Health Insurance FAQs

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What is Health Insurance?

It is a type of health insurance that covers all kinds of medical insurance and the insurance company will be obliged to give the policyholder an insurance cover in exchange for a premium.

What are the various forms of Health Insurance available?

Health insurance is mostly needed to cover the costs of hospitalization during the treatment of an illness. Nowadays, there are provisions of paying through a cashless facility and one can get a fixed benefit disbursed as well.

Why is Health Insurance Important?

Health Insurance is important for all family members but the needs of each family vary. Any member of the family could suddenly be hospitalized and a huge expense would have to be incurred from one’s own pocket if there is no insurance. In case one does not have the resources to pay for premiums of all the individual family members, one can also opt for a family floater plan as well.

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What are the various kinds of health insurance plans available?

One has the option to invest in microinsurance policies that start from Rs 5000 and they go up to a sum insured of Rs 50 lakhs as well. The amount can be even higher for critical illness plans. Most insurance companies will offer an amount of Rs 1 lakh to Rs 5 lakhs. The sum insured cannot be increased after the claim has already been made. On the other hand, non- life insurance companies offer health insurance for about one year only.

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What is the cashless facility?

Insurance companies now have tie-ups with all the major hospitals in the country and it forms a kind of network. So those who offer cashless facility will be paying the money to the hospital directly and the patient’s family would not have to undergo the additional hassle of claiming the money after having to pay the bills first from their own pockets. However, the expenses beyond the limit would still have to be covered by the patient himself.

Are there any tax benefits from health insurance?

Yes, there are often tax benefits that arise out of health insurance and there is also a section of the Income Tax Act that provides these benefits, mostly under Section 80D, which is unlike Section 80C, which is meant for life insurance and other investments. An annual deduction of Rs 15,000 is allowed according to present tax rules and it is higher for senior citizens like Rs 20,000.

What are the factors that may affect health insurance premiums?

The age of the person is of course a major factor and the higher the age, the more the premium, because one becomes more susceptible to illnesses. If the person already has a medical history then the premiums might be higher. The number of claim-free years one settles for would be another factor.

What are the aspects that a health insurance policy does not cover?

Any kind of pre-existing diseases are not covered or there is a no- claim period one has to settle for. There are also standard exclusions for optional treatments like cosmetic surgery. Contact lenses, hearing aids and dental treatments are not covered, along with congenital defects, AIDS and intentional self-injury. Please read policy documents carefully before sighing on the dotted line.

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How can Insurance Samadhan help: The Healthcare and Medical Services sector of any country is critical for its welfare. Government, employers and the society at large need to understand health insurance clearly. Only then can they implement productive strategies for managing health and medical insurance.

Presently, the majority of disputes usually occur due to misunderstandings, exclusions and non-standardization of laws related to medical insurance. Corporate Hospitals have TPA (Third Party Administration) desks but similar facilities are unfortunately not available everywhere. Additionally, an incorrect declaration at the time of policy initiation and poor documentation create even more issues.

At Insurance Samadhan, we firmly believe in the transparency and integrity of the system and understand the limitations faced by the common man who has trouble understanding the “Heavy Words” of the industry, like understanding exclusions and permissible limits linked to the room rent. This is exactly why at Insurance Samadhan we work relentlessly on case representation at all forums with the intention of resolving various health insurance complaints.

Register your complaint at https://www.insurancesamadhan.com/health-insurance-complaints

Shailesh Kumar

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