15 Most Commonly Health Insurance Frequently Asked Questions (FAQs), India 2023

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4 min read

Updated on Jan 23, 2023

Have you ever thought of a situation where you or any of your family members is facing a severe health situation requiring a huge expense. How do you plan to manage such conditions without comprehensive health insurance?   

Buying a Health insurance policy to provide coverage against sudden health emergencies is the best thing to do if you do not want to suffer any setback in terms of health. In fact, health insurance is becoming a necessity these days with the emergence of so many diseases including lifestyle and critical illnesses.

However, when the question of buying medical insurance arises, the policy seeker is surrounded by many inevitable questions. In this post, we are trying to answer your health insurance related queries that you might be interested in knowing.

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15 Frequently Asked Questions (FAQs) Related to Health Insurance Policy in India

So, below are some FAQs or frequently asked insurance-related questions that an individual willing to purchase an insurance policy would like to know.

1. Why do I need a Health Insurance Policy? 

A health insurance policy is the basic requirement if you want to secure yourself as well as your family against medical emergencies and the impending expenses that it causes. With a health insurance policy, you can ensure that you do not touch your savings or do not lose any money that you have kept for a different purpose due to paying bills for a medical emergency.

2. Is it possible to cancel a health insurance policy and get a refund?

Yes, it is possible to get a refund on health insurance plans during the free-look period offered by insurers. The free-look period ranges from 15 days to 1-month during which the policyholder can cancel it and get a complete refund. The only deductions in this case would be the stamp duty and the proportional risk (deduction or incremental) charges.

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3. What is the maximum number of claims that I can make in a year?

A policyholder can claim as many times as they want during a policy year. However, the total claim amount including all the claims shouldn’t exceed the maximum amount of sum assured.

4. Can health insurance premiums be paid on installment basis?

Yes, it is okay if an insured wants to pay his/her health insurance premium on installment basis. The instalments can be paid as per monthly, quarterly, half yearly or yearly basis.

5. Are there any benefits of buying a critical illness insurance plan?

Yes, the critical illness insurance plan allows numerous benefits. These plans ensure the safety of policyholder and his/her family members from the life-threatening diseases like cardio-vascular disease, cancer, stroke, heart attack, kidney failure and so on.

6. Can I get coverage against maternity/pregnancy related expenses under a health insurance policy?

Yes, there are many insurers offering plans that cover maternity and pregnancy related conditions. However, you have to check with the insurance company to make sure about the coverage. However, the premium of such plans is much higher as compared to the regular health insurance plans.

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7. Can I get coverage outside India with my health insurance plan?

Generally, a health insurance policy offers PAN India coverage. However, there are some companies that offer coverage outside India as well.

8. Can I get coverage against naturopathy and homeopathy treatments under my health insurance plan?

Generally, the regular health insurance policy may not cover expenses of naturopathy and homeopathy treatments. However, these treatments come under AYUSH cover and are allowed coverage by some standard health insurance policies. On the other hand, there are certain plans which may cover such treatments as an add-on coverage.

9. Can a foreigner living in India avail a health insurance policy in India?

Yes, foreigners living in India can purchase a health insurance plan in India sold by Indian insurers. However, depending on the policy terms and conditions, the coverage of the plan might be restricted within India only.

10. What is cashless claim settlement?

Cashless Claim settlement means that the policyholder can have cashless claim of their treatment if the treatment is done in a network hospital of the insurer. Unlike in the reimbursement claim, under a cashless claim the insured doesn’t have to pay any money from his/her pocket. Rather the hospital bills are settled by the insurer directly.

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To Conclude

If you are worried about the health of your near and dear ones, it is necessary to cover them with a comprehensive health insurance plan. However, to buy the best health insurance policy, you must read through the terms and conditions of different plans and compare them well so that you can get the best benefits under one policy.

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FAQs on Health Insurance Policy

Why do I need a Health Insurance Policy? 

A health insurance policy is the basic requirement if you want to secure yourself as well as your family against medical emergencies and the impending expenses that it causes. With a health insurance policy, you can ensure that you do not touch your savings or do not lose any money that you have kept for a different purpose due to paying bills for a medical emergency.

Is it possible to cancel a health insurance policy and get a refund?

Yes, it is possible to get a refund on health insurance plans during the free-look period offered by insurers. The free-look period ranges from 15 days to 1-month during which the policyholder can cancel it and get a complete refund. The only deductions in this case would be the stamp duty and the proportional risk (deduction or incremental) charges.

What is the maximum number of claims that I can make in a year?

A policyholder can claim as many times as they want during a policy year. However, the total claim amount including all the claims shouldn’t exceed the maximum amount of sum assured.

Can health insurance premiums be paid on installment basis?

Yes, it is okay if an insured wants to pay his/her health insurance premium on installment basis. The instalments can be paid as per monthly, quarterly, half yearly or yearly basis.

Are there any benefits of buying a critical illness insurance plan?

Yes, the critical illness insurance plan allows numerous benefits. These plans ensure the safety of policyholder and his/her family members from the life-threatening diseases like cardio-vascular disease, cancer, stroke, heart attack, kidney failure and so on.

Can I get coverage against maternity/pregnancy related expenses under a health insurance policy?

Yes, there are many insurers offering plans that cover maternity and pregnancy related conditions. However, you have to check with the insurance company to make sure about the coverage. However, the premium of such plans is much higher as compared to the regular health insurance plans.

Can I get coverage outside India with my health insurance plan?

Generally, a health insurance policy offers PAN India coverage. However, there are some companies that offer coverage outside India as well.

Can I get coverage against naturopathy and homeopathy treatments under my health insurance plan?

Generally, the regular health insurance policy may not cover expenses of naturopathy and homeopathy treatments. However, these treatments come under AYUSH cover and are allowed coverage by some standard health insurance policies. On the other hand, there are certain plans which may cover such treatments as an add-on coverage.

Can a foreigner living in India avail a health insurance policy in India?

Yes, foreigners living in India can purchase a health insurance plan in India sold by Indian insurers. However, depending on the policy terms and conditions, the coverage of the plan might be restricted within India only.

What is cashless claim settlement?

Cashless Claim settlement means that the policyholder can have cashless claim of their treatment if the treatment is done in a network hospital of the insurer. Unlike in the reimbursement claim, under a cashless claim the insured doesn’t have to pay any money from his/her pocket. Rather the hospital bills are settled by the insurer directly.

Do health insurance plans allow the policyholder to enjoy tax benefits?

As per the income tax act of India, tax benefits are available under health insurance in the form of tax deductions under section 80D. An annual deduction of over INR 25,000 is available under 80D for every citizen, except for senior citizens, whose taxable income is INR 50,000. The policyholder can avail this benefit on tax by showing proof of income.

What are health insurance policy exclusions?

Depending on the plan and the policy provider, a health insurance policy can have a set of exclusions, such as;
It doesn’t cover diseases like AIDS, Cosmetic Surgery and Dental Surgery etc.
Many policies do not cover cataract and sinusitis in the first year of policy. Though, they are covered in the subsequent years
Pre-existing diseases (PED) are also not covered under many policies before the completion of the PED waiting period of 2-4 years

Is it compulsory to have a medical check-up before buying a health insurance policy?

For most policy seekers above the age of 50 years, it is compulsory to undergo a medical check-up before buying a policy. For some policies, medical check-ups are a requirement at the time of policy renewal.

What is a top-up and super top-up plan?

Top-up and super top-up plans are used at the threshold limit of health insurance plans. Threshold limit is the deductible limit of an insurance policy. Hence, the top-up and super top-up plans become active when the claim amount of policyholder is higher as compared to the top-up deductible limit. Both these plans are almost similar to each other with the only difference being that the top-up plan covers a single claim over and above the threshold limit, while the super top-up plan covers multiple claims over and above the threshold limit.

What documents are needed to purchase a top-up health insurance plan?

Below documents are required to purchase a top-up health insurance:
Proof of Age
Proof of identity
Proof of Address
However, if the age of the policyholder is above 50 years, a medical check-up report is also required to buy a top-up health insurance plan.

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Jan 19, 2023
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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