As per the latest report, only 35% of the population of India is covered under the health insurance schemes, including government and corporate health insurance plans. Thanks to the recent pandemic, the awareness of health insurance have increased. In fact, in March 2021, there has been a 41% rise in the health insurance sector, because of the Covid-19 pandemic.
However, if you have not opted for a health insurance plan yet, the best solution would be to list down the questions and get the answers from your insurance company before choosing any policy. It will help you from making mistakes and ending up buying the wrong policy. Here are some important health insurance questions and answers.
1. When can you claim the policy?
Claiming a health insurance plan when needed is the primary reason for opting for the plan, right? So, you surely need to know the different waiting periods during which you will not be allowed to file a claim for the specific treatments.
“In India, the health policy comes with a strict rule of a waiting period to avoid fraud. According to Bhaskar Nerurkar, Health Insurance Claims Head, Bajaj Allianz General Insurance Co. Ltd. said that the top reason for a claim rejection is for waiting period and non-declaration of pre-existing ailments, among others.“
So, you must know the types and time limit of the waiting period in your policy such as:
- An initial waiting period of 30 to 90 days for filing any claim, other than accidental claims
- A disease-specific waiting period of 2 years for filing claims such as cataract operation, gall bladder surgery, hernia, prostate, etc.
- A pre-existing disease waiting period of up to 4 years for ailments existing before the policy inception such as hypertension, diabetes, thyroid, etc.
- A maternity waiting period of up to 4 years for any maternity and childbirth-related claim.
Tip:
The waiting period, the lower the better. So, while choosing any plan, compare the waiting period and select the minimum waiting period to maximize the benefit in a health emergency.
2. What does your policy cover?
It will be the primary question you have to ask your insurer to know what facilities you are paying for. Generally, the plan covers In-patient hospitalization expenses, pre and post-hospitalization, health check-ups, daycare procedures, maternity, ambulance charges, annual health check-ups, wellness benefits, etc.
Many insurance companies provide wellness benefits under the policy where a fitness mentor or coach is assigned to you who will guide you with the right amount of diet, nutrition, healthy tips, etc. without any additional cost such as gym membership, yoga classes, wellness discounts, etc.
Tip: Take the details of the doctors and hospital and use them for your preventive healthcare checkup and other coverage details, so that the claim is hassle-free.
3. What is your room rent cap or other sub-limits? Is there co-pay?
A sub-limit or a room rent cap means the insurance company will reimburse your hospitalisation costs but up to the limit only. The rest of the expenses need to be borne by you.
If you have a sub-limit in your health plan, your out-of-pocket expenses rise, as a significant amount would have to be paid from your own pocket, which would not be payable by the insurance company, unless you get admitted in a room within the specified limit. Every year 7% of India’s population gets pushed into poverty due to high out-of-pocket health care expenses, which mainly constitutes medicines.
Co-pay refers to the percentage of the claim amount that has to be borne by you. For instance, if you choose a 10% co-payment, it means at the time of claim settlement, a maximum of 90% of the claim can be paid by the insurer.
Tip: Try and opt for a plan with no sub-limits or co-pay even if that makes the plan slightly more expensive, so that your out-of-pocket expenses are not high at the time of claim.
4. How does the No Claim Bonus (NCB) work and how does it carry over?
The policyholder is qualified to cumulate the benefit under a no-claim bonus, wherein the sum insured increases by a specific NCB percentage in every claim-free year. The percentage will vary from company to company. For any year, if you do not claim then, the bonus keeps on adding.
Tip: This feature in the health policy helps the policyholder to get additional coverage and get support during medical emergencies to access quality treatments with no worry. So, do ask your provider the percentage and how it will work.
5. What is the claim settlement process?
You will never know when an emergency can arise, so for that, you have to understand the process of claim initiation. You must understand all the relevant processes for filing the claim.
Health insurance claim can be:
- Cashless, i.e. bill directly settled with the hospital
- Reimbursement, i.e. you need to first pay and then get it reimbursed
You can read more about claims here.
Tip: The most important aspect of the claim settlement process is to know about the relevant documents. For cashless claims, the documents are taken care of by the hospital. However, for reimbursement claims, you need to provide all original bills and receipts at the time of claim along with the claim form, insurance card and bank account details.
6. How much will the premium rise?
Premium plays an important role while purchasing the health insurance plan. You have to ask the provider the premium and how much it will rise. As the premium changes at the time of renewal, it is affected by several reasons like an increasing expense for treatment, the company’s claim experience, your age, change in health benefits, etc.
Tip: While selecting any policy, check with the insurer to get an approximate idea of the premium hike. This could go for multiple reasons such as age slabs and the insurer’s claim experience. So, you need to be mentally prepared for the same.
7. What additional benefits can be added at an extra cost?
After getting all the complete information on the policies, ask your insurer what other benefits can add at an extra cost. There are different additional benefits you can buy as a rider in your policy.
For example, you can get an accidental policy by adding an extra amount and, you can take a critical illness cover, etc.
Tip: So, it is necessary to ask the insurer about the types of additional benefits you can avail of with your policy and, as per your requirement, select them carefully.
Conclusion:
There are several key points you must remember while buying health insurance for you and your family members. Take the complete information from the insurance company about the plan and select the policy, which will benefit you the most. You have to read all the documentation and have to take information on what your policy offers or not. You can find more about what questions to ask about health insurance and related topics on our blog here.
Health insurance is essential while keeping in mind the uncertainties that may happen at any time. Read the documents clearly before signing the policy documentation. List down these questions and ask the insurer if you do not have an idea about buying health insurance. Get insured by choosing the right policy and stay safe. Get insured by choosing the right policy and stay safe.