10 questions you should ask your health insurance

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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.
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1. Does your health insurance cover accident,
outpatient treatment expenses, ambulance
expenses, surgery, and maternity care?
most insurance companies cover surgeries and
accidents, they dont 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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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 youd need to submit. 
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10. What is the grace period if you miss a
premium or dont 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.

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