Health Insurance FAQs

Q.  What is a Health Card?
A health card is a card that comes along with the Policy. It is similar to an Identity card with details like your policy no., policy validity, TPA nos. which can be very useful in case of medical emergency. This card entitles you to avail cashless hospitalisation facility at any of our network hospitals.

Q.  What documents are required for filing a claim?

The following are basic documents required for filing a claim:

  • Duly completed claim form
  • Original bills, receipts and discharge certificate/ card from the hospital
  • Original bills from chemists supported by proper prescription
  • Receipt and investigation test reports from a pathologist supported by the note from attending Medical practitioner / surgeon prescribing the test.
  • Nature of operation performed and surgeon's bill and receipt.

Q.  Do I get Tax Exemptions?
All health insurance policies are eligible for the Income Tax Exemption under Section 80D.

Q.  What are the eligibility criteria for purchasing Health Insurance?
(Need to verify this)

Q. Can a person have more than one Health policy?
Yes. But each company will pay its rateable proportion of the loss, liability, compensation, costs or expenses. E.g. If a person has Health Insurance from company X for Rs. 1 Lac and Health Insurance from company Y for RS. 1 Lac, then in case of a claim, each policy will pay in the ratio of 50:50 up to the Sum Insured.

Q. What are Pre-Existing Diseases?
By Pre-existing Condition we mean any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer

Q.  What do you mean by Pre and Post hospitalization?
Pre- and Post-hospitalization expenses cover all medical expenses incurred within 30 days prior to hospitalization and expenses incurred within 60 days post hospitalization provided the expenses were incurred for the same condition for which the Insured person's hospitalisation was required.

Q.  Is cashless facility available across all hospitals?
The cashless facilities are available only at the hospitals which are in our network.

Q.  In case of cashless treatments, in whose favour are cheques settled or who gets the payments?
The cheques are sent to the hospital to whom approvals for cashless are given.

Q.  What is Co-Payment?
Co-payment means a cost-sharing requirement under a health insurance policy that provides that the insured will bear a specified percentage of the admissible costs. A co-payment does not reduce the sum insured.

Q.  What is a Family Floater plan?
In a Family Floater plan all insured members are covered on floater sum insured basis. The sum insured for a family floater is our maximum liability for any and all claims made by all the insured members.

Q.  Why should I buy a critical illness cover?
With rapidly changing demographics and lifestyles prevalence of critical illness is on the rise in India. With rise in life expectancy and chronic nature of critical illness there is a requirement of additional funds to afford high medical costs for treating such critical illnesses. The insured member is compensated by a lump sum payment if there is a diagnosis of critical illness.

Q.  How do I select the appropriate cover amount?

The appropriate cover amount ought to be determined on the basis of the following factors:

  • Your age : Age is a critical factor for determining the cover since health risk increases with age.
  • Pre-existing / hereditary diseases : Pre-existing diseases are covered subject to sub-limits and waiting period. For example: A person whose parents suffer from Diabetes is more prone to the disease, so we recommend a higher cover at an early age so that the pre-existing disease also gets covered.
  • Moreover, also consider your financial status and lifestyle before selecting the coverage amount.

Q.  What are Network and Non-network Hospitals?
Network Hospitals
    The company ties up with hospitals for cashless claim process. When you avail of a cashless treatment in any of these network hospitals, the company would settle the claim with the hospital directly. For a complete list of network hospitals, log on to Service Provider's or TPA's website. Hospital network list of each Service Provider or TPA may vary. Non-network Hospitals
   Non network hospitals are the ones with which the company does not have a cashless tie up. When you avail treatment here, you first settle the bills yourself and then submit the relevant documents and bills to the service provider or TPA. The amount, consequently, is reimbursed to you based on policy terms and conditions

Q. What is Pre-Authorisation?
    Pre-authorisation is basically an authorisation issued either by the insurance company or the service provider, specifying the value of the medical treatment that can be claimable under their insurance policy. To receive a pre-authorisation, you need to submit duly fill in the Pre-authorisation form.