FAQs related to buying Health Insurance

When it comes to choosing a health insurance policy, most of the individuals get overwhelmed and puzzled with what to look in a health insurance cover. The right way to choose a suitable health plan is to make a checklist of your own and move accordingly. Here, we have discussed some of the important questions that you need to ask your insurance provider before you settle on one policy.

1. What kind of health insurance plan do I need?

This is one of the basic questions that you need to ask your insurer before purchasing a health insurance plan. There are different types of health insurance covers that you must consider before you can come to a final decision. There are individual covers, family floater covers, critical illness covers, disease-specific covers, etc. Every policy serves different purposes. So, you must carefully evaluate your insurance requirements before choosing any health plan.

2. How much coverage do I need?

After finalizing a policy, you must decide on the value of the coverage you need. Most of the top insurers in the market have a flexible sum insured options. The premium charges for these covers are based on the sum insured amount chosen. So, you need to choose the coverage value wisely to ensure that you have adequate coverage for emergency medical requirements.

3. How much should I spend on insurance coverage?

The answer to this question comes down to how much you can afford. Moreover, this should also be based on your existing health condition and family medical history. If you have higher requirements, you need to spend more to ensure proper financial security.

4. Are there enough network hospitals in my location?

To avail of a cashless settlement of your claim, you should be admitted to a network hospital. A company has a list of such hospitals and you need to find out whether the hospital in the company's network is your preferred choice of hospital and/or located in your area.

5. What is the waiting period for pre-existing illnesses?

As per the guidelines by IRDAI, the waiting period for pre-existing illnesses cannot exceed 4 years. However, many health insurers offer a shorter waiting period for pre-existing illnesses. It is always better to have shorter waiting periods if you are suffering from any pre-existing health conditions. This is one of the factors that you must check when buying a health insurance cover.

6. Will this policy cover day care treatments and OPD treatments?

Most of the health insurers offer coverage for daycare and OPD treatments. The list of daycare procedures covered by a health insurance policy will be provided in the policy document. If you need coverage for a specific daycare treatment, you need to check the policy document provided by your insurer. Also, check out the sub-limits set by the insurer for specific conditions.

7. Will I get coverage for medical examinations?

Coverage for medical examinations and diagnosis comes under OPD treatments. Very few health insurers provide coverage for OPD treatments. If this coverage is a major requirement for you, you must consider this at the time of buying the policy.

8. How good is the customer service in a health insurance company?

Most of the top insurance companies have dedicated customer service to take care of the needs of their customers. The official website of the insurer will have the information required to reach the company's customer care. You can check out the reviews from existing customers to understand the quality of service provided by an insurer.

9. Do routine examinations cover?

Routine examinations are very important and should be done very frequently, but it can cost quite a bomb if there are many tests involved. A health insurance policy that offers routine examination cover will save you a lot of money. So, try to look for such health cover that includes routine check-ups.

10.  Does the plan offer any special benefits?

Some of the health insurers offer special benefits such as cover for dental care, eye care, and other conditions. Make sure you check with your insurance company before you buy the policy for special benefits.

11. What is the out of the pocket costs?

When it comes to a health insurance plan, there will be a lot of out of the pocket costs such as deductible, co-pay, co-insurance, and out of pocket maximum. It is important to evaluate all the costs before selecting any policy to buy the one that best suits your health needs.

12. Is my policy valid PAN India?

This is one of the most important questions that need to be considered because medical emergencies may arise anywhere. Usually, health plan cover treatments anywhere in India but you should make sure of this clause beforehand. Find out whether the claim settlement in your policy has any geographical limitations or not. Some medical insurance plans offer international coverage too.

13. Can I cancel my policy mid-duration?

Most of the insurance plans have a 15-day cooling-off period called a free-look period during which you can cancel your policy with a full refund of premium. However, if you wish to cancel the policy during the mid-term, then you need to provide a suitable reason for your cancellation.

14. What happens if the primary insured dies?

In case of the death of a primary insurer, the other adult person may continue with the policy, and the sum insured will remain the same.

15. What is deductible & how does it operate?

The deductible is the amount that you need to pay towards your health care expenses before your insurance plan starts. The amount of deductible varies as per the plan and can be paid in a single claim or multiple claims during a policy year.

16. What does the policy cover?

Policy coverage or inclusions is the set of conditions that are covered under the health insurance policy. The coverage under a health plan includes hospitalization charges, pre and post hospitalization charges, ambulance services, laboratory tests, prescription drugs, organ donor charges, and others. You must read the policy document carefully to understand what all your policy covers.

17. What the policy does not cover?

Policy exclusions are the conditions that are not covered under your health insurance policy. Some insurance policies do not cover the treatment of certain diseases in the first year but after a waiting period. The exclusions in the policy may differ from one insurer to another, therefore being aware of these exclusions is equally important as that will help you decide which policy to buy. 

18. How much does the plan cost?

The cost of the plan is the monthly premium or amount that you need to pay per month to your insurer to keep your health cover active. Depending on the type of plan you choose and the amount of coverage you require, the cost can vary.

19. What is the maximum number of claims you can make in a year?

In general, there is no limit to the number of claims in a year, provided it does not exceed the sum assured of your policy. You must ask your insurer about your claim limit beforehand.

20. What is the claim settlement ratio?

The claim settlement ratio is one of the important factors that policy owners should consider before choosing any health plan. The claim settlement ratio of the company will give you a fair idea about the company relating to how it has treated its customers during the past and whether it stands true to its claims. The higher the ratio, the more trustworthy the company.