10 questions you should ask your health insurance

1. Ten questions you should ask your health insurance company Planning to buy health insurance? Here are ten things you should ask your insurance company, before you buy. www.policyadvisor.in

2. 1. Does your health insurance cover accident, outpatient treatment expenses, ambulance expenses, surgery, and maternity care? most insurance companies cover surgeries and accidents, they don’t include outpatient treatment, ambulance expenses, and maternity Emergency care benefits in the policy. So, it is better to find out if your insurance company covers these. Also remember to ask them how much coverage is given. www.policyadvisor.in

3. 2. What does a health insurance policy not cover? Generally, pre-existing diseases (read the policy to understand what a pre-existing disease is defined as) are excluded under a Health Insurance policy. Further, the policy would generally exclude certain diseases from the first year of coverage and also 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 hospitalization) not being covered ,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 hospitalization, treatment relating to pregnancy or child birth including cesarean section,Naturopathy treatment. www.policyadvisor.in

4. 3. What additional benefits and other stand alone policies does your health insurance company offer? Find out what ‘add-ons’ or riders your insurance company offers. Benefits like ‘Hospital Cash’, ‘Critical Illness Benefits’, ‘Surgical Expense Benefits’ etc www.policyadvisor.in

5. 4. What schemes are offered by the health insurance company? Check out the health plans existing currently – individual and family schemes, group insurance schemes ,senior citizens insurance schemes, long-term health care and insurance cover for specific diseases – and select the policy best suited to you. Most companies do not have separate health insurance Cover. www.policyadvisor.in

6. 5. How is your health insurance premium determined? In a health insurance policy, premium is calculated based on sum insured, number of people to be covered in the family, the age of the oldest person to be covered and type of policy chosen. The premium is largely determined by the age of the insured. The older you are, the higher the premium as the risk of developing health problems is higher. Past medical history will also influence premium. If there is none, the premium will be lower. With existing policies, if you have made no claims, premium discounts apply. www.policyadvisor.in

7. 6. Do you require a medical test for a health insurance plan? Some health plans require a medical test while others may not make it obligatory. www.policyadvisor.in

8. 7. Does your health insurance company provide cashless facility? According to the IRDA – ‘Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes Treatment in any of the net work hospitals, there is no need for the insured person to pay hospital bills. The Insurance Company, through its Third Party Administrator will arrange direct payment to the Hospital.’ Cashless hospitalization is available only in Network Hospitals. www.policyadvisor.in

9. 8. What is the maximum number of claims allowed over a year? You can make any number of claims during a plan year up to the extent allowed under the policy. Confirm it. www.policyadvisor.in

10. 9. What are the documents required for claims filing? • you will be required to submit – • a completed and signed claims form of the company, • all original medical bills, • all reports including medical reports, diagnosis, case histories, discharge summaries, etc., • medical services and treatments provided and their costs, • Drugs prescribed, and their costs. Ask your health insurance company/ broker for detailed list of documents you’d need to submit.  www.policyadvisor.in

11. 10. What is the grace period if you miss a premium or don’t renew your policy in time? • Every health insurance policy comes with a grace period that allows the policyholder extra time after the due date to make the premium payment without interest. If the policy lapses, it is possible to reinstate it within a specific period based on declaration of state of health during reinstatement. • In case the overdue premium is not paid during the grace period, so long as there is cash value in the policy, the insurance company takes a loan against this to pay the premium. While this will keep the policy alive, it attracts an interest on the premium. www.policyadvisor.in

12. Do your own research, compare different health plans, and make sure you are aware of the policy terms and conditions of your health plan. www.policyadvisor.in