employment.

  14. Poor health:

    Inactive lifestyles have led to an increase in the occurrence of many diseases related to heart and lungs
    claiming lives at a young age. It is a sad truth that health insurance is now no more relegated to senior
    citizens. The young and salaried segment of India’s population is vulnerable to a number of diseases.

Insurance company has tie ups with network Hospitals in various cities and the Policy holder may take
treatment on production of the Health Cards provided by the Insurance Company with valid identity proof to
Hospitals/TPA, without payment on taking necessary approvals from Insurance Company Assigned TPA in
advance in case of planned surgeries.

TPA is Third Party Administrators who act as intermediary for hustle free and unbiased claim settlement
between the Insurance companies, Policy Holder, and Hospitals.

Normally insurance covers provided by employers are of a lesser sum insured, which seems to be insufficient in case of any medical emergency. Most group insurance policies arranged by employers have co-payment and
high deductibles in-build, due to which you may require to pay from your own pocket.

There is a possibility of your leaving the job and the new employer might not offer the health cover. In such case you will have to buy a fresh health policy in which you will lose pre-existing benefits that you have accrued over the period.

Yes. As per guidelines of IRDA you can port out your existing Health Insurance Policy to another Insurance
Company of your choice without losing the benefits of the existing health Insurance Policy.

It covers all the family members under one single Health Policy with common FIXED Sum Insured which could
be used individually or separately by self, spouse, children and parents. The Maximum liability of the Insurance
company is Sum Insured fixed for the whole family.