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Questions Related to Health Insurance by Mr Datta from ICICI Lombard

Health Insurance has become the necessity of today. The unhealthy lifestyle of today’s youth- junk foods, late night parties, drinks and the chaos of the fast pace life of our societies is the mother of an unpredictable life in terms of health. On the other hand, Healthcare cost in India is increasing rapidly day by day. According to latest NSSO survey, average hospitalization costs in India has gone 10.7% higher in last 10 years. Investing in a Health insurance insures that one gets proper medication and treatment without the fear of sudden need of money.

Source- http://www.orangecountyinsurancebroker.com/
Source- http://www.orangecountyinsurancebroker.com/

We know that there are many insurance companies with various plans to choose from. This sometimes not just confuses us but also leaves many unanswered questions in our minds.

To help us understand this space better, Mr. Sanjay Datta – Chief, Underwriting and Claims from ICICI Lombard General Insurance has answered some very relevant questions regarding Health Insurance.

There are so many Health insurance companies, How should I chose which Health Insurance company should I go with?

There are different health plans available in market today. We suggest you should go for a comprehensive plan which not only covers inpatient hospitalization cover but also outpatient treatment covers which will cater to all your healthcare needs. Premium should not be the only factor to decide which insurer to go with. Features like out-patient cover, maternity, optional benefits, No claim bonus, free health check-ups and cost sharing features like Co pay, room rent capping and Deductibles should be paid attention to.

In house claim processing vs TPA and claim service efficiency of the insurer are also important factors to consider. Based on this comparison you can narrow down a product that suit your and your family’s health care needs.

Does Health Insurance help me save tax too?

Yes, tax benefit can be availed on premium paid for health insurance cover under section 80D. Currently the limit is Rs. 25,000. For senior citizens and for son/daughter who is paying premium for senior citizen parents, this 80D limit is Rs.30,000.

Should I consider a Health Insurance plan which comes along with Life Insurance or Mediclaim policies?

Health insurance policies offered by General insurance companies & by Life insurance companies are similar in basic concept that these cover hospitalization expenses. The products differ from one insurer to other in terms of various in-built covers like out-patient cover, hospital daily cash etc. Generally health policies marketed by general insurers have various in built add on covers like outpatient cover, emergency ambulance cover etc. which make the product more comprehensive. As explained earlier, you should choose a plan considering policy features and insurer’s efficiency and select a plan which suits your & your family’s health needs.

If I get delayed to pay the premium and something happens to me, Am I still eligible for the offers a health insurance gives? Keeping in mind, I have always paid my premiums on time!! 

A claim is considered if the policy is in force at the time hospitalization occurs. In case of delay in paying the premium beyond the grace period, the policy expires. Even during the grace period only continuity benefit is applicable, cover is not provided. So it’s most prudent to renew your policy in time.

If something happens to the one who has got his health insurance done, Will the health insurance still cover the hospital bills and ambulance charges?? (In case of death of the insurer)

In case of death of the insured following a hospitalization event, the health insurance still covers the hospital bills and ambulance charges as per the terms & conditions of the policy. Claim is paid to the nominee/ legal heir of the insured in such case.

What is the right age to get health Insurance?

It’s always prudent to buy a health insurance cover at an early age. Health exigencies can happen anytime- it may affect young people as well, so it is better to have a health plan to meet medical expenses arising out of such emergency. As age increases, the probability of contracting conditions like diabetes and hypertension may increase. This would make it difficult to buy a medical plan at that time given the sub optimal health condition. It is correctly said that “Buy health insurance when you don’t need it, because you may not get it when you want it.”

I am already 35, should I go for health insurance/ Am I late for health insurance?

You must go for a health insurance plan. If you do not have a health condition, you may get the health policy even without pre-policy medical checkup. Most insurers do not insist for a medical checkup up to a certain sum insured for customers below 45 years of age.

Policy agents sometimes lie just to sell policies, how to cross check?

You can check the details of the health plan on the website of the insurer. Alternatively you can go through the policy wordings carefully after you have bought the policy. Insurers give 15 days’ free look up period wherein if customer is not satisfied with the policy terms & conditions, he/she may cancel the policy within this period. If availed for cancellation within free look up period, the whole premium is refunded except the cost of pre-policy medical expenses, if any.

If you are buying a health policy through an agent and if agent is filling the proposal form on your behalf, make sure to check all the details especially pre existing ailment details before signing the form. In cases that information on your policy certificate that you receive from your insurer is missing or incorrect, do contact your insurer immediately for rectification.

Will my health insurance policy cover the medications I am taking right now?

If you are taking medication, the health condition will be considered as Pre-existing disease (PED) and will be covered only after PED waiting period, as applicable in the health policy you bought, has been completed. Medication expenses without hospitalization will be covered only if your health policy covers the out-patient expenses.

There are few random blood tests we recommend ourselves like CBC, Random Blood Sugar etc, does a health insurance cover medical expenses which are not prescribed by a doctor?

Such preventive health care checkups will be covered if your health policy covers the out-patient expenses, but doctor’s prescription is required. Most health insurance cover come with Complimentary health check up benefit under which such specified tests are covered once a year if undergone at insurer’s network diagnostic centres. Some plans offer it only if the policy was claim free during the policy year whereas some plans offer it irrespective of claim status.

Do I need to go to specific doctors/hospitals, or all the doctors and hospitals are covered in health insurance policies?

You can choose any hospital/ doctors as long as these are qualified as defined by IRDA. If you choose a hospital which comes under the network of your insurer, you can avail cashless services. Else you can claim for reimbursement. Few hospitals may be put into cautious list by the insurer due to some fraudulent activities. Claim is not payable for treatment at such hospitals. The list of such hospitals is available on insurer’s website, you can also check with the customer care of the insurer to know the same.

How many times can I claim about medical expenses through a health insurance?

You can claim any number of times however the total hospitalization claim payable under your health plan is maximum up to the Sum insured of your plan. The amount payable under any other feature/ add on covers like hospital daily cash is generally over & above this Sum insured. Go through your policy or check with your insurer to understand the same.

Does a Health Insurance cover maternity?

Some of the health plans available in market today cover maternity expenses as well. Waiting periods, limit of cover and eligibility may differ from one policy to the other.

How many of these do a health insurance plan cover?

  • Emergency services
  • Hospitalization and post hospitalization care
  • Pathology tests
  • Maternity and newborn
  • Mental Health
  • Dental/ Vision
  • Prescribed medicines
  • Preventive Services (Immunization, Mammogram)
  • Management of chronic diseases (Thyroid, Diabetes, Blood Pressure etc)
  • Homeopathy/ Ayurvedic/ Naturopathy expenses
  • Rehabilitation

Except for mental health, which is part of exclusion; all the above covers are available in the market. Some health plans may cover them all; others may cover a few out of these. Some health plan cover these expenses only if occurred along with hospitalization; some health plans cover these expenses as out-patient cover as well.

A check list before finalizing Health Insurance plan

  • Choose the health insurance plan that covers your PED (Pre-existing diseases) with minimum waiting time.
  • Choose the health insurance plan that helps you manage chronic diseases
  • Choose the health insurance plan that covers out patient expenses
  • Never blindly trust your Insurance Agent, Note down the details and confirm them from the company directly. Read the Insurance plan contract thoroughly before signing it.
  • Never hesitate to clarify your doubts regarding the health insurance plan.
  • Always choose a company whom you can trust. Some Insurance companies may have lucrative plans but the best companies have a good record when it comes to claim approvals.

I hope this article gave you a good insight about health insurance. We tried to answer the most asked Health Insurance questions, but we might have missed the question you wanted to ask. Feel free to post your question below or at payal@trendsnhealth.com. Mr. Sanjay Datta– Chief, Underwriting and claims – ICICI Lombard General Insurance would be happy to answer them as well.

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