Health Insurance

Even about a decade back, mediclaim companies were unwilling to extend cover to the aged and senior citizens. But of late, several insurance companies are providing health insurance plans for parents. Insurance cover paid to an individual aged 65 years or above can lead to an additional tax relief of up to Rs 20,000. But remember that premium payable for senior citizens is much higher. If you are employed and have a mediclaim cover from your employers, approach your HR manager and negotiate with the insurance company to provide an additional cover for your parents. The insurer may provide the cover at an attractive premium because the volume will be high.

Top 5 Senior Citizen Health Insurance Plans

To define the cost of mediclaim, the cost of the same depends upon the sum assured, health history, current health conditions, age of the customer, and many other things. If you are looking for a higher sum assured, then you must have to pay a higher premium as well. What should be the ideal health cover is like a question for many, but the answer is there within your needs. An ideal health plan will be the one which can provide the needful health cover to you on-time.

In India, offering health insurance plans to its employees has already become a trend, and almost every company is doing the same to motivate its employees and to make them feel secure.

The best health insurance for you is something that can go well with your needs. While buying a health insurance plan, there are a few things that you should keep in mind such as

The best health insurance for you is something that can go well with your needs. While buying a health insurance plan, there are a few things that you should keep in mind such as

Understand Your Policy

Before taking any final decision, it is important for you to understand what it would cover and what would not. Check what it offers exactly. Look for all the coverage options against pre-existing illness, accident-related expenses, day care procedures, and maternity expenses. Then, go for a plan which is enough for you and your family.

Check Exclusions

Normally people look for features and benefits, they forget that exclusions play a much more important role as it helps you in getting a clear image of where your insurance policy wouldn't support you. You can easily get the same on your policy's documents. But people normally avoid reading it, but you should read it thoroughly. Exclusions vary from insurer to insurer and plan to plan. Some of the popular exclusions are:

• Dental services
• Pregnancy
• Cosmetic surgeries
• Injuries caused by war, terrorism, commotion, protest, or strike
• Joint replacement surgery
• Homeopathy
• Ayurveda
• Injuries caused when under the influence of any drug/alcohol

Think About Co-Pay

While you are searching for a health insurance plan, you will often get the option of Co-pay. You have to decide whether you need it or not. For this, first you have to understand what co-pay is? At the time of filing claims, if you have opted for a co-pay then you have to pay a pre-agreed percentage of the claim and the insurer will take care of the remaining.

You should keep in mind that the sum assured amount under the plan will not be affected by co-payments. So, before taking a final decision, make sure that you need it or not.

Premium Payment Frequency

You have to renew your policy regularly to keep it active. You will get the option of paying the premium either monthly/quarterly/semi-annually/annually. However, before taking a final decision, check that you will be able to pay the premiums and renew the policy on time.

Claim Settlement Ratio

It is one of the most important things that you should look for. If you check the report online, then you would come to know that the claim settlement ratio of many insurance companies have gone up in the last few years.

Portability Option

It is normal that sometimes we are not happy with the current insurer and want to switch to another insurance company. In such cases, you can take advantage of the portability option. The policyholder will be allowed to switch insurer, and the best thing is that he/she does not have to compromise with the waiting period or any other features and benefits which were available with the existing insurer.

Lifelong Renewability

Check for this benefit while you are buying a new health insurance plan or changing the existing one. It is normal that people look for a plan that offers protection for the long term, especially when it comes to old age. That's why the health insurance companies start offering lifelong renewability option.

No Claim Bonus (NCB)

NCB or no claim bonus is the percentage of discount that the policyholder receives on completion of every claimless year. It motivates people not to make petty claims. Insurance companies offer this as a discount on the premium, or the policyholder may choose to increase sum assured amount at the time of renewal. At the time of buying a policy, look for the no claim bonus option and percentage that the company offers.

Restoration Option

Look for this feature to get most of your health insurance plan. To offer optimum use of sum assured, insurance companies these days offer sum assured restoration benefit. Under a plan with restoration option, once the sum assured amount is completely used, it gets automatically restored without paying the additional cost. Health insurance plans with restoration benefits are more expensive than regular health insurance policies.

There is no doubt in saying that choosing the right insurance company for your health insurance needs is a daunting task. Today, all internet facilities and several options of health insurance plans have made it easy for a person to buy the same in a few seconds, but this doesn't mean that you should become an impatient buyer.

Just because of our busy schedule and the long list of terms and conditions, we should not skip the same in a rush to make a decision. But, we are making a mistake while buying a health insurance plan. One of the common mistakes that people usually do and you should avoid are as follows:-

Insufficient coverage

Don't go for insufficient cover just because of the low premium; it will not be able to provide the desired coverage in the hour of need.

The cost that people pay towards his/her health insurance plays a vital role in deciding which policy you should go for. Hence, just because of saving an amount, people end up in choosing a plan with less coverage, or you can say insufficient coverage. It is true that cost plays an important role in choosing a health insurance plan, but it should not be the only element that you are looking for.

Avoiding the fine print

While many of the individuals are aware of different treatment and expenses that will get the needful cover under your health insurance policy. There is no doubt in saying that having an idea about the coverage area of your health insurance plan, but you should not skip the exclusions part of the same. It is equally as important as knowing the coverage part.

Don't rely on a single insurer or plan

Don't go with the first insurer that you got. While buying, or renewing the existing health insurance plan, it is vital for you to understand that comparison of several plans will help you in getting the best and most suited plan which can easily go well with your needs.

If you get something better than your existing health insurance plan, then you should switch the insurer without any hesitation. Many companies are offering exciting health insurance plans to remain at the top and to attract consumers from time to time. Just take advantage of the same and get yourself enrolled in the most suited plan according to your needs and budget.

Hiding medical history

This is the most common mistake that people usually do, and this becomes the biggest reason behind the rejection of health insurance claims by the insurer. While looking for a health insurance plan it is very important to be transparent about your medical history, don't hide anything and let your insurer know about all your medical problems in advance.

Not choosing co-pay wisely

If you do not choose co-pay wisely, then you may end up in the wrong situation at the time of claim. There can be a chance of rejection; you might have to pay a big amount from your pocket, not able to get the required coverage and several others.

Buying Over

There is no need of buying many additional riders if you don't need it. Purchasing too many extra riders will only lead you towards the stage of over policyholder. Spend a few minutes on understanding your needs first, write it down, and then go for a plan that can easily go well with your needs. Make sure you are not over-policyholder.

Delay in Buying

If you delay in buying health insurance, then you might have to pay a high premium, not liable of wider cover, and much more. Moreover, what will you do if you fall ill with serious health diseases before buying it? Invest in health insurance as soon as you can. The older you get, the less will be the options to explore as not all insurance companies will be ready to entertain you.

Rely on Insurance Offered by Employer

Don't rely on the employer's health insurance for a comprehensive cover. It would not be sufficient enough to get the required treatment on time. There is a possibility that you might be getting health insurance coverage by your employer, but it is not necessary that it would be sufficient for you as it is not customized as per your needs. You should also keep in mind that the health insurance coverage that you must be getting from your employer will stop once you changed the company. It is always necessary to opt for a supplemental health insurance plan that would be enough for you. You can also use your employer's health insurance plan to make a claim and enjoy a no-claim bonus on your health insurance plan.

Here are some of the important terms that you will come across while subscribing to a health insurance policy.

Sum Assured

The sum assured, in simple terms, is the maximum coverage amount you get with your insurance policy. It forms the basis of all your claims. Consider the increasing costs of hospitalization, medicines, and treatment before you decide on your sum assured. It's advisable to select a higher cover. At the same time, the cover shouldn't be high enough for you to dig into your pockets for paying the premium.

Co-pay and Sub-Limits

Co-pay is a fixed amount paid by a patient to the provider of service before receiving the service. Some health insurance companies have introduced the co-pay and sub-limit system to prevent hospitals from billing unreasonable room rents to patients. In a co-pay policy, you need to pay a part of the expenses irrespective of the sum assured. For instance, if a policy has 10% co-pay, then the insurance company will pay 90% of the expenses, and you have to bear the rest.

Besides, some insurers cap the expenses of treatments to reduce the claims of hospitals. This is known as sub-limit. While buying a mediclaim, choose a policy which has fewer sub-limits. Some mediclaim policies have no co-pay or sub-limits. Try to select such a plan.

Critical Illness

Critical illness refers to life-threatening diseases. There is a long list that comes under this section such as heart attack, kidney failure, cancer, and many more.

Restore Benefit

The restore benefit refers to a feature of the plan that reinstates your basic sum assured if you have already exhausted the same as well as the multiplier benefit within your policy year. But in most cases, the benefit is not available on the same illness if the limit is already used up.

But a restoration benefit can be useful if you have subscribed to a family floater plan where the full sum assured is exhausted for treating only a single family member. The remaining members will have no cover to fall back upon in case of hospitalization for the rest of the policy year.

No Claims Bonus (NCB)

No Claim Bonus, as the name suggests, is the insurance company's reward to the policyholder for not claiming in the preceding years.

Insurers usually extend an NCB to a policyholder if there has been no claim in the preceding year. While buying a mediclaim, check the NCB amount before signing on the dotted lines. NCBs can range from 5% to even 100% of the sum assured. A high NCB gives cover against medical inflation, and you don't need to worry about increasing your coverage year-on-year.

Pre-existing illness, Waiting Period

Pre-existing diseases refers to those diseases that you have before subscribing to the mediclaim policy. Most health insurance companies specify a waiting period for these illnesses. If you have a pre-existing illness, the insurance company is unlikely to give a cover against the same. In most cases, a pre-existing illness is covered after at least two years of buying the policy.

Exclusions

It simply means the diseases that are not covered under the mediclaim. For instance, if you have diabetes while taking the policy, then kidney ailments are likely to be excluded from cover if the same happens because of diabetes. Never hide any pre-existing ailments from your insurer while buying a mediclaim policy. It may reduce your hospitalization claims.

Top up Plans

Top-up health policy is additional coverage for people who have an existing individual plan or a mediclaim from the employer.

Medical costs are increasing. It calls for large covers. But not all can afford a high premium. A top-up plan is useful in such a case. It reduces the cost of deductibles i.e., the amount you pay before the insurance company pays up. The insurance company will only pay up to the sum assured. A top-up plan, on the other hand, doesn't pay until the hospital bill breaches a specific limit.

Suppose, if the hospital bill is Rs. 8 lakhs with Rs 3 lakhs as deductible, you need to pay the latter, while the insurer pays the balance Rs 5 lakhs. But you can use your individual/group policy to pay the deductible amount. This is usually helpful because a combination of a basic mediclaim plan along with a top-up plan is much cheaper than a single cover. For instance, the premium for a Rs 5 lakhs regular cover for a 26-year old male, will be around Rs 6,500. A top up with Rs 15 lakh cover will entail an additional premium of Rs 5,000, which is far cheaper than a standalone policy of identical amount.

Usually, we have seen that many policyholders look for better coverage or better insurance company for various reasons. Sometimes they are not happy with the current insurance company, sometimes, the plan doesn't look sufficient enough; sometimes the needs are more, affordability can be an issue or else attractive towards any other health insurance plan can be one of the reasons behind the change. Almost all health insurance companies do allow you to change the insurer and plan at the time of renewal. Yes, at the time of renewal you can opt for any other insurance plan provided by any other insurance company, and this is known as health insurance portability.

Health Insurance portability is a simple format under which the insured is free to change the insurance company and the plan. With the same he/she doesn't have to compromise with the existing benefits, waiting period, and bonus. He/she can carry the same with the new insurance company as well. It seems to be an effective procedure which is helping millions of people daily in getting sufficient health insurance plan, or you can say a more comprehensive cover at affordable premiums. There are many ways to porting your health insurance plan, but the online health insurance comparison seems to be the best when. The reason behind the same is that

• You will get free insurance quotes from top insurance companies.
• Multiple options to choose from.
• Can compare easily from a single page.
• Comparison can be made on the basis of features, benefits, price, coverage and many more are there in the list.
• Can buy directly from the page in a few minutes.
• Less documentation & Hassle free process.

Pros & Cons of Portability

"Porting has never been so easy before"

There is a term called TPAs, and most people are aware of it but they don't know how it got settled. Once a mediclaim policy is sold, the TPA takes up the baton from the insurance company. Some companies offer direct claim settlement process, and some take help of TPAs For claims settlement. Broadly the claim settlement process takes place in two forms which are mentioned below:

Broadly the claim settlement process takes place in two forms which are mentioned below

Cashless

You can avail cashless treatment facilities only in the networked hospitals of the insurance company. The TPA must be notified beforehand in case of planned hospitalization, or within a specified timeframe in case of an emergency. The hospital's insurance desk helps with all the paperwork. The TPA has to approve the mediclaim amount, and the hospital will settle it with the insurer. There are likely to be exclusions i.e., expenses that the TPA won't pay. Such expenses must be settled by the patient party directly at the hospital cash counter.

Reimbursement

The insurer can avail the reimbursement facility both at networked and non-networked hospitals. Here, you can avail treatment facilities and settle the bill directly with the hospital. You can then claim reimbursement of the expenses from the TPA by submitting the relevant bills and receipts.

Steps to Follow- Cashless

• Inform the insurance provider on a call or through email.
• Show the health card as provided by your health insurance company along with the identity proof.
• The hospital will examine the identity of the policyholder and will submit the pre-authorization form to the health insurance company.
• The insurance company will examine all documents, and if everything is fine according to their norms, then it will process the claim.
• A few health insurance companies provide a field doctor to help you with the whole procedure.
• After the completion of all formalities, the claim is settled as per rules of the company

Steps to Follow- Reimbursement

• Inform the insurance company about your hospitalization as soon as possible
• Keep all your documents ready with the bills of hospitals.
• Submit the documents along with the claim forms. Don't forget to attach bills of hospitals.
• The insurance company will check all the submitted documents and process the claim according to the terms and conditions of the health insurance policy.
• After the completion of all formalities, the claim is settled as per the terms and conditions of the policy.

Did you know that apart from the basic medical cover, a health insurance plan provide several additional benefits and tax benefits? PolicyX.com is here to make you understand the important benefit of buying a health insurance policy. Below are a few circumstances to understand how you can get tax benefits with health insurance.

No one over 60 years

In a case where no one in the family is over 60, the deduction is up to Rs 25,000. For health insurance paid for parents below 60, the deduction is up to Rs 25,000. Hence, total deduction a person can avail is up to Rs 50,000.

Either parent over 60 years

In case where one of the parents is over 60, the tax benefit of up to Rs 50,000 is allowed. Also, if a person pays a premium for family-self, spouse and children enjoys Rs 25,000 as a tax deduction. This means on a total; a person can avail tax benefits up to Rs 75,000 in a year.

Eldest member in the family over 60 years

Where a family member (self, spouse, or children) is over 60, one can claim up to Rs 50,000 in tax benefit on medical insurance. Additionally, for parents over 60, a person can get up to Rs 50,000 as a tax benefit. So, the total deduction, in this case, would be around Rs 1 lakh a year.

Proof of Age: Acceptable documents are Birth Certificate, PAN Card, Voter's ID, Driving License, Passport, School or College Certificate, etc.

Photo Identity Proof: Aadhaar Card, PAN Card, Driving License, Passport, Voter's ID, etc.

Proof of Address: Acceptable documents are Ration Card, Telephone Bill, Electricity Bill, Passport, Voter's ID, Bank A/C Statement, etc.

Proof of Income: Salary Slip, Employer's Certificate, Form 16, etc.

Medical Checkup: If asked by the insurance company.

Passport Size Photograph.

The Insurance Regulatory and Development Authority of India (IRDAI) has made it mandatory for all policyholders to link their Aadhar and PAN/Form 60 with their insurance policies. According to the mandate issued by IRDAI, insurance companies are now mandated to collect Aadhar and PAN/Form 60 details from their customers before issuing a policy.

The mandate also comes with a warning that all medical insurance insurance policies will cease to be operational if the required details are not submitted. It must be noted that the policies will not become void if a customer does not have Aadhar and PAN/Form 60 details. All claims during this period will be kept under abeyance, or temporary suspension, till the Aadhar details are provided to the insurer. All rules related to the submission of Aadhar and PAN/Form 60 details are framed under the Prevention of Money Laundering Act of 2002.

The government of India is focusing on increasing healthcare awareness, and thus for the same, it came out with several new plans for the people of the country. They are designed to improve the healthcare access for the unorganized sectors and for those who come under the Below Poverty Line (BPL) category. Here is a list of health insurance schemes provided by the government:

Ayushman Bharat

One of the most effective National Health Protection Scheme, which is offering the required health cover to almost 10 crore poor and vulnerable families. It is designed in a way that can offer required cover to around 50 crore beneficiaries. A cover of about 5 lakh rupees per family per year for secondary and tertiary care hospitalization will be there. This effective health program will subsume the current centrally sponsored schemes - Rashtriya Swasthya Bima Yojana (RSBY) and the Senior Citizen Health Insurance Scheme (SCHIS).

Rashtriya Swasthya Bima Yojana (RSBY)

The Ministry of Labour and Employment introduced a new health protection scheme to provide the helpful cover to offer the needful health insurance coverage, especially for BPL families. With this effective healthcare plan, all beneficiaries can avail hospitalization whenever it requires up to Rs 30,000. To enroll under this effective health insurance plan, there is no specific age limit, and you will be liable to get the cover of pre-existing diseases from day 1 of the policy. It can cover up to 5 members of the family includes spouse, children, and dependents. Beneficiaries have to pay only Rs.30 as registration fee. The central and state government to the insurance company will take care of the rest unpaid premium.

Pradhan Mantri Suraksha Bima Yojana

The universal fact is that accidents are unfortunate incidents which can happen at any place, anytime to anyone. It does not discriminate against people on the basis of rich and poor. In such a scenario, the one who suffers the most is the poor section of the society, who are unable to afford an effective and adequate health insurance policy. To provide the needful assistance to the poor section, the government has come out with this effective health insurance plan called Pradhan Mantri Suraksha Bima Yojana. It offers wider cover at affordable premiums and provides compensation to the family of the deceased or if the policyholder has been disabled partially or permanently following an accident.

Central Government Health Scheme (CGHS)

It was introduced a long time back ago, and since its inception, it is providing great assistance. It is now available in CGHS covered cities like Allahabad, Bhopal, Chandigarh, Ahmedabad, Lucknow, etc. The plan is designed to cover central government employees and pensioners. Under the same, the dependant's member of the government employee would also be able to reap the benefits of this plan. The insurance policy provides coverage against domiciliary care, specialist consultation facilities, laboratory tests, hospitalization, and health education to beneficiaries.

Aam Aadmi Bima Yojana (AABY)

A social security scheme launched in October 2017 intending to provide required healthcare facilities to all the rural and landless households. The head of the household or the earning member of the family will be covered under the scheme. The central and state government will pay a premium of Rs 200 per year is paid by the central and state government. The beneficiary should be between 18 to 59 years of age. With the same beneficiary will receive Rs 30,000 upon the natural death of the policyholder member, Rs 75,000 upon accidental death or permanent disability, and Rs 37,500 on partial permanent disability.

Janashree Bima Yojana (JBY)

This insurance policy was launched in 2000 on 10th August after replacing the Social Security Group Insurance Scheme (SSGIS) and Rural Group Life Insurance Scheme (RGLIS). This policy is specially designed for those people who come under the BPL category and slightly above the BPL category in 45 occupational groups covered under the scheme. Some of the occupations that would be liable to get the cover are beedi workers, carpenters, power loom workers, cobblers, handicraft artisan, agriculturists, construction workers, etc. Aam Admi Bima Yojana and Janashree Bima Yojana have been merged into one scheme and called as Aam Admi Bima Yojana since 2013.

Employment State Insurance Scheme (ESIS)

Again a social security scheme that is designed especially to offer the socio-economic protection to the working class and their dependents. The policyholder and his family who will receive complete medical care from day one. Under the policy, the beneficiary will receive cash benefits in times of sickness and temporary or permanent disablement that leads to the loss of earning capacity. This policy will also be covered by the policyholder's dependents as if the dependant is disabled on the job, a monthly pension called the dependents' benefit is provided under the ESI scheme. The scheme applies to non-seasonal factories, theatres, shops, restaurants, hotels, road motor transport undertakings, and newspaper establishments employing more than 20 people. Recently, private medical and educational institutions employing more than 20 people in certain states and union territories have also been included under the scheme.

Universal Health Insurance Scheme (UHIS)

A new health insurance plan that is py-1 font-15 specially designed to provide needful healthcare services to a wide area of the country and to cover poor section effectively. Under this plan, beneficiaries will receive reimbursement for medical expenses up to Rs 30,000 and accidental death cover up to Rs 25,000. This policy is there for the BPL families only. The insurance premium for this scheme is Rs 200 per person, Rs 300 for a family of 5, and Rs 400 for a family of 7. The four public sector/government health insurance companies in India are The New India Assurance Co. Ltd. United India Insurance Company, National Insurance Co. Ltd. and Oriental Insurance.

Before buying health insurance, we are sure you must be having a lot many questions in your mind. Do not worry PolicyX.com is here to help you figure out the best insurance policy for you.

1. What is cashless mediclaim?

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.

2. What are the tax benefits of health insurance?

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.

3. What factors affect the premium payable for a health insurance policy?

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.

4. What are the things not covered under a health insurance policy?

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.

5. What about the waiting period?

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.

6. What is a pre-existing condition?

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.

7. If I don't renew my policy before the expiry date, can I be denied renewal?

The policy can be renewed if you pay your premium 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.

8. Is my health insurance policy transferable, without losing renewal benefits?

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.

9. What happens to the coverage amount when a claim is filed?

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

10. What about "anyone illness"?

This means a continued period of illness and includes relapse within a specified number of days, subject to the terms and conditions are written in the policy. It's usually for 45 days.

11. How many claims are allowed in a year?

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

12. What is a family floater?

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.

13. How insurance helps in health check-up facility?

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

14. Which health insurance plans are available for women?

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.

15. How does smoking affect health insurance premiums?

Smoking has an adverse effect to 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.

16. What if I forgot to pay my health insurance premiums?

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.

17. What is GST and how does it impact health insurance?

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.