What is Health Insurance?

Which provides hospitalization expenses in lieu of premium paid to insurance company.

Why is Health Insurance Important?

Its protect our emergency funds and provides comfort to your family when hospitalize due to any accident or ailment.

Type of health insurance

• Individual & Family floater health insurance
• Only Critical health insurance
• Only Cancer health insurance
• health insurance for diabetic patients

What are the expenses covered during hospitalization?

All expenses like accommodation, pathology, ICU, Operation theater, Doctors and experts, nursing care etc., pre& post hospital expenses.

What is the cashless facility? Whether this facility is offered in all hospitals?

All hospital expenses to be paid by insurance company directly to the hospital subject to pre- approval.

What do you mean by Pre- hospitalization expenses?

Expenses incurred, before admission into hospital for same disease, subject to hospitalization claim is admissible.

What do you mean by Post- hospitalization expenses?

Expenses incurred, after discharge from the hospital for same disease, subject to hospitalization claim is admissible.

Does cashless hospitalization mean treatment free of cost?

Except some of the minor expenses which are not payable under the policy must be borne by the patient.

What is meant by domiciliary hospitalization?

Medical treatment require admission into a hospital and person is not in a condition to move then treatment carried out at home.

What is pre-existing condition?

The Disease which discover after taking the policy are covered only a gap of certain years depends upon the terms and condition of the policy.

What is family floater facility?

Entire family covers under single sum insured and can be used by any of the family member or all the members.

What is ambulance charge?

Requirement of ambulance to admit into a hospital will be paid by insurance company.

What is room rent capping

A maximum limit of hospital room rent per day.

What is other effects if room rent limit is lesser?

Insured have to pay a prorate of all expenses- For example, if sum insured is 3 lakh under a health insurance policy room rant limit capping is 1% of the sum insured i.e Rs 3000/- per day. During admission in a hospital if costlier room is selected then all other expenses like doctor charges, nursing charges, operation charges etc. would also be higher and the difference amount will be recovered from you only.

What is Waiting Period?

There are various waiting periods applicable under a health insurance plan, l

• 30 days waiting period:

  First 30 days of newly purchased health insurance does not cover any ailments except accidental hospitalization.

• Two Years waiting period:

  some of the listed ailments got covered only after completion of two years of purchase of new policy without any break.

• Pre-existing waiting period:

  Preexisting disease is not covered under any health insurance policy and it is covered only after continuous completion of two/ three/four years of the health insurance.

Reward or Bonus

Most health insurance policy reward you in the form of bonus for every claim free year. As a bonus, insurance companies either provide an increase in the sum assured or Offer a discount in renewal premium.

What is daily cash benefits?

This is again added on benefit and very limited insurance policies have this cover. This cover provides daily cash to the patient during the hospitalization for their routine expenses.

What is Automatic Restoration?

It is a very good option and all the policy doesn’t have these cover. This cover provides the automatic restoration of your sum insured consumed during the first hospitalization.

Pre-acceptance health checkup requirement

Most of the policies having entry age to buy the insurance policy after a certain age, they ask for a health checkup before providing the health insurance plan. However, some of the insurance companies are providing insurance without any health checkup up the 60 year age.

What is Claim Settlement Ratio?

Claim settlement ratio or CSR is the ratio of the total number of claim settled by your health insurance company divided by the total number of claims received in the same duration of time or year. So if a company has high CSR, it means it is more likely or hassle-free to settle a claim for you.

What is Free-look Period?

The Policy allows you a period of 15 days from the date of receipt, to review the term and conditions, and to return the same if not acceptable.

What is Convalescence Benefit?

In the event of insured hospitalized for a disease/ illness/ injury for a continuous period exceeding 10 days, some Insurance companies will pay a benefit amount of Rs. 5,000 or 10000 per policy year. This benefit will be triggered provided that the hospitalization claim is accepted under the In-Patient Hospitalization Treatment Cover.

This benefit will be applied annually for policies with a term of more than 1 year.

What is Medical Second Opinion?

The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company's network of Medical Practitioners. All medical records that were provided by the insured are submitted to the Doctor chosen by him/her online and also the medical opinion is directly available to the Insured person by the Doctor.

What is Incurred Claim Ratio?

Incurred Claim Ratio is the total amount of all claims received by the health insurance company divided by the total amount of premium collected in the same duration of time. High incurred claim ratio of a company indicates that they are more likely to accept new customers. Also, it also results in the lesser waiting period for the pre-existing illnesses and other such diseases, in your health insurance plans.

What is Premium Amount?

Within a single health insurance plan, you can have multiple variants wherein your premium cost would be different depending on the sum assured and age. Therefore, you need to know what are the benefits that you are eligible to receive for the amount of premium you have paid.

What is Sum insured?

Is the maximum value for a year that your Insurance Company can pay in case you are hospitalized. Any amount above the sum insured will be bear by you.

What is online purchase?

Most people can buy a health insurance policy online these days. You can compare policy online and select the best and save time. So insurers should ensure the website remains easy to navigate and use so that policy purchase remains simple.

What is the grace period for renewal of health policy?

As per IRDA guidelines, a 30-day grace period is allowed for renewal of Individual Health policies, all continuity benefits are maintained if the policy is renewed within 30 day from expiry of the earlier insurance. Claim, if any, during the break period will not be considered.

What is free health checkup facility?

On continue renewal of a health insurance policy for two/ three/ four years, depend upon the insurance company & product, the insurer provide the facility for defined free health check up of the covered members.

What is day care treatment?

Day care treatments are listed under a health insurance policy where 24 hours hospitalization is not required.

What is Co-Payment?

Cost sharing of a specified percentage between insured & insurance company, payable to hospital for a treatment. A co-payment does not reduce the Sum Insured.

What is ICU Charges?

ICU (Intensive Care Unit) Charges are also predefined under a health insurance policy which are normally double the room rant.

Is OPD treatment covered under the policy?

Most of the health insurance policies don’t cover OPD treatment.

What is Network hospitals?

Hospitals empaneled by an insurer, TPA or jointly where cash less facility is available.

What is AYUSH treatment? Is it covered under Health Policy

Non allopathic treatments like “Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy AYUSH treatments. Most of the health insurance policies are not having these coverage. However, because of Government focus, it may be considered in coming days.

Is Dental Treatment covered

No, but due to accident damage to the dentals is covered.

What is critical illness health insurance policy?

Critical health insurance policy is indemnity-based policy where upon diagnostic of the listed critical illness, the total sum insured is reimbursed. There is no requirement for any treatment to get the claim.

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

Critical disease are covered under normal health insurance policy while in critical illness policy, normal disease are not covered.

What is Top Up health insurance and how does it works?

This policy is given to enhance the sum insured of base/ normal policy and it is operated only when entire sum insured of base policy is exhausted in a single hospitalization.

What is super top up?

A super top-up plan applicable when the hospitalization expenses exceed the sum insured of base policy in a single or in various hospitalization during the policy period.