FAQ

Every individual must buy a health insurance policy for all the members of his/her family, according to need and capacity. Subscribing to Medical insurance will cover you from sudden and unexpected cost of hospitalisation, and other serious health issues, like critical illness. Not having a health insurance policy could hugely impact your income and household savings, and may even land you in debts. 
All of us are exposed to different types of health hazards. Medical emergencies are known to strike sans any warning. Healthcare, at the same time, has become increasingly expensive. New procedures, technological development, and better medicines have triggered a rise in the cost of healthcare. These expenses are beyond the reach of most of us, and buying a health insurance policy is much more affordable, to pay off the medical bills.

These days, most insurers have arrangements with various hospitals spread across the country as part of a network. An individual, if insured under a policy which offers cashless facility, can get treated in any hospital of the network without paying hospital bills because the same is paid directly by the 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 insured 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 reimbursement basis.

Section 80D: Deduction for premium paid for Medical Insurance

Deduction is available up to Rs. 25,000/- to a taxpayer for insurance of self, spouse and dependent children. If individual or spouse is more than 60 years old the deduction available is Rs 30,000. An additional deduction for insurance of parents (father or mother or both) is available to the extent of Rs. 25,000/– if less than 60 years old and Rs 30,000 if parents are more than 60 years old.

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 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, 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 hospitalisation), 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 hospitalisation, 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 hospitalisation charges. But this is not applicable in case of an emergency hospitalisation arising out of an accident. The waiting period is not applicable for renewal of the policy for subsequent years.

Domiciliary hospitalization means medical treatment for a period over three days for such illness / injury / disease in which person needs treatment and care both at a hospital or nursing home but actually taken whilst confined at home in India under any of the following circumstances: Patient is not in a position to take him to the hospital or nursing home OR Patient cannot be moved to nursing home or hospital due to lack of accommodation therein.

A hospital which has a contract with the insurance company for offering cashless treatment facility is called as a ‘Network Hospital’. This facility is offered only at the network hospitals. On the other hand, non-network hospitals are those with whom insurer do not have any contract and any insured person seeking medical help in such hospitals will have to pay for his medical treatments and later claim according to the reimbursement process.