Health Insurance FAQs: Answering Common Customer Queries

Although the concept is popular, people still get stuck with the technical jargon. In this article, we will discuss all the common FAQs to make the entire concept more easily understandable.  

List of top 10 FAQs of Health Insurance: 

Here are some of the most popular questions that confuse most. 

What is a health insurance plan? 

This type of insurance essentially covers all medical-related expenses. This is basically a mutual contract between the insurer and the insured, which can be an individual or a group of individuals, where the insurer agrees to provide health insurance coverage up to a certain pre-defined limit in exchange for a pre-determined premium, subject to the terms and conditions of the chosen plan.  

Why should I buy health insurance? 

Not only does it allow coverage for medical costs, but health insurance also offers multiple benefits like cashless hospitalisation, ambulance cost coverage, room rent cover, etc. It protects you from unforeseen medical costs. You can also enjoy tax exemption for premiums paid towards health insurance.  

What is the difference between family floater health insurance and individual health insurance?  

In the case of an individual plan, one plan insures one individual. However, every insured member can avail of the entire value of the sum insured. A family floater plan is an umbrella plan where you need to pay a single premium. It maintains a fixed sum insured amount, which may get exhausted if any family member gets hospitalised and files a claim. 

What documents are required for claim settlement? 

In the case of claim settlement, the insurer usually demands the identity proof of the insured, the health card, all the invoices and bills generated during treatment, etc. For cashless claim settlement, a duly filled-in and signed pre-authorisation form is required to be submitted to the TPA. Apart from these, the respective insurer demands other additional documents depending on specific case scenarios as applicable.  

Are pre-existing ailments covered? 

Pre-existing diseases or PEDs are usually covered after the specific waiting period has elapsed. This waiting period varies from one insurer to another. Your policy document specifies it. You must be aware of this clause to avoid any misunderstandings. 

What happens if the treatment occurs at any non-network hospital? 

During a medical emergency, you may not always get time to check the network hospitals for accessing immediate treatment. Under such circumstances, you have to inform your insurer as soon as possible. You have to collect and file all the bills, receipts, invoices, and other documents without fail. You have to settle the hospital dues out of your pocket during discharge. Within the stipulated tenure, usually 30/45 days, you must file your claim for reimbursement claim. 

 However, the “cashless everywhere” initiative has been launched, enabling you to avail of cashless facilities even in non-network hospitals. However, please check with your hospital if this facility is available in order to avail cashless facility. For seamless processing of claims, look up network hospitals nearby so that you can get your treatment in any of the network hospitals. 

What happens to the premium paid if the policy gets rejected? 

If your plan gets rejected, irrespective of the circumstances, your premium amount gets reimbursed to the original payment source within a few business days from the rejection date. Considering the policies of your chosen insurer, the medical check-up costs might get deducted from the premium amount.  

However your policy would not start or renew if the payment is not processed. So, contact the PayBima team or the insurer urgently to get your policy enforced. 

What are the eligibility criteria for purchasing health insurance? 

Everyone can buy health insurance for themselves as well as their family members. However, the approval of the application depends on the discretion of the insurer concerned. They will consider all the proposed insured individuals' current health status, previous medical history, age, health checkup reports, etc. 

Am I eligible to alter my plan after purchasing it? 

Yes, you can do so, but only during plan renewal. You must confirm all the relevant terms from your respective insurer. 

What is the meaning of sum insured? 

This is the technical term for the money that the concerned insurer assures to pay the insured during claim settlement. This is the optimum limit up to which the insurer will cover.