5 Questions to ask before buying Health Insurance

A medical policy is one of the most important investments you can make. It is very important to do your due diligence and research before you purchase it. One must remember that there are several different insurance providers in the market and each insurer has something unique to offer. Instead of looking for a policy based on the premium amount payable, it is better to check the coverage offered under it. There are a few questions you need to get answers to before you invest in a health insurance plan. Let’s look at the most important ones.

Q1: Can I seek admission in any hospital of my choice all over India?

A medical emergency can arise out of the blue. You could be on a vacation or posted in a different city for work. You could be living in a smaller city and may want to seek treatment in one where you can get the best medical attention. As such, it is important to check if you can encash your medical insurance policy anywhere. Generally, most health policies offer PAN India coverage. You can seek admission in any hospital across the country. That said, it is better to check the terms of your policy and see if there are any geographical limitations with regards to the claim settlement ratio.

Q2: What documents do I need to file a claim?

While filing a claim, you need to provide a photocopy of your identity proof document (PAN, Aadhaar or Passport) and the health policy identification card provided by the insurance provider if you are seeking treatment in a network hospital where you can utilise the cashless treatment facility. You will also need to submit a pre-authorisation form to the third party administrator for cashless claims.  If you are seeking treatment in a non-network hospital, you need to apply for reimbursement. For this you must submit original copies of all hospitalisation bills; including pre and post-hospitalization (medical tests, X-rays, biopsy reports etc.) and similar other documents required by the insurance provider.

Q3: What should I do if my preferred hospital is not listed in the network hospitals?

If you wish to seek treatment in a non-network hospital, you can do so. However, you cannot avail the cashless treatment facility and will need to file the health insurance claim on a reimbursement basis. This means that you will need to pay for the treatment up-front and then submit all bills for reimbursement. You also need to inform your insurer that you could be filing a claim and check if you need to submit any additional documents.

Q4: In what time can I expect a reimbursement?

Generally, it takes approximately 3 weeks for you to receive the claim reimbursement cheque. The insurer has to validate your claim. Note that claims are reimbursed only if you provide all the original bills as required by your insurance provider.

Q5: Can I purchase insurance if I have a pre-existing medical condition?

Yes, it is possible to purchase a health insurance policy even if you have a pre-existing medical condition. However, every insurance company, offering this service, has its own set of rules and regulations for such policies. For instance, you cannot encash the policy for a certain tenure (typically 2 to 4 years), known as the waiting period. The waiting period for pre-existing medical conditions policies is generally higher than a regular medical policy. You also need to check if the pre-existing condition is not covered in the policy for a temporary duration or if it is completely excluded for treatment as per the terms of the policy.