Frequently Asked Questions on Health Insurance

The commonest form of health insurance policies in India cover the expenses incurred on hospitalisation, though a variety of products are now available that offer a range of health covers, depending on the need and the choice of the insured. The health insurer usually provides either direct payment to hospital (cashless facility) or reimburses the expenses associated with illnesses or disburses a fixed benefit on occurrence of an illness.

Insurance companies have tie-up arrangements with several hospitals as part of their network. Under a health insurance policy offering cashless facility, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the third party administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits allowed by the insurance policy or expenses not covered under the policy have to be settled by you directly with the hospital.

Generally, pre-existing diseases are excluded under a health insurance policy. Further, the policy would generally exclude certain diseases from the first year of coverage and impose a waiting period. There would also be certain standard exclusions such as cost of spectacles, contact lenses and hearing aids not being covered, dental treatment/surgery (unless requiring hospitalisation), convalescence, general debility, congenital external defects, venereal disease, intentional self-injury, use of intoxicating drugs/alcohol, AIDS, expenses for diagnosis, X-ray or laboratory tests not consistent with the disease requiring hospitalisation, treatment relating to pregnancy or child birth, including Cesarean section, naturopathy treatment.

Family floater is one single policy that takes care of the hospitalisation expenses of your entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite often, family floater plans are better than buying separate individual policies. A family floater plan takes care of all the medical expenses during sudden illness, surgeries and accidents.

Source: IRDAI

COMMENT NOW