Get your health insurance queries resolved by expert
Here you can find all the health insurance queries, our expert has responded to readers of the Financial Express newspaper.
I was advised to buy a standard health insurance policy which is cheap and gives all the coverage. Should I?
My parents are above 60 years old and have no health insurance policy now. Should I include them in my office group policy or buy a separate policy for them?
I am not satisfied with my private company health insurance policy and want to port it to a government company like New India Assurance. How can I do it and will the premium structure be the same?
I am facing a cash crunch, can I defer payment of health insurance premium for six months?
My wife works with a MNC and has a family cover from her office. She is planning to start her own business. I am an entrepreneur. Should we take a family floater policy now?
My father was discharged from the hospital. He needs nursing, oxygen support, etc. Can I claim money from insurance for home arrangements?
I have health insurance through my employer. If I quit my job, how can I get same health cover later?
I am 64 years and have an individual health insurance plan. I plan to undertake a cataract surgery. My insurer says it will pay a fixed amount which is half of the amount that the hospital will charge. What should I do?
This varies as per the product guidelines of the insurance firm. There are some who have a capping when it comes to procedures like cataract. There are some who apply a mandatory age-based co-pay at the age of 64 and there are some who honour the full claim without any co-pay. I would request you to refer to the terms and conditions document in your policy kit and understand the benefit better.
I, along with my spouse and two children, are holding a mediclaim policy. My 81-year-old father-in-law does not have any health cover. Can he be included in our policy?
In case your policy is an individual policy with four members in it then your father-in-law can be added at renewals. In case it is a family floater, then you will have to purchase a separate policy for your father-in-law. Declare his pre-existing medical conditions while opting for this cover. He may be asked to undergo pre-policy medical check-up. Also check the applicable conditions like maximum entry age, co-pay, sub-limits.
I had a family health insurance floater policy about seven years ago. I went to Dubai and my family had a cover from the employer. I have lost my job and we are back in India. Can I revive the policy and get the benefits?
This is kind of difficult as the maximum grace period generally allowed for renewing a health insurance policy is 30 days. In all probabilities you will have to opt for a fresh cover.
What is co-pay in a health insurance and will it reduce the premium?
There are different kinds of co-pay such as mandatory co-pay basis entry age, voluntary co-pay, etc. The one which reduces premium is called voluntary co-pay where you agree to bear a per cent of the admissible claim and hence get the premium reduced as per the terms of the product. One takes a call on opting for voluntary co-pay, considering age, health status and possibility of claim etc.
My firm has a group health plan for my family. Can I port that policy post retirement and continue with the same or a new insurance provider?
As per the guidelines on Portability and Migration, all group insurance policy customers are eligible to migrate into a retail product offered by the same insurer. This migration, however, would be subject to underwriting. You should approach your HR team and establish contact with your group insurance provider and procure details at the earliest and continue to stay secured.
We are a family of four covered under an individual health insurance plan with highest age member (52 years). Can we convert it into a family floater plan?
This is possible but subject to the product and underwriting guidelines of the insurer. However, in the current circumstances, where there is a chance of the whole family getting infected, continue with the individual policies as the coverage shall be available for every member.In floater plans the premiums are payable, generally basis the age of eldest insured member, which the younger insured may not find relevant.
Can I pay premium of three years in one-go? Will I get any discount on it?
Yes, you can pay your health insurance premium for a three-year term at one-go provided the insurance company has that feature available in their product. Whether paying for a two- or three-year term makes you eligible for a discount on premium depends on the product but in general, there is a long term discount available for two and three years policy tenure.
My sister is a single mother and is dependent on me and my wife. Can I include her and her minor daughter in our family floater plan which includes my wife, our two sons and I?
A family floater policy generally refers to self, spouse, two or three dependent children-. You can opt for a floater plan where your sister and her daughter are covered as insured members and your sister can be the proposer. You may also go for multi-individual policy where spouse, children, brother and sister, niece and nephew could be covered under the same policy with individual sum insured.
Two years ago I bought a health insurance policy and am not satisfied with it. If I port the policy, will all the benefits be carried to the new policy?
Yes. Portability is allowed under all individual indemnity health insurance policies issued by general insurers and health insurers including family floater policies. Wherein, the continuity benefits are offered on time-bound exclusion to the extent of the previous sum insured.
I plan to visit the US next year. Will my family floater plan cover any treatment, if required, in the US?
Usually, health plan bought in India do not cover any treatment outside India. However, there are a few high-end products which offer coverage outside India. Check the terms of your policy to see if treatments outside India are covered.
How much discount will I get if I buy a health insurance policy online?
Discounts are based on the product you intend to buy. While many life insurance products offer discounts for online purchase given the long term policy nature, many health insurance products do not provide any discount.
I had a cataract surgery in February. Due to lockdown and Covid-19, I sub-mitted my bills to the insurer in November. But it says it is too late to file a claim. What should I do?
This is a situation that is a byproduct of Covid-19 related logistic challenges. Irdai has taken steps to safeguard the policyholder’s interest. Hence, insurance companies cannot reject a claim merely on delay of submission of documents. In such a situation, the customer should give a valid explanation as to why the delay has happened. Based on it, insurer should honour the claim.
I have an office group cover and a family floater policy. Can I claim a part of the bill from my office policy and the rest from my floater policy?
Of course you can. If coverage from one policy is insufficient to pay the bills then you can claim the remaining amount from another policy. The rule is that the same expense cannot be claimed twice from two different insurers.
My wife is aged 50 and I am 56. My son is 22 and my daughter is 19. Till what age can they be included in health floater policy?
It depends on the product / company where you and your family members are intending to be covered. Generally, in many products, the dependent children are covered till the age of 25 years. You may want to check with the prospective insurers and decide accordingly.
I have a family floater policy and my daughter aged 23 is also included in the policy. She is getting married next month. Can she continue with the policy and avail all the benefits accumulated over the last 12 years?
The child is mandatorily shifted into an individual policy when the child attains the age of majority as defined in the policy or if the child is no more dependent (becomes independent). Since the daughter is getting married, her dependence would shift from the existing family to the new family if the daughter is not earning. Continuity benefits are offered on such policies.
My office health insurance covers myself, my wife and two kids. If I pay extra premium, my parents can be included. Should I go for this or take individual health insurance for them?
Employee group insurance does not have any pre-existing waiting period. So any hospitalization incidence would be covered from day one. In retail policy, a pre-existing waiting period is applicable. Retail health insurance can be renewed lifelong but group coverage ends when the employee exits the group and so the parents could be left without any insurance. Hence, take an independent retail policy for parents as well.
Last year, I paid more than Rs 45,000 for cataract eye surgery. The insurance company did not pay the full amount as reimbursement. It said the amount is fixed at Rs 30,000. What should I do?
If there is any capping on certain procedures such as cataract, etc., the amount shall be paid as per the applicable sub-limits. However, super top -up which has no such sub limits and capping could be a good choice to cater to such out-of-pocket expenses.
I had bought a family floater health insurance policy 10 years ago and did not renew it after five years because I got a job that had an insurance cover from my office. After the pandemic, I lost my job. Can I port my office health insurance into a family floater or should I have to buy a new policy?
Individual members including family members covered under an indemnity-based group health insurance policy have an option to migrate at the time of exit from group or in the event of modifica-tion of the group policy or withdrawal of the group policy, to an individual or family floater health insurance policy offered by the same insurer subject to underwriting. In this case, if you are currently not covered under any group health insurance policy, you may want to get you and your family covered under a new retail health insurance policy.
I will be 69 this month and my wife will be 61 in April, 2021. We don’t have any health insurance policy. I had a bypass surgery in 2016 and now I am in perfect health. My wife is suffering from rheumatic arthritis now. Should we take a comprehensive health insurance policy?
You may want to look at different covers for both of you as the age group and health issues are different. Some insurers have a restriction on entry age beyond 65 years. As you have been treated for a heart problem and your wife has a chronic condition, check with some insurers on acceptance as underwriting guidelines differ from insurer to insurer and product to product. Some insurers have certain plans for senior citizens with chronic health issues.
Will an insurance policy have a cap on room charges every day? How can it be increased without a substantial rise in the premium?
Policy premium depends on the features of the policy you have opted for. There are policies which offer room rent as a per cent of the sum insured, there are some which offer specific room category or even any room without any limitations as a per cent of sum insured. Policies which have capping on room charges also have optional covers to remove capping or enhancing the room category. It is better to have minimum restrictions even if it costs a little more premium.
As I am 65 years old, what kind of health policy should I buy and what will be the premium?
It is important to opt for a health insurance plan at the earliest and not let any unforeseen hospitalisation claims eat up your hard-earned retirement savings. You should look for such plans where there are no restrictions on entry age. If you can afford the premium, considering your age, it is advisable to have a comprehensive cover with high sum insured. You can look for a plan which covers in-patient hospitalisation, day care treatments, pre & post hospita-lisation, ambulance, donor expenses apart from other health and wellness related benefits. Check for the sub limits and co-pay which can impact your claim pay-outs.
My wife, daughter and I have individual health insurance of Rs 3 lakh each. Should I convert it into a family floater for Rs 10 lakh?
I would recommend a sum insured of Rs 10 lakh or more as a floater cover given the fact that in case one of you gets hospitalised then you have a sufficient cover at your disposal. Most insurers offer a restoration or recharge benefit in their core product proposition which works really well in a floater cover and acts as a backup for the family. Alternat-ively, you may increase the sum insured by purchasing top-up plan.
How can I opt for OPD cover as I am spending a lot of money on doctor consultation for my dental problem?
There are many plans available which gives the OPD cover. But while buying a plan, it is always better to go for compre-hensive cover which can take care of all kinds of health eventualities and not just dental or OPD related expenses. I have an office cover and a personal floater policy. Last month I had a bypass surgery and the total bill was Rs 5 lakh.
Can I claim Rs 4 lakh from office policy and the rest from my personal insurance policy?
Of course you can. If coverage from one policy is insufficient to pay the bills then you can claim the remaining amount from another policy. The rule is that the same expense cannot be claimed twice from two different insurers.
Wondering how much coverage is enough to safeguard you and your family’s health?
Questions you should ask before making a financial commitment.
What am I buying?
1. Coverage against medical expenses -The main purpose of medical insurance is to receive the best medical care without any strain on your finances. You may, therefore, focus on your speedy recovery instead of worrying about such high costs.
2. Coverage against critical illnesses- Insurance providers nowadays offer critical illness insurance, either as a standalone plan or as a rider. This amount may be used to meet your illness-related treatment costs, daily expenses, and any other financial obligations.
3. Cashless claim benefit- Many insurance providers offer cashless claim facility.
4. Additional protection over and above your employer cover- You may be left uninsured in case of loss of job or change in employment. In order to protect yourself against such an event, purchase a health cover individually.
5. Tax benefits- Health care plans provide tax benefits. Premiums paid towards your health care policy are eligible for tax deductions under Section 80D of the Income Tax Act, 1961.
How much cover do I need?
Your cover is the extent of protection that your loved ones will receive, simply put it’s the funds that your family will need to maintain their lifestyle in your absence. A few simple questions can help you find out what is the right cover for you.
- How much of the family income do you provide?
- How many people are financially dependent on you?
- What are your current liabilities?
What do I need to pay and for how long?
You will need to pay premiums, the amount that you invest for your policy, regularly for a specific time period known as the ‘Pay term’ which depends on the type of policy you purchase.
You can have Single Pay which requires you to pay a one-time premium or Regular Pay where you need to make multiple payments. A regular pay term can be monthly, quarterly, half-yearly or annual. Your pay term is different from your Policy Term which is the tenure of the policy.
Do determine the policy term and the pay term before signing up. Only commit what you are comfortable committing on an annual basis over the long term.
What are the benefits of my insurance policy?
The sales brochures and other promotional material can help you understand the benefits of your policy, always ask for the policy literature provided by the insurer.
Your policy benefits depend on the type of policy you chose such as term insurance, or a unit linked insurance product.
It’s always advisable to read and understand the risk factors, terms and conditions of the plan. When in doubt ask your advisor to explain the details or contact the insurer.
What should I keep in mind while filling the application form?
Verify all the policy details before signing up for your policy. It is in your interest to provide correct information regarding your personal, medical and contact details to ensure smooth policy processing and a hassle-free claim processing in the long run. While filling the form, always remember to:
- Check and fill the necessary details yourself and only then sign.
- Ensure that your details match the KYC documents submitted by you.
- Complete the nominee details and inform your nominees.
What are the malpractices I should be aware of?
Always keep in mind the following:
- Do not fall prey to promises of guarantee unless specifically mentioned in the product material.
- No insurer can offer rewards or discounts on a policy purchase
- Always check the advisor license if he has not been referred to you
- Inducement to purchase insurance is illegal, in case you come across such instances immediately inform the nearest police station and lodge a complaint against the person.
Why do you require a health insurance plan?
I am 27. Is this the right time to buy health insurance for me? If yes, how can it help me?
Is health insurance any sort of investment?
What is better : individual health insurance or family health insurance?
Am I supposed to get personal health insurance when I have my company's health insurance?
When can I buy health insurance?
Can I buy health insurance just for my parents?
How much health cover do I need?
Is health insurance entirely digitised yet?
Can I have more than one health insurance policy?
Yes, of course, you can. Investing in multiple health insurance policies should be a calculated choice, as it may result in an additional premium amount paid unnecessarily for the same/common tenure. Instead, you can buy a comprehensive health insurance policy and opt for additional coverage/riders to ensure that your medical expenses are fully secured.
On the other hand, if you have a group insurance policy provided by your employer, you must have a personal health insurance policy. The group policy doesn't cover your parents. Furthermore, if you resign from the organisation, the policy coverage terminates for you. It is valid you work in the same organisation. This is where you must have a separate, personal health insurance policy.How many members can I include in my health insurance policy?
How is private health insurance different from government health insurance?
Do I require health insurance if I have life insurance?
What do you mean by an individual policy?
What do you mean by the Family Floater policy?
Who regulates health insurance in India?
Can I buy a floater policy?
Do I get any tax benefits by purchasing health insurance?
What if I never make use of my health insurance policy?
Immediately check, to avoid surprises in the future!
What are the things I need to check immediately after receiving my policy?
Is my policy as per my expectations?
To ensure that you have received the policy that you expected, it is advisable to immediately review your policy document.
Check for some key benefits like Sum Assured, Policy Term, Premium amount & Pay term to ensure that it is as per your need. If you have any doubts, call the insurance company to enquire/confirm the same.
Are my personal details & nominee details accurate?
Accuracy makes for easy claim. Your policy document contains all your personal information, bank details, contact details and nominee details so do ensure that it is accurate and updated from time to time.
This will help avoid any confusion during the claiming process.
Have I informed my nominees about the policy and stored the documents safely?
In case of an unforeseen circumstance, your family deserves utmost ease. Store your documents in a safe and accessible place and ensure that your nominees are aware of the policy details, benefits and all documents are easily accessible.
This helps in avoiding unnecessary delays and makes for a smooth claims process.
What are the key things I should remember as a policy holder?
A few things that are important for you to practice are:
- Keep a list of all the policies you own and standard claims practices along with your policy documents so that your nominees can find all information at one place.
- Pay your premiums regularly; it will help you get the right benefit out of your policy.
- Evaluate your cover every 5 years, just like your lifestyle – your cover needs an upgrade.
What should I keep in mind while filling out the application form?
How long after buying health insurance can I use it?
How do I go about buying health insurance when I have a pre-existing condition?
Is buying health insurance from a broker advisable or should I buy it online?
How much does a ManipalCigna health plan cost?
Do I need to mention all my health issues before buying health cover?
Can I get a discount while buying a health insurance policy?
What is a critical illness (CI) insurance?
Why buy critical illness insurance if I have a health insurance cover?
Can I make multiple claims for the same or any other listed critical illnesses?
Is there an income tax exemption on the health insurance premium? If yes, under which section and what is the Income Tax exemption limit?
After Buying Policy
What are the things I should keep in mind as a policy holder?
How can I ensure that I get maximum benefit from my policy?
Insurance benefits you only in the long-term. It is also important that you pay premiums regularly to enjoy benefits. Missing a payment may leave you without health insurance cover and also the benefit of tax saving.
What do I do in case of loss or lapse of my policy?
If you lose your policy document, report it to the insurance company immediately. You can get a duplicate policy by complying with the formalities. The duplicate policy confers the same rights as the original policy document.
If you are unable to pay the premium in time, your policy may lapse. You can contact the insurance company through your advisor or directly for reviving it. It is always advisable that you revive your policy and continue to enjoy its benefits.
What’s the best way to maintain my policy?
As a policy holder, you should know the following:
- Your contact details must be updated with the insurer so that you can be reached for any service offerings and communication.
- Your nominee details must be updated at all times so that the insurer can ensure a hassle free claims experience for your family.
- In case your agent is not being responsive to your queries and requirements, you always have the option of contacting the insurer directly.
- You must evaluate your protection cover every 5 years, as your cover needs to keep pace with your increasing responsibilities.
What are the malpractices I should be aware of?
Don’t fall prey to temptation/inducements/hoaxes/threats without checking the truth behind calls/claims. Here are a few things you should know:
- No insurer can offer rewards/discounts on giving up your policy for another one.
- Surrendering your policy is never a good idea if someone is offering you a reward or inducement.
- Cross - check any suspicious refund calls or policy replacement with your insurer.
What should I do in case I receive any fraudulent calls?
Please note that IRDA or an insurer would never make calls for additional benefits, declaring bonus, surrendering policies etc.
Do not believe such fraudulent calls, always cross-check all scheme related information and benefits either on the company’s website or by visiting the branch.
In case you receive such calls, immediately lodge a complaint by calling your insurance service provider with the details of the caller (phone number, name of the caller etc.)
Will the medical costs be reimbursed from day one of the cover?
How can I make amendments in my policy?
Will I be covered if I am in an accident and ManipalCigna has not finished processing my application?
What happens if the hospitalisation expenses exceed the cashless authorised limit?
What happens if the primary insured person covered under a family floater policy expires?
Can I cancel the policy midway? Will the unused premium be refunded?
If I am hospitalised due to accidental injury, can I avail the cashless facility?
What happens when I have to undergo a treatment like dialysis when I am discharged on the same day?
Does a higher cover mean preferential treatment in case of hospitalisation & claim?
Is there a limit as to how long I can stay in the hospital?
No such limit has been defined. You can stay in the hospital as long as it is medically necessary to provide safe and adequate medical care in scope, duration or intensity. Here are some points to keep in mind:
• Your hospital stay must be prescribed by a Medical Practitioner.
• You have to adhere to the professional standards that are widely accepted in international medical practice or by the medical community in India.
What happens in case of an emergency hospitalisation where a cashless facility is not authorised to me?
What are the situations under which one may be denied cashless hospitalisation?
Whom do I call at the time of emergency hospitalisation?
What to do if I am admitted to a non-network hospital?
If I'm travelling, can I go to any doctor?
What are the circumstances under which the condition of minimum 24 hours hospitalisation does not apply?
Does the insured have to pay the difference if the actual expenses are more than the cover?
Would I be able to avail of my medical & premium reimbursements in case my policy is rejected?
If I have a health insurance policy in one city, can I make a claim in another city?
How many claims can be availed in a year?
My reimbursement claim will be processed in how many days?
Can any claim be rejected or refused?
Is the claim amount subject to tax?
Whom do I have to contact for claim intimation and settlement?
Can I cancel my policy and if yes will I get my premium back?
How can I raise a complaint?
How can I renew the policy?
You can renew the policy by any of the below methods:
● Making health insurance premium payments at the ManipalCigna local branches
● Making the health insurance premium payments online using net banking or using your Credit/Debit card