Health Insurance FAQs

Below are the FAQs you must go through to know about general questions on Health Insurance (HI)

What is Health Insurance?

Health Insurance is a type of insurance that covers your hospitalization expenses in the following situations:
a. In case of a sudden illness
b. In case of an accident
c. In case of any surgery, which is required in respect of any disease which has arisen during the policy period.

What are the benefits of buying a Health Insurance policy?

The basic benefits of buying a Health Insurance policy are:
a. Reimbursement for Hospitalization due to illness / disease / surgery.
b. Reimbursement for Domicilary Hospitalization expenses in lieu of Hospitalization.
c. Pre-hospitalization expenses
d. Post-hospitalization expenses
e. Ambulance charges

What are different types of health insurance?

The major types of health insurance plans available in the market are –
i) Individual Health Plan
ii) Family Floater Plan
iii) Critical Illness Plan
iv) Senior Citizen Health Plan

I am already covered under the Group Health Insurance Policy provided by my employer. Do I still need Health Insurance?

Well, it depends. If you plan to stay with the company forever, it may be ok. However, when you leave the company, your cover expires and you will have to buy a new policy. This may have implication. For example, any existing disease may not be covered if you go for a new policy. Considering this, you may consider buying an additional policy which will increase your coverage amount as well as come handy if you ever decide to leave the company.

Can a person get claim from his own company or spouse company if they both are covered under group insurance policy by respective companies?

Yes, if both husband and wife are covered from their respective employer, they can claim from insurance provided to them by either of the companies, but not both the companies.

How much amount is provided as coverage under the Hospitalization Charges head?

The hospitalization charges generally cover:
Pre-hospitalization expenses – Expenses incurred for the treatment of a disease, illness or injury during a specific period immediately before hospitalization.
Hospitalization charges – Expenses incurred while being hospitalized and in the course of treatment.
Post-hospitalization expenses- Routine expenses incurred for the treatment of disease, illness or injury for a specific period after discharge from hospital.

What is Domiciliary Hospitalization?

Domiciliary (Home) Hospitalization means medical treatment for a period exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at a Hospital/Nursing Home but actually taken at home under any of the following circumstances:
i) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home, or
ii) The patient cannot be removed to Hospital/Nursing Home for lack of accomodation therein.

What is Cashless facility?

Cashless facility is the benefiit of health insurance in which you will be able to avail the hospital services without making any advance payments. Hospital should be one out of the list of empanelled hospitals with the respective health insurance company.

How to avail the benefit of Cashless facility?

You can avail the benefit of cashless facility through a health card provided to you by the TPA (Third Party Administrator) of your health insurance company.

What is the method to inform the TPA in case emergency for Hospitalization arises?

You can contact your TPA for assistance at any time by calling on the helpline numbers provided to you on your health card.

Does my health insurance policy provide coverage when travelling abroad?

No, generally your health insurance policy does not extend the coverage to international trips and is limited to geographical area of India, unless you have specifically bought an international health cover policy.

How can I cover myself for medical expenses incurred during my trip outside India?

For this you need to buy a Foreign Travel Insurance Plan.

What are the important things to check in a health insurance policy?

While taking a health insurance policy, one should check the following:
List of hospitals that are tied up with the insurance company for cashless treatment
Waiting period for pre-existing diseases
Others exclusions

Can I take more than one health insurance policy? How will I make a claim in that scenario?

Yes, you can take multiple health insurance policies from the same company or different companies. In that case, you can make a claim either under any one policy or split the claim between the policies in proportion of the sum assured availed.

Will the premium amount remain constant throughout the policy period?

The premiums charged by the health insurance company is usually the same for specific age group. The premium usually remains constant as long as you are in the same age bracket. But once you shift from one age bracket to another, the premium will increase.

Can I transfer my policy from one insurance company to another without losing the renewal benefits?

Yes. You can transfer your health policy from one insurance company to another and from one plan to another, without losing the renewal benefits for pre-existing illness. However, this benefit will be limited to the Sum Assured (including bonus) under previous policy.

What is critical illness insurance?

This policy pays an amount equal to the sum insured upon first diagnosis of a critical illness covered under the policy. It pays the whole sum assured at the point of diagnosis, irrespective of actual cost incurred on treatment.

What are the critical illnesses that are covered in the Critical Illness insurance?

Generally, the following critical illnesses are covered :- cancer, multiple sclerosis, coma, heart attack, bypass surgery, stroke, paralysis, kidney failure, major organ transplant, etc. However, the same may differ from insurer to insurer.

Why to buy Critical Illness insurance if I have a Health Insurance cover?

A basic health insurance policy generally pays only for hospitalization bills. However the amount of health cover may not be enough for treatment if you are diagonised of a critical illness. It may also lead to loss of income, change in lifestyle and permanent disability. To help you combat these, the critical illness insurance plan pay you lumpsum money to meet your large medical cost as well as meet your day to day expenses.

What is the difference between critical illness insurance and normal health insurance?

In a critical illness policy, you are covered for certain mentioned critical illnesses only. If you have normal health insurance, you will get cover for normal disease as well as critical illness.

Does the Critical Illness policy cover hospitalization expenses or provide any cashless benefit?

There is no hospitalization expenses or cashless benefit under Critical Illness policy. The insured is paid an amount equal to the sum insured at the time of diagnosis of a critical illness.

Is there any Health Check-up required for taking a Critical Illness insurance?

Yes, depending on your age, plan, sum assured and other factors, the insurer company may require you to undergo a medical check.

Can I make multiple claims for the same or any other Critical Illness covered under the policy?

No, once a claim for a particular Critical Illness has been admitted and paid, the coverage under the Policy will automatically terminate for that insured person.

What are the exclutions under Critical Illness Cover?

The Critical Illness Cover generally do not insure you against following:
i) Critical illness diagnosed within first 90 days from the inception of policy
ii) Death within 30 days of diagnosis of critical illness or surgery
iii) Illness due to smoking, tobaco, alcohol or drug intake
iv) Illness occuring due to internal or external congenital disorder
v) Critical conditions or consequences due to pregnancy or childbirth, including caesarean
vi) HIV/AIDS infection
vii) War, terrorism, civil war, navy or military operations
viii) Any dental care or cosmetic surgery
ix) Infertility treatment
x) Hormone replacement treatment
xi) Treatment to assist reproduction
However, the above conditions may vary from insurer to insurer.

What is Family Floater Health Plan?

A Family Floater Health Plan covers all the family members under one single plan. The total sum insured is fixed and gets exausted as and when any member avails medical services and makes a claim.

Which family members can be covered under the Family Floater Health Plan?

The members coverable under a family floater can be the policyholder and his/her parents, spouse and children. Some plans also give option to cover parent-in-laws as well.

What is the Tax benefit in Health Insurance?

Premium spent for Health Insurance Premium can be claimed for deductions under Sec 80D with some limitations according to age.

Insured Deduction Amount
Age below 60 Yrs Age Above 60 Yrs
Self, Spouse & Children 25000 50000
Parents 25000 50000
Maximum Deduction 50000 100000

Can I get a claim for Ophthalmic or Dental treatment under my health insurance?

No, all health insurance policies do not cover dental insurance as standard coverage. If your plan has an inbuilt feature then you can get the coverage. Some policies offer the same as add on features.

What is a “Top-up” Health Insurance policy?

A “Top-up” health policy is an additional coverage for a person/family already having an existing health insurance. It is for reimbursement of expenditure which arises out of beyond a threshold limit of the existing cover. Reimbursement can be one time hospitalisation or recurring during a policy term.

What is the Difference between Normal Top-up Policy & Super Top-up Policy?

Regular top-up health insurance plan only covers claims when a single claim surpasses the threshold limit, the super top-up plan is similar to top-up plans that enhance your health insurance sum insured. However, the difference is that super top-up plans work on the total medical expenses incurred during the policy year and not on a per claim basis.

What is the ' Hospital Cash Benefit’ available under medical insurance?

Hospital Cash Benefit is a facility that provides a fixed sum for each day of hospitalisation of more than 24-hours. It is a fixed daily allowance that is paid to the policyholder to meet miscellaneous expenses during the period of hospitalisation.

What is an Air Ambulance Facility?

The Air Ambulance facility combines air transport with basic emergency medical services that can transport sick or injured patients to and from healthcare facilities.

What is No Claim Bonus?

No-claim bonus (NCB) is a discount in premium offered by health insurance companies if a Policy holder has not made a single claim during the term of the health insurance policy.

What is the Auto Restoration benefit available under various health insurance plans?

Auto Restoration benefits in health insurance let the insurer restore your sum insured to the original amount when it is exhausted by claim.

What is the Recharge benefit?

Recharge benefit available under health insurance policy restores the sum insured when it gets reduced due to a claim.

Do Maternity Expenses get covered under Health Insurance?

Most of the health insurance policy does not cover Maternity related expenses except some Individual/Floater Policy where it is clearly mentioned and some group insurance policy. There are certain conditions for maternity related cover that may vary as per policies.

What is Organ Donor Expense?

Organ donor expense benefit covers the medical and surgical expenses of the organ donor when harvesting a major organ transplant for the insured.

What is Sum Insured in Health Insurance?

Sum insured in health insurance is the maximum value for a particular year that the insurance company can pay you in the event of a hospitalisation.

What is Pre Medical Screening?

The pre-policy medical screening refers to the medical examination that is requested by the health insurance company before the health coverage is provided to the person.

What is a network hospital?

Network Hospital means Hospitals or health care providers enlisted by an insurer, TPA or jointly by an Insurer and TPA to provide medical services to an insured by a cashless facility.

What is Room Rent?

Room Rent means the amount charged by the hospital for the occupancy of a bed on a per day basis.

What is shared accommodation?

Shared accommodation means a Hospital room with two or more patient beds.

What is a Day-care Facility?

Day-care facility refers to the medical procedures that require hospitalisation of less than 24-hours.

What is Mid Term Inclusion?

Midterm inclusion allows adding a newly married spouse and New Born Baby by paying an additional premium under your existing policy.

What is Co-pay in Health Insurance?

Health insurance co-pay refers to an arrangement in which the policyholder will need to pay a portion of the medical expenses on their own and the insurance company will pay the remaining amount.

What is the Waiting Period in Health Insurance?

An initial Waiting Period in health insurance, refers to the amount of time you’ll have to wait from the date of issue to actively start using your health insurance policy and benefiting from it.

What is Capping in Health Insurance?

Capping in health insurance refers to the limit, which is usually a percentage, up to which the insurance company settles claims for various hospital expenses.