Health Insurance | FAQ's
FAQs About Health Insurance Policy;
01: What is a health insurance plan?
Health insurance policy is an agreement whereby an insurance company agrees to undertake a guarantee to compensate the insured for medical expenses in case of a medical emergency. A health insurance policy protects the insured for several surgical expenses, critical illnesses, and daycare expenses, for a policy term, for up to the sum insured limit.
02: Can I purchase more than 1 health insurance plan? How are the claims settled in this case?
Yes. You can be covered under more than one health insurance plan. In this case, the claims are settled as per the contribution clause, when the claim is higher than the sum insured for one health insurance policy.
03: Why should I buy a health insurance plan?
A health insurance policy not only protects the insured financially for the future, but also offers relief in the present. Lifestyle habits such as drinking, smoking, or sedentary lifestyle invite health issues, which can be minor or serious, and may be expensive to treat. To stay financially protected in such times, you need a reliable health insurance plan that covers you at all times. Apart from this, buying a health insurance policy also reduces your overall tax liability by allowing you tax deductions on the premium paid, under Section 80D of the Income Tax Act, 1961.
04: How is health insurance premium determined?
Different health insurance plans have different premiums. The insurance companies determine premiums after considering various factors that are explained below:
Type of Insurance Plan: Your health insurance premium is based on the type of plan you choose. If you choose a critical illness insurance plan, then the premium will be high. If you choose an individual health insurance policy, then the premium will be different from that of a family floater plan.
Age of the Insured: With age, you become more prone to health issues and are more likely to make health insurance claims. Therefore, you are required to pay higher premiums if you buy health insurance plans in later stages of life. This is why it is recommended to buy a health insurance policy when young.
Policy Term: Most health insurance plans come for a period of 1 year, 2 years, or 3 years. Greater the policy term you choose, the greater will be your coverage, and hence higher will be your health insurance premium, and vice versa.
Lifestyle Habits: If you drink alcohol or smoke regularly, then you may be denied health insurance completely. However, there are some insurance companies that cover you for the same, for which they charge high premiums. This is because, with these lifestyle habits, you are more prone to health issues.
Family Medical History: Before deciding your health insurance premium, the insurance company will ask about your family medical history. This is because if someone in your family has a certain disease that you are also vulnerable to, then the insurance company will charge you a higher premium due to increased risk.
Sum Insured: Health insurance plans come with different sum insured options that you can choose from as per your budget and requirement. The higher the sum insured, the higher the medical coverage and hence higher the health insurance premium. But it is not recommended to compromise on the sum insured to save on premiums. This is because it will not cover you adequately in the time of need.
05: Can I cancel my health insurance policy? If yes, will I get a refund for the same?
Yes. You can cancel your health insurance policy. Every health insurance company provides you a free look period to understand the policy terms and conditions. During this period, if you find any objectionable clause in your health insurance policy, then you can cancel the policy and ask for a refund. Note that you will receive the refund only if no claim has been made during the policy term. The amount of refund will be calculated after taking into consideration the expenses incurred on medical check-ups, stamp duty, and proportionate risk premium, i.e. the number of days you have been covered for risks under the policy. To know more about premium refunds, it is recommended to go through the policy document.
06: How can I renew my health insurance policy?
It is imperative to renew your health insurance policy to avail continued coverage, and save on accumulated benefits such as waiting period benefits and No Claim Bonus (NCB). You can easily renew your health insurance policy by following the simple steps given below:
Step 1: Visit the website of the insurance company and navigate to the ‘Health Insurance Renewal’ page.
Step 2: Enter the required details such as health insurance policy number and the registered mobile number.
Step 3: Check the policy details displayed and renewal premium.
Step 4: Pay the required health insurance premium via Credit card/Debit card or Net Banking.
07: What if my health insurance policy lapses when I am hospitalized?
There can be two situations. First, where you get hospitalized before the policy expiry date and notify the insurance company before the policy lapses, and the policy lapses when you are still in the hospital. In the second situation, you may be hospitalized during the grace period, the policy lapses then, and you inform the insurance company about the same during the grace period. In both cases, the insurance company will compensate for the coverage availed, as per the terms and conditions stated in the policy document.
08: Can I avail coverage benefits if I get hospitalized for less than 24 hours?
Yes. Most health insurance plans cover you for medical treatments that do not require hospitalization of at least 24 hours. These are known as daycare procedures. Daycare treatments are performed under local or general anesthesia in a clinic, hospital, or daycare center. Some daycare treatments that health insurance plans cover you for are chemotherapy, eye surgery, sinusitis, dialysis, angiography, etc.
09: Do health insurance plans cover diagnostic charges like X-rays, Ultrasound or MRI?
Yes, most health insurance plans give compensation for various types of diagnostic tests including X-rays, MRIs, blood tests, etc., if the policyholder stays in the hospital for at least 24 hours.
10: Does health insurance cover robotic surgery and modern treatments?
According to the health regulations issued by the Insurance Regulatory and Development Authority of India (IRDAI) in 2019, all insurance companies are required to insure robotic treatments. Therefore, all insurance companies provide it with some sub-limits and policy conditions.
11: What Is a cumulative bonus in a health insurance plan?
A cumulative bonus in health insurance refers to the financial benefit which you receive as a reward for not making any health insurance claims in a policy year.
12: How does smoking affect health insurance premiums?
Smokers have to be prepared to make the payment for higher premium costs for their medical insurance policy as health risks increase for smokers and insurance companies charge a higher amount to combat the medical crisis.
13: Under what conditions is my policy premium likely to increase at renewal?
Here are different situations that increase the premium during the renewal:
Healthcare Inflation – Inflation in healthcare is soaring at a rate of 12% to 18% which comprise the costs of medicines, hospital admission costs, medical advancements, etc. It leads your insurance companies to increase your sum insured every year which increases your premium too during policy renewal.
Age of Policyholder – Increase in age can also impact your health insurance premium while renewing the health insurance policy, especially for those touching 60 just before renewal.
Change in Coverage – If you change your health insurance policy coverage during the renewal process either by adding some add-on covers to your plan or by changing your insurer altogether, it may increase your premium.
14: What if I forgot to pay my health insurance premium?
If you could not make the payment for the health insurance premium on time, then your policy can be canceled. After paying the first premium, you will be given a grace period if you do not make the payment for the premium on time. You can renew your health insurance plan by paying the premium within 15 to 30 days of the grace period, which can vary from insurer to insurer, but, if you miss this opportunity too, then it could risk you losing your coverage.
15: What happens to my health insurance plan after a health claim is filed?
After a health insurance claim is filed and settled by the insurance company, then the policy coverage tends to be reduced by an amount that has already been released during the settlement. For Instance, if you buy a plan with Rs. 5 lakh policy coverage and make a claim of Rs. 2 lakh, then you can avail of the health insurance of Rs. 3 lakh in the remaining policy year.
Link: Understand more on Health Insurance in detail.
Terms and Conditions:
*Standard T&C Apply. For more details on risk factors, terms and conditions, please read the sales brochure of respective insurers carefully before concluding a sale. Tax benefits are subject to changes in applicable tax laws. For detailed communication on sales contact below authority.
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Insurance Advisory Club
IRDAI Licensed Agent
- Mr. Dheeraj Bodduna
Financial Advisor
Contact: 85220 66133
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