Top 10 Health insurance queries

S.K. Sethi, Vice President of Insurance Foundation of India answers 10 most frequently asked questions about Health Insurance.

Q.1. How is the agent helpful in settling claims in future?

Ans. Yes your agent will be helpful but he is getting 100% of his income from the insurance company and he may be getting .001 % of his income from you. If he has to make a choice, he will favour Insurance Company. You are the best person to decide whether directly from the company or through an agent. Theoretically he is supposed to help you in claim settlement but time will tell when the claim is to be lodged. Be positive and buy it through agent but better buy through an Insurance Brokerage Firm as it offers wider choice.

Q.2. What are the minimum and maximum policy durations?

Ans. Minimum is 1 year. Some companies offer 2 years duration also.

Q.3. Can I buy more that one Health Insurance policy?

Ans. Yes, you can buy more than one insurance policy but the claim should not be duplicated to two insurance companies. Under normal circumstances the claim amount will be shared by both insurance companies in the ratio of the sum insured. Let us say Company 'A' insured you for Rs. 2 lakhs and Company 'B' insured you for Rs. 3 lakhs, then the claim will be shared in the ratio of 2:3. In case you have gone in for a normal policy of Rs. 2 lakhs from Company A and Top-Up policy of Rs 3 lakhs from United, then in that case first Rs. 2 lakhs will paid by Company A and the claim above Rs. 2 lakhs will be paid by United. Top up Policy costs less than normal policy of Insurance Company. For right advice it is always better to consult an Insurance Brokerage Firm.

Q.4. Can I buy health insurance policy even if I am not an Indian National but am living in India?

Ans. Yes, if you are a student studying in India or you are working on a valid Visa then you can get the policy. But if you are a tourist coming to India for a short duration say 3 weeks then it will not be worthwhile to buy health insurance as 30 days cooling off period will take away the benefits, you are looking for.

Those who are coming for Medical Tourism can not buy the policy and avail the benefit i.e. claim.

Q.5. Who will receive the claim amount under health insurance if the policyholder dies during treatment?

Ans. Nominee will receive the amount if the policyholder dies during treatment.

Q.6. Can I seek treatment at home and be reimbursed for it under health insurance?

Ans. It can be possible in exceptional cases only when there is an epidemic and no beds are available in hospitals. This is called domiciliary treatment in insurance language/terminology.

Q.7. I might be laid off soon. Should I see my doctor before I lose my insurance?

Ans. No purpose will be served by seeing your doctor. You should consult an insurance brokerage firm and buy a health insurance policy which should be in place 30 days before your last day in your company. This protects your interests as on the day you leave the present employer –on the same day cooling off period of your new policy will be over.

Q.8. I am unable to work due to Disability. What are my options for health coverage?

Ans. It depends on the disability. We suggest that you should buy a health insurance policy. Suppose you are disabled due to poor eyesight, you may not be able to work but you may fall ill and need hospitalization. Insurance company will put eye disease /ailment as pre existing disease and it may not be payable –but there can be hundreds of other ailment and accidental happenings, which get covered.

Q.9. Who is a Third Party Administrator?

Ans. TPA is an abbreviation for Third Party Administrator. These companies are BPO’s of insurance companies and are responsible for coordinating all aspects of claims pertaining to health insurance policies.

These companies are licensed by IRDA (Insurance Regulatory & Development Authority) and are having
•    Telecom facility generally with phone number starting with 1600 (toll free no.)
•    Computer network having details of all policies holders.
•    Medical specialists, for assessing need for hospitalization treatment being given in the hospital and for passing of the claim bills.

The role of TPA is to coordinate with hospitals with respect to treatment and also
to pass the bills on behalf of the insurance companies. The actual payment is made by the insurance company. As far as the legal contract is concerned, it is between the insurance company and the person insured.

The individual insured will get an ID card issued by the TPA. This ID card is useful and may be needed at the time of hospitalization.

Q.10. Are naturopathy and homeopathy treatments covered under a health policy?

Ans. In all policies naturopathy is not covered. However Homeopathy is now being covered by some insurance companies, provided treatment is taken in a Homeopathic Hospital, which is empanelled with the insurance company. Star Health permits use of Homeopathic medicines during post hospitalization period.

We foresee more and more Insurance companies will start covering naturopathy and homeopathy treatments in future.