Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses, among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement.
Research and development are the two key words which we stick to whenever we buy any product from the marketplace. The reason is simple – we want to get the best deal out of our money spent. Online research, visiting various outlets and comparing every feature is what we do before buying any product. What about health insurance? Do we conduct any research and go through the checklist of health insurance FAQ when buying a policy or do we settle on whatever the agent pitches us?
Buying a medical insurance plan should involve some consideration on your part when it comes to the plan features and coverage options. Blindly buying a plan because your friend bought that too or your agent asked you to would be a foolish practice. Instead, you should ask some very pertinent health insurance related questions when settling on a plan to make sure that the plan bought would fulfill your requirements, especially at the time of claims, and be the best plan.
Handy list of health insurance FAQ:
Q – Which are the network hospitals in your vicinity?
To avail a cashless settlement of your claim, you should be admitted in a network hospital. A company has a list of such hospitals and you need to find out whether the hospital in the company’s network is your preferred choice of hospital and/or located in your area.
Q – Is my policy valid PAN India?
This is a one of the most important health insurance questions to be considered because medical emergencies may arise anywhere. Usually, health plans cover treatments anywhere in India but you should make sure of this clause. Find out whether the claim settlement in your policy has any geographical limitations or not. There are some medical insurance plans that offer international coverage too.
Q – Will I get covered for my pre-existing illnesses?
Every insurer excludes coverage on the pre-existing illnesses for certain tenure at the starting of the policy. You need to find out what this waiting period for your pre-existing illness is and how soon can you be covered for your pre-existing illnesses. Basically, you need to understand whether your pre exiting condition is temporarily not covered or is it completely excluded from the scope of coverage.
Q – Whom do I call at the time of an emergency hospitalization?
An emergency situation involves a lot of stress and you don’t need the additional burden of finding out the claim settlement process. If your policy facilitates cashless settlement of claims, find out the policy of emergency hospitalization. Ask about the documentation and, most importantly, whom to contact at the time of such emergency hospitalization. Good brokers have a customer service desk or a specifically appointed representative who would help at the time of claim.
Q –What to do if I am admitted in a non-network hospital?
In an emergency situation, you might be admitted in a non-network hospital and knowing the claim protocol at that time is imperative. Always remember that treatment in a non-network hospital would be on a reimbursement basis only where you would have to shoulder the medical bills and then get them reimbursed from your insurer. So find out the reimbursement process, the documents required in this case, and the deadline for informing the insurance company, etc. for this situation.
Q – What are the documents required for claiming?
This is one of the most common health insurance queries, and knowing the answer from the get-go makes the claims process much smoother. Essentially the company asks for the identity proof of the members covered, the health card, the hospital bills, etc. at the time of a claim. A pre-authorization form is required in case of cashless claims which are to be submitted to the TPA. Other documents might also be required and you should have the knowledge of the required documents so that you can get your claim processed smoothly.
Q – What is the method of claim processing followed by the company?
The claim settlement process is the true test of your health plan. You should ask about the company’s claim settlement process to assess whether the process is simple or ambiguous. Moreover, take special care to notice whether the company settles the claims through cashless facility or by reimbursement. A cashless facility is your best bet to avoid any financial burden of medical bills.
Read More- Health Insurance Companies in India
Knowing the answers to these health insurance questions is very important if you want your claim under the plan to be settled without much harassment. Your broker would be the best party to answer these questions by virtue of their immense experience in handling health insurance claims. So talk to your broker, get your health insurance queries answered and only then buy your health plan.