All of us understand the importance of health insurance in today’s time. But that doesn’t necessarily mean that we understand what our health insurance plans entail. Therefore, we either postpone buying health insurance policies or we depend on our friends or parents to make the buying decisions. Worse still, we just accept whatever health insurance policy is shown to us the first time. However, health insurance buying decisions need to be taken after careful assessment, and for that it is important to understand what our health insurance plans comprise. So, here are questions to some commonly asked questions about health insurance plans.
A pre-existing illness is a condition that the policyholder is already seeking treatment for at the time of buying a health insurance plan. While your health insurance provider might offer you coverage for your pre-existing illness, you will have to wait for a certain amount of time until you start receiving coverage. This is known as the waiting period. The waiting period can be up to four years in certain cases.
We buy health insurance so that we can make claims in case of hospitalization or any other medical emergency. Therefore, it is important to know how the health insurance claims process works. If you are availing yourself of the cashless facility, you need to present your identity proof and health insurance policy number to the hospital. If you have access to your health insurance card, you can present that too. The hospital might ask you to fill a pre-authorization form for cashless claims. In case of reimbursements, you have to submit medical bills along with original doctor prescriptions to your health insurance provider. This can be done digitally for faster processing of health insurance claims.
Health insurance claims are either settled in a cashless manner or they are reimbursed. In a cashless facility, your health insurance provider will directly settle your medical bills with your hospital. Only differences that are not covered in your health insurance policy will need to be paid by you. The cashless facility can, however, is only available at network hospitals. In case of reimbursement, you clear your dues with your hospital following which you make a claim with your health insurance provider. Your health insurance provider reimburses the claimed amount to you after applying exclusions if any.
If during an emergency you are admitted to a non-network hospital, you will not be able to take advantage of the cashless facility. Instead, you will get reimbursements from your health insurance provider. To make a claim, you will need to submit medical bills and other documents as may be required by your health insurance company. Claims usually have to be made within certain days of the hospitalization so find out about the timelines from your health insurance provider. It is recommended that you inform your health insurance provider prior to hospitalization in a non-network hospital.
You can increase the sum insured on your existing health insurance plan at the time of policy renewal. This depends on the indemnity guidelines of the company so make sure you read the policy wordings carefully before buying the health insurance plan.
Here are some important things you can look at while buying a health insurance policy:
Yes, you are allowed to have more than one health insurance policy either from one provider or various ones. You can also split your claim on the different health insurance policies according to your sum insured.
If you are unsatisfied with your current health insurance provider, you can transfer your existing health insurance policy to another health insurance company while retaining your benefits such as the No Claim Bonus (NCB) discount and the credits earned on the waiting period. This is known as portability.
There is no limit on the number of claims you can make in a year, however the total claimed amount cannot exceed your sum insured.
When your health insurance provider directly clears your medical bills with your hospital, it is known as the ‘cashless’ advantage. It is offered by most health insurance companies today.
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