Health Insurance

Yes, there's no limit to the number of claims in a single year unless there is a specific cap laid down in the policy. The sum insured, however, is the maximum claimable limit under the mediclaim policy.

According to statistics, Rs 5 lakh family floater policy will cover self, spouse and one child will cost anywhere between Rs 10,000 and Rs 17,000 on an annual basis whereas Rs. 5 lakh individual health plan will cost a 35 year old Rs. 4,000-7,000 a year.

The difference between a mediclaim and health insurance policy is all about the coverage provided. Mediclaim is confined to hospitalization expenses and domiciliary care costs whereas health insurance provides full protection against the treatment, hospitalization, surgery expenses.

Therefore, health insurance is a better decision to secure your and your loved ones' future.

During Emergency Hospitalization you can claim for cashless treatment in the following ways:

• Show your health insurance card in the hospital, containing policy number, insurance company name and the type of insurance policy.
• Fill in the pre-approval form after which the person at the insurance desk will speed up your claim process.

A health insurance plan is for the future security and a smart investment financial plan. If you buy it early premiums will be low and can cover the diseases coming up in life. It is an absolute necessary and important but not mandatory plan in India.

As we have discussed above, it is important to buy health insurance at an early stage of life. If you are 25 years of age you should buy a health insurance plan to safeguard your health from future medical expenses.

Yes, it is possible to utilize your health insurance immediately after all the paperwork and documentation is done from the insurance company's end along with the payments. However, most companies offer the facilities after a certain waiting period.

Yes, every insurance company has a network of hospitals in which cashless treatment facilities are available to the policyholders.

It varies from insurer to insurer, most of the companies do not provide cover for pre-existing diseases but on the other hand, many companies cover the same after a waiting period of 4 years.

The policy can be renewed later if you pay your premium on time or within the grace period, which is usually 15 days from the date of expiry of the policy for most insurance companies. However, you will not be entitled to any coverage for the period during which the insurance company did not receive any premium. Also, the policy would lapse if the premium is not paid within the grace period.

Yes, according to a circular issued by the Insurance Regulatory and Development Authority (IRDA), with effect from 1 October, 2011, the insured can transfer a policy from one insurer to another, and also from one plan to another. The insured will lose no renewal credit for pre-existing health conditions which he/she enjoyed in the incumbent policy. But the credit would be limited to the sum insured and the bonus eligible under the present policy. Check with your insurance company for the detailed clauses in this regard.

Some insurance companies reimburse general health checkup expenses usually once every 4 years.

Smoking has an adverse effect on health insurance premiums. This means that if you are a smoker, you end up paying higher premiums as you are subjected to greater medical risks.

In case you forget to pay your health insurance premiums, the provider gives you a grace period that usually varies from one to three months. However, if you fail to pay the premiums during this time as well, your insurance policy lapses and you are no longer entitled to the health insurance benefits of the policy.

Yes, health insurance provides cover to diabetes patients and related complications. However, it may vary from insurer to insurer, most of the companies provide the same after a waiting period of 4 years.

Yes, health insurance covers the medical tests and scans for the inpatient treatment, i.e., during hospitalization for at least 24 hours. For outpatient treatment, out of the hospital cover for the same is not applicable.

A waiting period of 48 months is applicable to avail the maternity insurance benefits and cover. A cover of Rs. 25,000 in caesarean delivery and Rs. 15,000 is provided usually from a maternity health insurance plan.

These days, most insurers have arrangements with various hospitals spread across the country as part of a network. An individual, if policyholder under a policy which offers the cashless facility, can get treated in any hospital of the network without paying hospital bills because the same is paid directly by a third party administrator (TPA), on behalf of the insurer. However, all expenses beyond the sum insured or the ones not covered under the policy, have to be paid by the policyholder directly to the hospital. Cashless facility is not available if the hospital is not included in the network. In such cases, payment by the insurance company to the hospital is usually carried out on a reimbursement basis.

You can claim several tax benefits if you subscribe to a health insurance scheme. Such benefits are extended by section 80D of the Income Tax Act. Presently, subscribers to health insurance, who purchased the policy by a payment mode other than cash, are eligible for Rs 15,000 annual deduction from their taxable income for the payment of health insurance premium for self, dependent children, or spouse. The deduction is higher for senior citizens at Rs 20,000. Also, since the 2008-09 financial year, an additional deduction of Rs 15,000 can be claimed for mediclaim premium paid for parents. It's Rs 20,000 if parents are senior citizens.

Age is the biggest factor which determines the premium payable. The older you are, the higher will be your premium, because you'll be more prone to illness. Your medical history is another factor that will go into determining the premium. If you don't have any medical history, the premium would be naturally lower. You are eligible for a discount on the further premium payable for the years for which there has been no claim of the insurance money. Some insurance companies cover add-on benefits like free medical checkups and/or diagnostic tests in case of no claim.

Read the offer document/prospectus and understand it fully before signing on the dotted lines. What's not included will be clearly written in the prospectus. Any pre-existing illness, usually, is not covered under a policy. But read the offer document to understand what the insurer means by pre-existing illness. Also, the majority of the policies generally exclude certain types of diseases in the first year of coverage. A waiting period is also often imposed on such diseases. Some expenses not covered under most health insurance policies include cost of contact lenses, spectacles and hearing aids, dental surgery (unless it requires hospitalization), general debility, convalescence, venereal disease, congenital external defects, use of drugs and alcohol, intentional self-injury, expenses for diagnosis, AIDS, X-ray and/or laboratory tests not connected with the illness requiring hospitalization, treatment related to pregnancy or childbirth, including C-section, naturopathy treatment and others as deemed exclusive by the insurer.

As already said, there is usually a 30-day waiting period when you buy a new policy, starting from the day you enrolled in the health insurance scheme. During this period, the insurance company won't pay any hospitalization charges. But this is not applicable in case of an emergency hospitalization arising out of an accident. The waiting period is not applicable for renewal of the policy for subsequent years.

It's a medical condition or ailment that existed before you took the health insurance policy. This is a significant point in all policies because insurers don't cover such conditions within 48 months prior to taking the first policy. It means a pre-existing condition may be considered for payment, only after the completion of 48 months of continuous insurance cover.

Once an insurance claim is filed and settled, the coverage gets reduced by the amount paid on settlement. For instance, if you take an Rs5 lakh mediclaim policy in January, and in April, the insurance company pays? 3 lakhs towards your hospitalization and treatment, then you will be eligible for the balance Rs 2 lakhs as coverage for the remaining duration i.e., May to December

In a family floater scheme, a single policy covers the hospitalization expenses of the entire family. Such a policy has only one sum insured which can be utilized by a single or all members collectively in the family. The limit of coverage is capped at the sum assured. Family floater plans are considered better than buying a separate health policy for each member of the family. It takes care of all medical expenses, including surgeries, sudden illness, and accidents.

Women of all walks of life are now progressing and trying to maintain the fine balance between their personal and professional commitments. Hence, it is important that their medical needs are catered to. Various health insurance providers have now come up with unique health insurance plans that specifically cater to female medical conditions such as breast cancer, ovarian cancer, cervical cancer, complications during pregnancy, childbirth or other forms of critical illnesses. Some of the top companies that provide these kinds of health insurance plans are TATA AIG, Bajaj Allianz, etc.

Goods and Services Tax (GST) - implemented in 2017 - is an indirect tax levied on the sale of goods and services in India. It has replaced many indirect taxes imposed on goods and services by State and Central Government. Tax slabs under GST have been fixed at 0%, 5%, 12% and 28%.

Before the new tax regime, the service tax rate applicable on health insurance was 15%. However, with the implementation of GST, the tax rate has been raised by 3%- placing health insurance in the 18% tax bracket.