Health Insurance Online : Compare & Buy Best Medical Insurance

Upon realising just how many people do not have access to insurance, the Government of India took steps to provide affordable solutions to help include the masses under insurance schemes. Some of these schemes have been listed below:

Pradhan Mantri Suraksha Bima Yojana:

The Pradhan Mantri Suraksha Bima Yojana is designed to help the low income groups access personal accident insurance at affordable rates, and through an easy and transparent process. If the life insured under this scheme incurs permanent or partial disablement due to an accident, they will receive compensation. In case of death due to an accident, then the family is entitled to receive the compensation.

Rashtriya Swasthya Bima Yojana:

Through this scheme, the government extended insurance cover to the poor sections of society. Beneficiaries of this scheme can receive cover of up to Rs.30,000 p.a. on a family floater basis for almost all the diseases that require the person to be hospitalised. The most beneficial features of this Rashtriya Swasthya Bima Yojana is that there is no limit on the eligible age and all pre-existing illnesses will be covered from the first day. Insured people under this scheme are also entitled to transport expenses. The scheme only requires a registration fee of Rs.30 making this one of the most affordable schemes available to the masses.

Aam Aadmi Bima Yojana by Government of India:

This scheme was introduced by the Government of India to provide the rural areas of the country with access to social security and financial aid. This scheme provides cover to the earning member or head of a rural landless household. Aam Aadmi Bima Yojana is designed specifically for people living below the poverty line and any one living in rural areas where there is minimal access to facilities like hospitals and pharmacies. Anyone between the age of 18 years to 59 years can enrol in this scheme. The premium of Rs.200 per annum is contributed by the State and Central Government.

Universal Health Insurance Scheme by Government of India:

The Government of India introduced the Universal Health Insurance Scheme to help families and individuals that live below the poverty line gain access to healthcare facilities. Those who fall above poverty line can also apply for this scheme but is available only for families. Through this scheme, people can benefits from a number of features that helps improve the overall quality of life such as hospitalisation cover, maternity cover and personal accident insurance.

Bhamashah Swasthya Bima Yojana by Government of Rajasthan:

The Government of Rajasthan introduced an innovative solution to help IPD patients get cashless medical treatment. All families that are covered under the RSBY (Rashtriya Swasthya Bima Yojana) and NFSA (National Food Security Act) are eligible for this scheme. By providing financial assistance against illnesses, the government hopes to reduce the financial strain on the people through the Bhamashah Swasthya Bima Yojana. This policy also helps in creating a health database which can be used in the future to help make policy related changes.

Yeshasvini Health Insurance Scheme by Government of Karnataka:

This scheme helps provide farmers across the state with inexpensive medical facilities. Launched by the former chief minister of Karnataka, the scheme became operational in 2013. The Yeshasvini Health Insurance Scheme is designed for workers who belong to a co-operative society and fall in the lower middle income and middle income groups. It provides cover against several ailments like neurosurgery, angioplasty, surgical oncology, neonatal intensive care, orthopaedic surgeries, animal bites, paediatric surgeries, drowning, etc. More than 30 lakh people benefit from this scheme.

West Bengal Cashless Medical Treatment Scheme:

The West Bengal Cashless Medical Treatment Scheme is an all-round health scheme that was introduced in 2014 for all employees and pensioners of the state government. The scheme is designed to provide cashless medical facilities of up to Rs.1 lakh to all officers, employees, IAS officers and pensioners working under the state government. Family members of the eligible people can also avail benefits under this scheme. The facilities are available at all hospitals which are a part of the panel of this scheme.

Mukhyamantri Amrutum Yojana by Government of Gujarat:

Introduced by the Government of Gujarat, the Mukhyamantri Amrutum Yojana is a health coverage scheme. It aims at providing medical facilities, including the cost of surgeries and hospitalization, to all families with an income below Rs.1.5 lakh p.a. There is no fee for enrolment and the cover offered is Rs.2 lakh per family of 5 members. The cost of this scheme is fully borne by the government.

Mahatma Jyotiba Phule Jan Arogya Yojana:

In April 2017, the Maharashtra government renamed its Rajiv Gandhi Jeevandayee Arogya Yojana scheme to Mahatma Jyotiba Phule Jan Arogya Yojana. With so many people falling out of the realm of insurance, the Maharashtra government introduced this state government health insurance scheme to ensure quality healthcare access to the below poverty line section of the society. For those who are economically underprivileged, the plan provides free healthcare. Anyone who holds an Orange Ration Card or a Yellow Ration Card can be a part of this scheme. If a member of this scheme was to seek any treatment at government hospitals, the cost will be covered by this plan.

Chief Minister’s Comprehensive Scheme by Government of Tamil Nadu:

The Chief Minister's Comprehensive Health Insurance Scheme was introduced to provide the benefits of health insurance to the economically weaker sections of society in Tamil Nadu. The scheme is offered in association with United India Insurance Co. Ltd., a public sector insurance provider. Over 1 crore households benefit from this scheme. Some of the benefits include cashless medical facilities and surgical treatments, not only from public but also private sector hospitals. All expenses arising due to illnesses, follow-up treatments, consequent diagnostic procedures, etc., are covered.

Rajiv Aarogyasri by Government of Andhra Pradesh:

The Rajiv Aarogyasri Health Insurance scheme was designed for individuals below the poverty line in Andhra Pradesh. The benefits of the scheme are available on a floater basis and an individual or a family as a whole can make health insurance claims up to Rs.1.5 lakh. In case the Rs.1.5 lakh benefit is exceeded, an extra amount equal to Rs.50,000 can also be availed. The treatments for a wide variety of serious ailments that require hospitalisation or surgery are covered. All in all, 938 treatments are covered under the scheme. Pre-existing diseases of specific conditions are also covered.

Biju Swasthya Kalyan Yojana by Government of Odisha

Named after a former Chief Minister, Biju Patnaik, Biju Swasthya Kalyan Yojana is a health coverage scheme launched by the Government of Odisha. The scheme is expected to offer medical protection to 70 lakh families in the state. The scheme will offer coverage for secondary and tertiary treatments up to Rs.5 lakh per family. The coverage amount is extended to Rs.7 lakh in the case of women.

Ayushman Bharat by Government of India or Pradhan Mantri Jan Arogya Abhiyaan

Ayushman Bharat is an ambitious universal health insurance scheme that will cover 50 crore Indians and provide Rs.5 lakh coverage to the underprivileged families of the country. This free government-backed health insurance scheme will provide coverage for secondary and tertiary medical treatment services. The services can be availed in government hospitals as well as private hospitals. One of the highlights of the scheme is that it covers all pre-existing diseases.

1. >What is a no-claim bonus?

   If a policyholder does not make a claim during the policy term, the insurance company rewards him/her with a bonus known as No-Claim Bonus. This bonus is given in the form of a discount on the next premium paid to renew the health insurance policy. The intention of the NCB is to discourage policyholders from making petty claims. Discount for the 1st claim-free year starts at 5% and increases every subsequent year. The maximum amount allowed as NCB is 50%.

2. >Are there family discounts given on health insurance policies?

   Yes, if the proposer of the policy adds additional members or takes a family policy, then the premiums per person would be reduced. Under family policies, one can add their spouse, dependent parents and up to two dependent children. There are family policies that allow up to 15 members to be insured under one policy.

3. >What is meant by claim-settlement ratio? Is it important?

   Claim settlement ratio is the number of claims that have been settled by an insurance company against the number of claims that have been processed and rejected. A very high or very low ratio indicates a skewed process. A positive CSR indicates that the company has settled many claims. A low CSR should indicate that the company has rejected many claims, however, this does not indicate that the company is not good. Claims can be settled or rejected for various reasons.

4. >Is it safe to buy insurance online?

   Buying health insurance online is safe because the feature purchase these policies is available on their own secure website. A number of other third-party websites also offer online policies through safe and secure websites. Always look for “https” in the address bar to ensure that the website is secure. Making the payment for the premium is done through online payment gateways that are safe and require your authentication and verification to carry out the transaction. Never give out your OTP and CVV to anyone.

5. >Why are online health insurance policies cheaper?

   It is cheaper than going through an agent because the middleman viz. the agent does not play a part in the process and the cost of the policy is reduced by the amount of commissions paid (to the agent).

6. >What is switching?

   Switching and porting are synonyms which refer to when a policyholder moves or ports from his/her current provider to another. If a policyholder is unhappy with the current insurance company, then at the time of renewal, they can renew the policy with a different insurer. Under this facility, the policyholder will not have to compromise on the time lapsed on waiting periods and no-claim bonuses earned.

7. >Are tax benefits or deductions available on health insurance plans?

   For premiums paid towards health insurance plans, you can claim deductions under Section 80D of the Income Tax Act, 1961.

8. >What is free-look period?

   A free-look period is the time given by the insurance company to the policyholder to view the terms and conditions of the plan. If the policyholder is not satisfied with the policy, they can return it and get a refund of the premium paid. The insurance company will deduct the money spent on medicals, stamp duty and also for proportionate risk borne by them. The free-look period granted is usually 15 days to 30 days.

9. >Is GST applicable to premium payments?

   Yes, effective 1 July 2017, GST is applicable to health insurance premiums. The current rate of GST on these premiums is 18%.

10. >What should I do if I have lost my original health insurance policy?

    If the original policy is lost, you need to inform the health insurance provider. A duplicate policy will be issued to you. There may be a fee charged for this service depending on the insurance company.

11. >Who can I add as a dependent under my policy?

    Dependents are usually the immediate family that includes spouse, parents and children. Some policies cover up to only 2 children. Children are covered up to the age of 18 years. This is sometimes extended to 25 years if they are unemployed or unmarried.

12. >How are premiums calculated?

    Premiums vary between people and based on the age and location of the insured member and the sum assured chosen. Other factors that influence premiums include co-pay options, riders, pre-existing illnesses, hazardous occupations, etc. In case of plans on a family floater basis, premiums are calculated based on the age of the oldest member. Premiums in this case are also affected by the family size i.e. the number of family members covered under the policy.

13. >What is meant by cashless claim?

    A cashless claim is a facility provided by the insurance company through tie-ups with various hospitals. If the insured decides to get treated at one of these hospitals, then they are not required to pay the bill. The insurer and the hospital will deal directly between themselves regarding all matters of documentation and bill settlement. The insured might be required to pay any portion of the bill that is not covered under the policy.

14. >What is Co-payment? What are deductibles?

    Some insurance companies require or provide the option of co-payment. This means the portion of any claim the insured is willing to pay should a claim arise. This option reduces the premium according to the deductible sum chosen. However, this will also mean that at the time of a claim, the insured will be able to claim a smaller amount.

15. >What is ‘sum assured’?

    The sum assured is the absolute amount the insurance company is liable to pay in the event of a claim. You cannot claim an amount higher than the sum assured.

16. >What is meant by sub limits? What is included under sub limits?

    Sub-limits are caps placed on different kinds of claims. This cap defines the maximum amount the insurance company will pay for certain expenses covered under the policy. For example, the insurer might pay only 40% of the room rent charges, or 60% in case of specific illnesses. Sub limits are imposed usually on room charges, medical tests, operation theatre expenses, medicines costs, and hospitalisation expenses.

17. >What is meant by ‘restoration’ or ‘reinstatement’ of sum assured?

    If a person exhausts the total sum assured under the insurance policy within the policy period for one particular illness, the sum assured will be restored fully in case of another illness. For example, if a person is diagnosed with a heart condition and uses the full sum assured to get treated, and later he is diagnosed with a liver condition, then the sum assured will be restored. The insured can claim the same amount for the second time in the same period. Insurance companies sometimes offer three restoration benefits.

18. >What is the Difference between Health Insurance and Mediclaim:?

    Both terms are often used synonymously, however, there is a difference between the two. Mediclaim covers specific things such as hospitalisation expenses, particular illnesses and hospitalisation/treatment in case of accidents. Health insurance plans has a broader base of coverage and can be customised to include expenses pertaining to pre/ post-hospitalisation, ambulance charges, critical illnesses, etc.

19. >How beneficial is day care health insurance?

    Day care is an important part of your insurance plan because most of the time, medical expenses do not end when you leave the hospital. You will be required to take further medication, diagnostic tests (without hospitalisation), and various other treatments that fall under day care. Under these circumstances, it is beneficial to have day care insurance as it will cover these costs.

20. >How can one choose a good day care health insurance plan?

    Many health insurance policies have inbuilt coverage of day care treatments. When choosing your health insurance plan, it is important to read the fine print and check the number of day care treatments covered. This information is usually available in the plan brochure or will be provided to you upon request. Many companies list the number of treatments they cover. However, it is also important to check the coverage department-wise such as oncology, urology, or cardiology. Another important measure to take is to read the exclusions of the policy.

21. >What is domiciliary hospitalisation?

    Domiciliary hospitalisation refers to the treatment of a certain illness that can be done at home. A hospital or nursing home is not required or cannot be given as the patient may be immobile. This can also happen due to non-availability of accommodation in the hospitals. Treatment is considered domiciliary hospitalisation if it occurs for 3 continuous days for a certain disease or injury.

22. >What are the benefits of having coverage of domiciliary hospitalisation?
    • Domiciliary hospitalisation can be expensive as the nurse or doctor will have to do house visits. Equipment and other necessary implements/medication will also have to be brought home. If your insurance plan covers domiciliary hospitalisation, then you will most likely receive cover for the following:
    • Home nursing service expenses
    • Consultation fees, doctor charges, and specialist fees
    • Expenses incurred to get blood, anaesthesia, and oxygen
    • Diagnostics tests and X-ray charges
    • Medicines and drugs
23. >Can I claim insurance for dental treatment?

    Many health insurance providers in India do not cover dental treatments. However, now a few insurance plans do offer coverage of dental procedures. There may be a waiting a period from the commencement of the policy before the dental cover starts.

24. >How do I choose the best health insurance plan for myself?
    • Choosing a suitable health insurance plan can be a difficult task. Here are a few things to keep in mind while buying a health insurance policy:
    • Always take your time to read the brochure and policy document.
    • Buy a comprehensive health insurance plan that suits your requirements.
    • If you a have a family history of a specific illness, you should find a policy that will offer coverage for that.
    • Ensure you are fully aware of the exclusions.
    • Keep your co-pay options at a moderate level so as to pay an affordable premium but also so that you don’t have to shell out huge sums at the time of a claim.
    • No-claim bonuses are beneficial when it comes to renewing your policy.
    • Make comparisons of policies online.
    • Do your research on the health insurance company and its reviews.
25. >The fine print of the policy document is not easy to read. Any tips?
    • Often, insurance documents contain jargon that is not easily understood by the public. To help make it easy, you can use the following:
    • The terms and conditions will have a list of definitions of such words. You can go through this list and learn the meaning of these terms. This will make it easier to understand the document.
    • If you still have trouble, you can call the customer care and ask them to explain any part that you have difficulty in understanding.
    • Talk to a friend or an advisor to get more information.
    • Internet advice maybe helpful but it is not recommended as it may confuse you even more.
    • You can also do your own research on third-party websites like BankBazaar that have a lot of information on simplifying insurance.
26. >What are some of the top myths about health insurance?
    • I will pay high premiums only to have my claim rejected later - This is not true. Majority of health insurance claims go through smoothly. There are many people who have not read the terms and conditions, exclusions and coverage of the policy and therefore have difficulty when it comes to making a claim. Furthermore, if you have not provided accurate information, your claim can be rejected.
    • I can hide information about smoking, they will never find out - It is important to disclose your lifestyle habits and pre-existing illnesses. If you are lucky, you may not get caught. But if you do, then your entire premium will be wasted as your policy will be void or your claim will be rejected.
    • All insurance plans are the same - No, each insurance plan offers something different. They may cover the basics but it is important to compare and do your own research before buying a plan. Plans are designed differently to suit the needs of various people.
    • I don’t need insurance because I live a healthy lifestyle - Just because you do not smoke and drink, does not mean health insurance is not for you. There are various health problems that can arise due to the nature of our environment, occupation, stress, diet, weight and so on. Health insurance is for everyone.
    • A high claim-settlement ratio determines the best health insurance provider - Claim-settlement ratio is the number of claims settled against the number of claims made in a year. A high claim-settlement ratio means the insurer has rejected very few claims. This is an important factor to consider, but should not be the sole determining factor when choosing your health insurance provider. You must take into consideration the cover offered, the exclusions, waiting periods, reviews and so on.
27. >What documents are required when you submit a reimbursement claim?
    • When you make a reimbursement claim, you will be required to submit the following:
    • Health card and identity proof of the insured
    • Duly-filed reimbursement claim form
    • A copy of the discharge summary
    • Original hospital bills
    • Original pharmacy bills
    • Original cancelled cheque
    • A bill for ambulance charges, if it is covered by your insurer
    • Any medical investigation report like ECG, X-ray, MRI, CT scan, or any other reports.
28. >What are floater health insurance policies?

    Floater policies are those that cover multiple people under a single insurance plan. The sum assured can either be used entirely by one person, or there may be a fixed sum assigned for each person.

29. >What is the difference between individual and floater options?

    Individual plans are designed to cater to a single person whereas a floater plan caters to multiple people. Floater options are suitable for families and groups. Premiums between the two policies will differ. Floater plans usually carry higher premiums, but it will average out to lesser person as it is a group plan.

30. >What do you mean by reimbursement?

    Under reimbursement claims, the policyholder needs to settle the hospital bill once they are discharged. They can later fill up the insurance claim form, submit the required documents and get a reimbursement of the money spent at the hospital. This is usually done when the patient receives treatment at a non-network hospital where cashless facility is not available.

31. >Can I claim insurance for Homeopathy treatments?

    In the past, health insurers did not provide any coverage for alternative treatments. However, in 2014, the central government made it mandatory for all health insurers to provide coverage for AYUSH treatments. AYUSH treatments include Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. The percentage of coverage may differ from one insurer to another. You may check with your insurer to determine the level of coverage available for homeopathy treatment.

32. >If I am hospitalised due to an accident, are there any special benefits

    Some insurance plans offer special benefits for personal accidents. This covers hospitalisation, consultation fees, and so on. Apart from this, you will also be covered in case of permanent disability or dismemberment. In case of death due to accident, your nominee can claim a death benefit.

33. >When is it a good idea to switch health insurance providers?

    Switching health insurance providers would be ideal under the following circumstances:

    • You are getting the same cover for lesser premium.
    • You are not satisfied with your current insurance provider and feel another company might serve you better.
    • You require cover for a specific illness that is not covered by your provider.
    • The sum assured on the new plan is more than the current policy.
    • You need to change your plan from individual to family floater and vice versa.
    • You should also make sure you can carry forward the waiting period already completed under the current policy.
34. >What is covered under pre-hospitalisation and post-hospitalisation expenses under a health insurance plan?

    If you insurer covers pre-hospitalisation expenses, the following will be covered:

    • Doctor or physician consultation fees
    • X-rays
    • Blood tests
    • Scans
    • Urine tests
    • Pharmacy expenses

    Post-hospitalisation cover usually pays for:

    • Consultation fees
    • Pharmacy bills
    • Acupuncture
    • Physiotherapy
    • Diagnostic charges
    • Cost of medicines
35. Can I get a refund of the premium if I do not make a claim during the policy period?
    • Premiums paid are not refundable if you do not make a claim. If you have not made a claim on your insurance policy, then you will be eligible for a no-claim bonus which is given in the form of a discount on the premium you have to pay to renew your policy. You may also receive the benefit of an enhanced sum assured.
    • When you purchase a health insurance plan, you are paying for the risk borne by the insurance company. The company is not liable to pay you back if you do not make a claim.
36. >What is day-care health coverage?

    With the technological advancement in the medical industry, many surgeries and treatments which usually required a prolonged hospitalisation in the past can now be completed within 24 hours. Health insurance companies now provide insurance coverage for day-care procedures like angiography, chemotherapy, radiation therapy, dialysis, and more.

37. >What is the benefit of day-care health insurance?

    Although you avoid prolonged hospitalisation in the case of day-care procedures, the expense of day-care treatments is still high. With a day-care health insurance cover, you can meet these expenses easily without putting a dent in your pocket.

38. >What treatments do day-care procedures include?

    Gastroenterology, Chemotherapy, Thoracic surgery, Radiotherapy, Tonsillectomy, Auroplasty, Cataract, Hydrocele, Lithotripsy, Oncology, Stapedotomy, Neurology, Tympanoplasty, Urology, Myringotomy, Ophthalmology, Plastic Surgery, and ENT are some of treatments included under day-care procedures. Any treatment received on an outpatient basis is not considered a day-care treatment.

39. >How do I choose a good day-care procedure health insurance plan?

    Insurance providers list a huge number of day-care procedures to attract customers. However, it is important to check out the broad categories of procedures covered under the day-care health insurance rather than just the number of treatments. Choose a health insurer who provides insurance coverage for numerous broader categories such as cardiology, oncology, urology, and ophthalmology.

40. >What is domiciliary hospitalisation?

    Domiciliary hospitalisation is when the life insured receives treatment for an illness or injury while confined at his or her home due to the lack of accommodation at the hospital or the physical inability to move to a hospital for treatment.

41. >What is Domiciliary hospitalisation benefit?

    When the stipulated 24-hour hospitalisation is not possible due to the lack of accommodation at the hospital or the life insured’s inability to move to a hospital, domiciliary hospitalisation benefit will cover the expenses incurred from treatment taken in the confines of his or her home.

42. >Is dental treatment covered under a health insurance policy?

    Due to the technological advancement in dentistry, the cost of dental treatments have risen over the years. Most standard health insurance plans don’t offer insurance coverage for dental treatments. You can opt for a dental health insurance plan to supplement your base health insurance policy.

43. >How do I select the best health insurance plan?

    First, determine the type of health insurance plan you require (individual, group, family, critical illness, etc). Second, compare the features and benefits of various health insurance policies across top health insurance providers. Comparison can be easily carried out for free on third-party websites like BankBazaarInsurance.com. Beside insurance premium, make note of the inclusions and exclusions of the policy, co-payment, insurance coverage, sub-limit, waiting period, diseases covered, etc. The best health insurance policy is one that offers a comprehensive health cover at an affordable premium.

44. >Is it necessary to read the fine print of the policy document?

    Reading the fine print of your health insurance policy document carefully is important to avoid any problems when making a claim. Read the inclusions and exclusions of the policy. Focus on the cancellation and renewal guidelines. Check for waiting period for initiating a reimbursement claim.

45. >What are the Top myths about health insurance?

    Certain myths about health insurance results in you being either underinsured or overinsured. Some of the top myths about health insurance are:

    • Cheap insurance premium means the best insurance plan.
    • Younger generation doesn’t fall sick often, thus, don’t need a health insurance plan.
    • Health insurance policy benefits begin from the time of policy inception.
    • Group insurance plan is adequate for your insurance needs.
    • Purchasing health insurance policy online can be unsafe.
46. >What are the documents required for health insurance claim reimbursement?

    The documents required for health insurance claim reimbursement are:

    • Duly filled and signed claim form.
    • Cancelled cheque.
    • Discharge card or summary.
    • Hospital bill with payment receipt and pharmacy bills with prescription.
    • Doctor’s consultation papers.
    • Photo ID proof.
    • A copy of the health card.
47. >What do you mean by floater option?

    A family floater plan offers health insurance cover to the entire family under one policy, wherein you pay a single premium but the sum insured is shared by the entire family. Insured members under a floater option usually includes self, spouse, children, and dependent parents.

48. >What do you mean by reimbursement?

    Reimbursement works on the indemnity principle wherein the medical expenses incurred by the life insured during the policy period is paid back by the insurance company after the policyholder makes a claim for reimbursement.

49. >What is the difference between individual and floater options?

    Individual health insurance covers only one person whereas the family floater plan covers the entire family under a single policy. The sum insured of a family floater plan will be shared by the insured members whilst paying single premium.

50. >What expenses are included in the sub-limit amount?

    Sub-limit is the limited amount or percentage of the sum insured that the insurer will pay for certain expenses like room rent, pre and post-hospitalisation, cost of surgery, cost of medicines, etc.

51. >Does a health insurance policy cover homeopathy treatments?

    Homeopathy treatment received at a government hospital or any medical facility accredited by the government is covered under health insurance. Usually, up to 10% of the sum insured is used to cover homeopathy treatments.

52. >If I don’t raise a claim in a policy period, can I get a refund of the premium?

    In the case of health insurance, the premiums paid will not be refunded even if you don’t make any claim during the policy period.

53. >What are the benefits of health insurance portability for policyholders?

    Health insurance portability allows you to transfer your existing health insurance policy from the current insurance provider to another without losing the policy benefits provided by your current insurer.

54. >What covers are offered under pre and post-hospitalisation expenses?

    Pre and post-hospitalisation expenses includes medical expenses incurred by the life insured 30 days prior to and 60 days after hospitalisation.

55. >How is the premium for a family floater policy calculated?

    The premium for a family floater plan is calculated based on the age of the oldest insured member of the family.

56. >What do you mean by cashless hospitalisation?

    Cashless hospitalisation - If you receive treatment at one of the network hospitals of your insurer, you can avail cashless facility wherein the medical expenses incurred by the life insured will be directly paid by the insurer to the hospital. Show your health card at the hospital desk and get approval from your insurer’s TPA to avail cashless treatment. You don’t have to pay the medical bill upfront out of your pocket. Check the insurer’s website for the list of network hospitals.

57. >What is the minimum and maximum age at which one can enter and buy a health insurance policy?

    The minimum entry age to apply for a health insurance policy is 18 years and the maximum is 65 years. Children from the age of 3 months and above can be insured under the parent’s policy.

58. >What do you mean by pre-existing diseases?

    Any illness or disease for which the life insured showed symptoms, was diagnosed or took treatment prior to the inception of the policy is considered a pre-existing disease or condition.

59. >Why do I need health insurance?

    With the steady increase in healthcare costs and lifestyle diseases, it is advisable to have a suitable health cover handy. Health insurance offers financial protection to you and your family against unexpected medical expenses incurred during the policy period. In addition, you can also maintain good health with preventive healthcare cover.

60. >What is the difference between a family floater, a critical illness, and a hospital cash insurance policy?

    A family floater plan provides insurance coverage against medical expenses incurred by any of the insured members of the family during the policy period. Critical illness plan provides a lump sum amount to the policyholder if the life insured is diagnosed with any of the specified critical illnesses under the policy regardless of whether the person receives treatment for the illness or not. Hospital cash plan provides daily cash of up to Rs.4,000 to the life insured to meet non-medical expenses during the period of hospitalisation.

61. >Do I need to undergo a medical check-up while buying a health insurance policy?

    For a group or employee health insurance plan, you don’t need to undergo a medical checkup. For an individual health insurance plan, people under the age of 45 don’t have to undergo medical checkup. For senior citizen health insurance plan, the policyholder will have to undergo medical checkup. Some insurance providers will share the cost of medical checkup. It is advisable to get a medical checkup done when applying for a health insurance policy to avoid any hassle when making a claim.

62. >How do I cancel my health insurance policy?

    Health insurance policies can be cancelled if no claims have been made during the policy period. Policy can be cancelled during the free-look period and you can get premium refund based on the cancellation policy specified in the policy document.

63. >Why is medical insurance important?

    Medical insurance is important because without it you may have to borrow money to pay your medical bills. With a suitable health insurance plan, you can get access to timely and adequate healthcare, network hospitals, cashless treatment, and enhanced financial protection against unexpected medical expenses.

64. >What type of health insurance plans are available today?

    The types of health insurance plans available in India today are individual health insurance plans, group or employee health insurance plans, family floater plans, senior citizen plans, critical Illness plans, personal accident covers, and maternity insurance plans.

65. >What are the covers offered under critical illness?

    Critical illness plan provides guaranteed payout when the life insured is diagnosed with any of the critical illnesses specified under the policy regardless of whether the person receives treatment for the illness or not.

66. >What parameters are considered for calculating the premium?

    The parameters for calculating health insurance premium are age, gender, location, occupation, lifestyle habits, sum insured, coverage, pre-existing conditions, etc.

67. >What is the procedure for reimbursement settlement?

    You must intimate the insurer within 48 hours of hospitalisation. You will have to pay for the medical expenses out of your pocket. The duly-filled and signed claim form should be submitted to the insurer along with the supporting documents such as the original medical bills (hospitalisation, medicines, tests), discharge card, and cancelled cheque. After the insurer-appointed surveyor verifies and confirms your claim, the claim settlement amount will be sent you.

68. >What is the process for claim?
    • For planned hospitalisation: Contact the helpline number of your insurance provider and submit the pre-authorisation form filled by the hospital for approval. Carry your ID card, health card, and policy document with you at all times. The hospital will get approval from your insurer’s TPA for cashless claim.
    • For unplanned hospitalisation: Contact the helpline number of your insurer immediately after hospitalisation and submit the duly-filled pre-authorisation form. In the case of reimbursement claim, pay the medical bills out of your pocket and furnish all the original medical bills along with the reimbursement claim form to the insurer for claim settlement.
69. >What are the steps for cashless claim?
    • Show your e-card at the network hospital desk.
    • The hospital will verify your identify and confirm if you can avail cashless treatment.
    • The hospital will submit pre-authorisation form to the insurer.
    • After receiving approval from your insurer’s TPA, cashless settlement will be made directly to the hospital.
70. >What if I want to renew my health insurance policy after one year?

    If no claim has been made in the previous year, you can renew the policy. Renewal has to be done on time or the policy will lapse.

71. >What is a health card?

    Health card is an identity card provided by the insurance company to the life insured to avail cashless treatment at a network hospital. The health card will contain the health policy and contact details of the insurer’s TPA.

72. >What are the benefits of a health card?

    If you show the health card at the network hospital desk, the hospital will immediately confirm your identity and policy details. You can get cashless treatment instantly without any hassle. You can contact the insurer’s TPA for any policy-related queries or assistance on the helpline numbers listed on the health card.

73. >What are the best health insurance companies of 2018 in India?

    Aditya Birla, Iffco Tokio, Reliance General Insurance, and ICICI Lombard, based on the latest claims incurred ratios, are some of the best health insurance providers of 2018 in India.

74. >How do I select the best health insurance plan of 2018 in India?

    To select the best health insurance plan, you must consider certain parameters such as premium, waiting period, diseases covered, No-Claim Bonus, co-payment, sub-limit, network hospitals, and claim settlement ratio of the insurer. Apollo Munich Easy Health, Care Health Insurance Plan, ICICI Lombard Complete Health-iHealth, Max Bupa Health Companion, and Apollo Munich Optima Restore are some of the best health insurance plans of 2018.

75. >What is the procedure for change of address for medical insurance?

    Visit the insurance company’s website, login with your username and password, provide your policy number, upload proof of your new contact address, and make the changes in your profile. If you want to make the change offline, you can request a change of address in the policy documents by providing proof of address and policy number to your insurance agent.

76. >I already have health insurance and want to increase sum insured, what should I do?

    During policy renewal, you can increase the sum insured if needed.

77. >Can a person have more than one health policy?

    Yes, an individual can have more than one health insurance policy. If you aren’t receiving sufficient insurance coverage under your group health insurance policy, you can opt for an individual health insurance plan.

78. >What are the tax benefits I get if I opt for health insurance?

    You can get tax deductions on premiums paid towards a health insurance policy under Section 80D of the Income Tax Act, 1961:

    • Annual tax deduction of up to Rs.15,000 for individual and family health insurance premiums.
    • Up to Rs.20,000 for senior citizen health insurance premium.
    • Up to Rs.15,000 for health insurance premiums paid on behalf of your parents. Up to Rs.20,000 if your parent is a senior citizen.
79. >What are the factors that affect health Insurance premium?

    The various factors that affect health insurance premium are:

    • Gender
    • Age
    • Occupation
    • Location
    • Pre-existing diseases
    • Family medical history
    • Lifestyle habits
80. >What does a health insurance policy not cover?

    Exclusions of a health insurance policy includes:

    • Pre-existing diseases, subject to a long waiting period.
    • Cost of spectacles, contact lenses, and hearing aids.
    • Dental treatments.
    • Venereal diseases.
    • Self-inflicted injuries.
    • Drugs and alcohol abuse.
    • AIDS.
    • Diagnosis, x-ray, and laboratory test costs that are not consistent with the disease requiring hospitalisation.
    • Treatments relating to pregnancy or childbirth.
    • Naturopathy treatment.
81. >Is there any waiting period for claims under a policy?

    There is a 30-day waiting period starting from the policy inception date for the policy benefits to begin, except for unexpected hospitalisation due to an accident. The waiting period for pre-existing disease claims is 4 years.

82. >If my policy is not renewed in time before the due date, will I be denied renewal?

    You can pay the premium due within 15 days from the due date. This period is called the grace period. If you fail to make premium payments within the grace period then your policy will lapse.

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

    Health insurance portability allows you to transfer your health insurance policy from the current insurance provider to another without losing the policy benefits offered by your existing insurer.

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

    After a claim has been settled, the policy coverage will reduce by the settled amount till the end of the policy term.

85. >What is the maximum number of claims allowed over a year?

    Any number of claims can be made over a year during the policy term until you reach the specified limit mentioned in the policy document. Sum insured is the maximum limit one can claim under the policy.

86. >What is ‘health check’ facility?

    Some insurers pay for health check-ups of the life insured once every 4 years. This is called ‘health check’ facility.

87. >Who is a health TPA?

    Some insurance companies appoint a Third Party Administrator (TPA) to process all the claims made by the policyholders. The hospital needs to receive approval from the TPA to provide cashless treatment to a life insured. The contact details of the TPA will be available on your health card or the insurer’ website.

88. >Do I have to undergo any medical examination?

    A medical examination may be required based on the age and medical condition of the life insured.

89. >Do I have to undergo a medical checkup every year?

    No, you don't have to undergo a medical check-up every year if the policy is renewed continuously without fail and if there are no changes in the policy terms and conditions.

90. >Who pays for the medical examination?

    Usually, the customer pays for the pre-policy medical checkup. However, some insurance providers share the cost of the medical examination on a claim reimbursement basis.

91. >Who is a medical practitioner?

    Any person registered with the medical council of any state of India and thereby entitled to practice medicine within its jurisdiction is called a medical practitioner, can be a physician, specialist, surgeon, etc.

92. >What do you mean by medical expenses?

    Medical expenses are the expenses incurred by the life insured for medical treatments received on the advice of a medical practitioner due to an illness or accident during the policy period.

93. >How can I indemnify or claim benefits under the policy?

    The medical expenses can be indemnified through reimbursement claims or by availing cashless services at a network hospital of the insurer.

94. >Is cashless facility available across all hospitals?

    No, cashless facility is available only at the network hospitals of the insurer. For the list of network hospitals in your location, visit the insurance provider’s website.

95. >Are all the major corporate hospitals on the network?

    Use the network hospital locator available on your insurer’s website for the list of network hospitals available in your area.

96. >Will I get cashless treatment at government institutions like AIIMS/TMH/ARMY Referral hospitals?

    No, cashless treatment cannot be availed at government institutions.

97. >If I avail cashless facility, will you pay the entire amount or will I be required to bear part of the bill at the hospital?

    Yes, the insurer will pay the entire amount for the medical expenses incurred at the network hospital subject to the sum insured limit. However, you may have to pay for the non-medical expenses that are not covered under the policy before your discharge from the hospital.

98. >In case of cashless treatments, in whose favour are cheques settled or who gets the payments?

    The cheque will be sent directly to the network hospital where the life insured received treatment.

99. >What is co-payment?

    Co-payment is a cost-sharing requirement for certain health insurance policies wherein the policyholder will bear a specific percentage of the admissible costs.

100. >What is waiting period?

     It is the specified period of time, usually 30 days from the date of policy inception, after the completion of which full or partial health insurance coverage will begin. The waiting period varies from insurer to insurer based on the type of disease and policy.

101. >Why should I take a health policy if I already have health insurance from my employer, or if my family and I are already covered by my corporate?

     The group or employee health insurance policy provided by your employer offers basic liability cover which will not fully cover your insurance needs. Also, If you quit the organisations, the insurance cover will cease.

102. >What is the basic difference between individual and group health insurance coverage?
     • Group insurance package is purchased by the employer for the benefit of the employees. Individual insurance is bought by individuals for themselves or their families.
     • Group health insurance policy can be availed at a low or no cost to the employee. The premium for group insurance is deducted directly from the employee's salary. Individual health insurance cost is borne fully by the individual.
     • All employees of the organisation are granted approval for group insurance whereas in the case of individual insurance, there are possibilities of rejection.
     • Group insurance cover lasts only as long as you work with that employer which is not the case when it comes to individual health insurance.
     • Individual insurance can be customised to suit your medical needs which is not possible with group health insurance.
     • Unlike group health insurance, you can benefit from No-Claim Bonus only in the case of individual insurance.
103. >Why should I buy overseas travel insurance?

     Most foreign countries insist on seeing a valid travel insurance policy upon entry. Sometimes even visa approval depends on having a suitable travel insurance plan. Healthcare costs in a foreign country can be expensive. With an overseas travel insurance plan, you can receive timely and adequate healthcare without putting a dent in your pocket.

104. >Why should I buy a critical illness cover?

     Treatment for critical illness is not only expensive but the probability of contracting a critical illness has become higher with the sedentary lifestyle habits. Critical illness plan will pay a lump sum amount if the life insured is diagnosed with any of the specified critical illnesses under the policy regardless of whether the person receives treatment for the illness or not. Most policies cover 9 to 15 critical illnesses like first heart attack, cancer of a specified severity, stroke, multiple sclerosis, etc.

105. >What is a Unit Linked Health Plan (ULHP)?

     Unit Linked Health Plans (ULHP) are developed to provide insurance and investment benefits for users. This is a relative new product offered by health insurers in the market. Similar to ULIPs, these products come with a market-linked investment plan that provides returns on maturity. The premium amount paid towards a ULHP has both insurance component and savings component. After deducting the premium amount for insurance coverage, the balance amount will be invested in the investment plan. The return generated from the investment plan is subject to market conditions, and this plan is ideal for people who are already familiar with similar investment products like ULIPs.

106. >What type of coverage is offered for pre-existing diseases in health insurance?

     Pre-existing disease cover is offered by most of the top health insurance companies in the market. There is a specific waiting period for pre-existing diseases before they get covered under an insurance plan. During this waiting period, insurance coverage will not be available for any treatment costs incurred due to these ailments. The policy on waiting period varies from one insurer to another. Typically, most insurers have at least 2 years of waiting period for pre-existing illnesses.

107. >What is a top-up health insurance plan?

     A top-up health insurance plan is taken to provide additional insurance coverage over the existing insurance policy. The key thing here is the deductible amount chosen by the insured. The deductible amount for the top-up policy can be chosen based on the basic health insurance coverage. If a person has a basic health cover for Rs.2 lakh, the deductible can be chosen for Rs.2 lakh. Any medical expenses beyond Rs.2 lakh will be covered by the top-up policy (within the sum insured limit). Higher the deductible opted, lower the premium charges for the top-up policy.

108. >How does the sub-limit on room rent affect health insurance coverage?

     This refers to the fixed percentage of sum insured amount available for room rent expenses within a health insurance policy following the hospitalisation of the insured. Room rent sub-limit is an important criteria when it comes to getting claim settlement. If the actual room rent exceeds the sub-limit, the overall compensation for other hospitalisation expenses will be reduced proportionately. This proportional reduction in hospitalisation expenses based on room rent charges may not be explicitly stated in the brochures. It is better to check the policy document or enquire with the insurer directly in order to get clarity on the connection between room rent sub-limit and hospitalisation settlement.

109. >What is premium loading?

     Premium loading refers to the hike in renewal premium after a claim is made in a policy. With the loading charges, the premium amount on health insurance will be increased by a certain percentage. Following the introduction of Health Insurance Regulations in 2013, health insurers in India are prevented from charging claim-based loading. Most health insurance policies typically have fixed premium charges for a certain number of years.

110. >What is ‘Any one illness’?

     In health insurance terms, ‘Any one illness’ refers to the continuous period during which an illness takes place. This continuous period may also include the relapse of the same illness within a particular number of days. The typical period of consideration is 45 days.

111. >Can I get a health insurance plan without a job?

     A health insurance company only looks at the health status of an individual while issuing a health insurance policy. Therefore, as long as you can pay the premiums, it does not matter whether you have a job or not.

112. >What is the monthly cost of a good health insurance plan?

     The cost of health insurance depends on the type of plan, the insurance company, and the coverage amount. The cost per month for a family floater could be below Rs.1,000 or go up to Rs.5,000 per month, depending on the sum insured amount.

113. >What is the monthly cost of a good health insurance plan for a single person?

     The premium of a health insurance plan for an individual is cheaper than a family floater. In most cases, the cost per month would be below or around Rs.1,000.

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