Health Insurance FAQs

From soaring medical expenses to lost income due to an inability to work, an unanticipated health emergency can severely disrupt your financial planning. This underscores the importance of selecting a policy that can sufficiently safeguard you against unexpected losses and offer you reassurance. When choosing health insurance, it is crucial to determine the best plan for you and your family. Below is a compilation of essential questions to ask your health insurer before acquiring a health insurance plan.

Q1. What are the benefits under the health insurance policy?

It is vital to ascertain whether the policy is a benefit policy or if it will compensate you for the actual expenses at the time of the claim. You should inquire about the primary benefits encompassed in the policy and how the claim payments will be processed. Additionally, request information on the various options available under health insurance benefits and coverages when opting for a provided plan.

Q2. What is the Sum Insured (SI) that the insurer can offer, and what SI would you suggest for my specific needs?

Instead of simply stating that you require a health insurance policy, inform the insurer if you need coverage for yourself, your spouse, and your children, along with a separate policy for your parents, or if you prefer a single policy that covers all family members. Based on this information, the insurer should present the different SI options available for your family size and type.

Q3. Until what age is this policy renewable? Is there a maximum age for the policy?

You should request the insurer to clarify the age limit for policy renewal and the maximum exit age. For instance, if an insurer states that they will not issue a policy beyond 65 years of age, this is not permissible. In India, a health insurance policy can be renewed for life.

Q4. What about pre-existing conditions?

Any medical conditions you had prior to applying for insurance, including health issues like diabetes and heart ailments, would be deemed pre-existing conditions. Based on the health status, the insurer may determine the premium and coverage.

Q5. Based on the Sum Insured (SI) that they are providing, what is the premium?

You need to inquire with the insurer whether the premium will remain consistent year after year or if adjustments will be made as you age.

Q6. In the event of a claim, will I pay the same premium, or will there be an increase in the premium?

You should ask the insurer about any changes to the premium (if applicable) after a claim is made. At times, insurers may impose a loading on the premium post-claim. This should be clarified when purchasing the health insurance.

Q7. Are there any extra advantages that the customer will receive along with the health insurance policy?

While purchasing the policy, review the extra advantages like value-added services, discounts, health checkups, etc.

Q8. Who is the provider of the service?

One of the essential questions to consider is the identity of the service provider. Is it managed internally or outsourced to a Third Party Administrator (TPA)? Bajaj Allianz is among the limited insurance companies that have its own well-qualified Health Administration Team and internal claims team. This minimizes the Turn Around Time (TAT) for addressing a query.

Q9. What is the coverage of the network under the policy?

Examine the co-payment, deductible, or penalization clause for using a non-network hospital before acquiring a health insurance plan. For instance, there might be a co-pay option for opting for a non-network hospital. It is crucial to verify the specific stipulations concerning network hospitals in the policy.

Q10. Are there any sub-limits applicable for the condition?

Generally, for certain common conditions, there will be a cap regarding treatment, including ailments such as hypertension or cataracts. For instance, even if the sum insured (SI) is for 2 lakhs, there may be sub-limits for cataract, piles, tonsils, knee replacement, etc. This indicates that you might need to cover expenses out of your own pocket at the time of claims. The listing of ailments and the treatment restrictions differ from one company to another.

There are various types of health insurance policies available to meet individual preferences. To discover the most suitable coverage for yourself, explore our health insurance plans.