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Essential questions answered about medical insurance plans in India.
When you are in the market for a product as vital and valuable as health insurance, it is natural to want to get the best deal out of the money you’re spending. Thankfully, you can accomplish this by conducting thorough research and learning about every feature of the policy before dropping the hammer. At the end of the day, your policy should work for you in the hour of need and fulfil your requirements.
Regardless of whether you are buying your medical insurance policy online or offline, you should be fully aware of its ins and outs. Below, we answer the 10 most common questions people ask about health insurance:
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1. Is my policy valid across India?
This question arises frequently in the minds of potential policyholders, and the answer is yes. If you purchase a health insurance policy in India, it will cover treatment costs anywhere in the country. However, you should read the policy documents carefully to make sure this clause is included.
2. Will I be covered for pre-existing diseases?
Most insurers exclude pre-existing diseases from their coverage for a fixed period of the policy. This is known as the waiting period. If the policyholder must be hospitalised during this time as a result of this condition, it will not be covered. Additionally, keep in mind that there are some conditions that are excluded from the policy coverage altogether, usually critical illnesses.
3. Will I be covered for accidents, surgeries, and normal hospitalisation?
Yes. The purpose of health insurance is to cover you in case of an accident, illness, or other health-related problems. Your policy will cover room charges, diagnosis costs, surgeon/nurse/specialist fees, etc.
4. Will the insurance be valid only in network hospitals?
No, the insurance will be valid even in non-network hospitals. The only difference is that in network hospitals, you can avail of cashless claim settlement, whereas in a non-network hospital, you will have to pay the medical bills on the spot and then get them reimbursed from your insurer.
5. What are the documents required for filing a cashless claim?
The most important documents are ID proof of the insured, health card, policy copy, pre-hospitalisation medical papers, and hospital bills. You will be required to submit a pre-authorisation form in case of cashless claims. The insurer will let you know if any other documents are needed.
6. When should I file a claim?
Your claim must be intimated at least 48 hours prior to hospitalisation if it is planned, and within 24 hours of hospitalisation in case of an emergency.
7. How long will it take to process my claim?
A reimbursement claim will be processed within 15 working days, subject to the receipt and approval of all the documents. A decision on cashless claim will be taken within 6 hours of the receipt of the required documents.
8. I want to increase the sum assured in my policy. Is this possible?
Yes, you can easily do this at the time of renewing your policy.
9. Under which circumstances can my reimbursement claim be rejected?
Your reimbursement claim can be rejected if:
It falls in the category of policy exclusions
It occurs as a result of a pre-existing condition during the waiting period
There is a violation of the policy’s terms and conditions
The policy is invalid or has not been renewed
There is a discrepancy in the submitted documents
The sum assured is exhausted due to previous claims
The insurer suspects any foul play in the claim
10. Under which circumstances can my cashless claim be rejected?
Aside from the aforementioned reasons, a cashless claim can be rejected if:
The information provided is insufficient to judge the claim’s admissibility
The hospital is a non-network hospital
The claim is not filed in time. In this case, you will be reimbursed after treatment
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