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Introduction
 
Ques. Ways health insurance companies can mess with you?
Ans. They are in business of providing service – why they should mess with you. You as a responsible customer should follow the rules/ procedure for lodging claim. It is a good idea to refer to policy document, read it thoroughly and avoid hassles.
Ques. I have health coverage through my employer but i’m leaving my job soon. Though I like my current coverage, I cannot carry it from job to job. What are my options?
Ans. Find out what your pocket can afford. Buy your own health insurance policy.
Ques. My insurance company failed to authorized coverage and treatment. Is there anything I can do?
Ans. You should analyze the reason why they have not authorized payment. Refer to policy document as well as medical document. If it is not covered in policy then you can not do anything. If it is covered under the policy, you have the following options:
 
  1. Take up the matter with the branch office.
  2. Lodge grievance with the Head Office of the Insurance Company.
  3. Lodge your grievance on website of Insurance Foundation of India.
  4. Go to Insurance Ombudsman.
  5. Go to consumer forum.
Ques. How does the health care ombudsman role work?
Ans. There is no post of health care ombudsman. It is Insurance Ombudsman and it is at state level. Sometimes an Insurance Ombudsman may be covering 2 or more than 2 states also. He also covers all cases of Health Insurance.
Ques. What is a network?
Ans. This term is used whether the hospital is empanelled with insurance company/ TPA or not. If it is then it is called as network hospital of the insurance company.
Ques. How do I waive student health insurance?
Ans. If you are a student in a foreign educational institution then you can not escape yourself from this responsibility. You must have the policy. It is in your interest.
Ques. Can I enroll in both my own employer's plan and my spouse's plan? Is it worth the extra cost I would have to pay in premiums? What about our dependent children?
Ans. Yes- you can. The same is applicable for your dependent children. Decision making can be done on knowing facts & figures. Seeing the health case costs you may consider going in for both.
Ques. What types of expenditures are commonly excluded under health insurance policy?
Ans. Expenditure commonly excluded is:
 
  • Costs which are not associated with treatments
  • Diagnostic Tests not associated with treatments
  • Medicines which you might be taking every day but are not part of this treatment.
Ques. Is there a minimum annual income requirement under Critical Illness insurance?
Ans. No. but if you are planning to go in for a very high sum assured –then Insurance company many ask for the same.
Ques. What type of hospitalization expenses are not covered by Mediclaim?
Ans. You have to refer to exclusion lists (1 year/2 years/4 years/permanent exclusion. Any thing not covered in these is supposed to be covered.
Ques. Is there a minimum time limit for stay within the hospital under Mediclaim?
Ans. Yes – 24 hours is the limit. This is waived off in case of Day surgery for which every company has its own list. One insurance company has list of 147 day surgeries.
Ques. What happens when the limit of insurance is exhausted under Mediclaim?
Ans. Nothing is payable beyond this limit so you have to pay for treatment out of your own pocket. You will have to wait for year to end, pay renewal premium – again you start with same limit as mentioned in new policy.
Ques. Is the insured value based on my income?
Ans. Not in case of health insurance. It is based on what you have the capacity to pay.
Ques. I made a mistake in entering my data while purchasing the insurance, what should I do?
Ans. Inform the insurance company, get it charged/ corrected. It is in your interest.
Ques. Sir, I am having a family Health Insurance policy with National Insurance. My self and wife is insured with Rs. 1 lakh each and one daughter with Rs. 0.50 lakh. On my policy I am availing Bonus of 25% as on date. I would like to convert this policy in January 2009 when it becomes due for renewal in to the family floater. My question is weather the policy can be transferred into the family floater and bonus will be continued. The benefit of the family floater as old policy holder will be available to me or not.
Ans. Most probably bonus benefit will not be available. You will have to forget the benefits of old policy. You will be happier with family floater policy as it is economical for you.
Ques. Do I receive a discount if I buy the policy for my entire family together?
Ans. Yes if it is normal policy with sum mentioned against the name of every family member – then you are eligible for discount of 10% for more than 2 persons. But in case you go for family floater then premium itself will be lower-may lower by 25%. No discount will be mentioned or given to you separately.
Ques. If a claim has been made for a particular ailment; does it become a pre-existing disease for the next policy term?
Ans. No, if you continue with the same insurance company. But if you go to a new company then it will be treated as a preexisting one and it becomes non payable.
Ques. My son is studying in the USA. I want to take health insurance for him. Will any one guide me which Company in India offers the best policy for an Indian student in the USA?
Ans. Yes – you can contact an insurance brokerage firm and they will give you good choice. You can contact us at Ria (9810090853 or 01141324957)
Ques. Is it possible to transfer insurance from one company to another and yet get the No claim/history of claims.
Ans. Generally- yes you can get no claim bonus if you can prove that you did not lodge any claim for last few years.
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ASSOCHAM - 10th Global Insurance Summit on 22nd September 2017 at Hotel Taj Lands End, Mumbai   more........
 
Upcoming Seminar
ASSOCHAM - 10th Global Insurance Summit on 22nd September 2017 at Hotel Taj Lands End, Mumbai
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