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Frequently Asked Questions

Health insurance, also called as Mediclaim, is way to pay for advance medical treatments, that typically require you to be in-hospital overnight. It also covers certain other day procedures like cataract surgery, etc that don't require you to be hospitalized but are expensive nevertheless.

A basic health insurance plan provides all the essential coverage features. You would find coverage for the following –

A basic health insurance plan provides all the essential coverage features. You would find coverage for the following –

Inpatient hospitalisation

This includes coverage for room rent, ICU room rent, cost of treatments, doctor’s fees, surgeon’s fees, nurses’ fees, etc.

Pre and post hospitalisation

Expenses incurred before being actually hospitalised and after being discharged from the hospital are covered under this head.

Ambulance costs

Costs incurred in transporting the insured to the hospital is covered up to a specified limit.

Day care treatments

Treatments which do not require hospitalisation for a minimum of 24 hours are covered under this section.

Besides these common coverage features, different health insurance plans provide different coverage features too which make the plan comprehensive in nature.

Health insurance will not cover the following -

  • Treatments for HIV/AIDS
  • Drug/alcohol abuse
  • Self-inflicted injuries
  • Cosmetic surgery
  • Routine doctors’ visits, medicines or tests unless specifically included in the plan as add-ons.
  • Maternity is not covered, unless explicitly mentioned as an add-on.
  • Some specified conditions such as hernia, varicose veins and fibroids, etc. are covered only after you have spent some time in the policy, typically 1-3 years. Its best to disclose your medical history truthfully before you buy a policy to ensure your claim expectations are met. Discuss this with our expert to figure out your best options - we will maintain strict confidentiality.

Employer cover is often too less and/or does not cover all the family members. Does your employer policy have atleast 5 lakhs of cover?

  • You lose the cover when you retire or leave the job, and
  • It can become difficult to get health insurance at that time if you are suffering from conditions like diabetes or blood pressure, the risk for which increases steeply with age.

As soon as you decide that you are going to be hospitalized please call us or the insurer to confirm claim eligibility as well start the pre-admission work. Our friendly customer service team will help and guide you through the process.

Your claim may be rejected if,

  • You are claiming for something that is not covered by the plan, OR
  • You are claiming for a disease existing prior to your enrolment in the plan, which you did not disclose to the insurer.
  • Speak to our expert advisors to understand cover restrictions & disclosures.

Health insurance is a form of insurance which covers the medical costs incurred in case of medical emergencies. These plans, thus, take care of the financial burden associated with medical contingencies. In today’s age, when illnesses and diseases are on the rise, a health insurance plan becomes necessary. Though medical developments have provided a cure for most of the illnesses, such cures and treatments come at very expensive costs. These costs become unbearable for the common middle-class man. A health plan, by covering these costs, takes off the financial strain caused by frequently occurring illnesses. It, therefore, proves to be an essential requirement for every individual looking to secure his finances against medical contingencies.

Health insurance claims are of two kinds –

  1. Cashless claims
  2. Reimbursement claims

In cashless claims, the insurance company settles the medical bills directly with the hospital. The policyholder does not have to pay for any medical costs himself. Cashless claim settlement can be availed if the policyholder chooses to get admitted to a hospital which is tied-up with the insurance company.

In case of reimbursement claims, the medical expenses are to be borne by the policyholder initially. Thereafter, when the insured is discharged from the hospital, the claim is submitted to the insurance company with all the relevant bills and medical documents. The company analyses the claims and then reimburses the policyholder for the medical expenses incurred. Reimbursement claims are applicable if the policyholder does not choose a networked hospital for treatments.

Yes, come health insurance plans cover Ayurvedic and alternative treatments taken by individuals. However, there might be a limit to the coverage allowed.