Family Floater FAQ

FAQ Health Insurance:


What does a Health insurance cover? :
A health insurance policy covers expenses that incurred due to the medical treatment/surgery. In order to get the benefits of the health plan, the policyholder has to go for at least 24 hours of continuous hospitalization. There are some day-care procedures (less than 24 hours) that are also covered under a health plan, but you also need to get hospitalized to avail benefits. It is suggested to go through your policy document to ascertain what is included and excluded under your policy.
Do I need to buy a health insurance policy even if I’m young and healthy?
Yes, it’s always advisable to buy a health insurance policy of adequate sum insured when you are young and in good health as the possibility of becoming sick in younger age is comparatively lesser so you can get a health insurance policy of adequate sum insured at best premium rate and the most important reason is- ‘peace of mind’. Having a health insurance policy, you won’t have to worry about the doctor’s fee and other medical expenses.
Please note that the possibility of any mishap or accident or sickness cannot be ruled out; it can happen to anybody, anywhere, anytime.
There are many reasons to opt for a health insurance policy at a young age. There are manifold advantages to it as listed below:
1.     Waiting period: In most cases, health insurance policies have a waiting period ranging from 30 to 90 days, during which you cannot make any claims even if you have a medical emergency. There is a waiting period for many ailments such as cataract, urinary tract stones, knee replacements, arthritis and so forth. Most insurance providers declare at least 10 to 15 ailments which have a waiting period of 1 year or 2 years. Individuals above 60 years have even longer waiting period in some cases. Buying a health insurance policy at a young age is, therefore, a big advantage in this context, as you would exhaust the waiting period without any concerns
2.     Comprehensive: If you make the wise decision of buying a health insurance policy when young, you can enjoy the benefit of comprehensive and holistic coverage. You will, therefore, enjoy greater security during employment and even after retirement.
3.     Low premium: In most cases, the premium amount charged by an insurance provider depends on your current age. If you opt for a policy at a young age, you can avail of a lower premium.
4.     Duration: It is important to note that most health insurance policies on offer come with a ceiling on upper age. If you buy a health insurance policy at a young age, you will not have to worry about age limits and thereby enjoying the benefit of health insurance for a longer duration.
5.     Tax benefit: Buying a health insurance policy at a young age will allow you to enjoy tax benefits for a longer period in that you can claim the premium you pay as deduction from your total income under 80D of the Income Tax Act, 1961.
6.     Coverage: Taking a health insurance policy at a young age ensures that you have greater coverage. Many latest health plans offer wide coverage from day care procedures and vector borne diseases to maternity benefits and OPD expenses among others. In short, your coverage costs will only increase as you grow older owing to possibility of more medical complications.
7.     Pre-existing conditions: Buying a health insurance policy in your late 40s will only increase your financial burden with reduced benefits. Many health insurance providers exclude many pre-existing conditions from getting covered which defeat the purpose of opting for a health insurance policy.
8.     Bonus: Most insurance companies offer a ‘no claims Bonus’ in the absence of any claims in the preceding year of a policy term. If you buy a health insurance policy at a young age, you can avail of cumulative bonus as you will most likely renew your policy every year. As a result, the bonus accumulated increases your coverage amount which will prove to be an advantage at later stages of life when you are old and grey. No claims bonus may range from 5% to 50% and in some cases 100% of sum insured.
9.     Wider options: You will be in a better position to choose from a wide variety of health insurance plans at a young age rather than in your late 40s. You have the freedom to opt or a plan which best suites your requirements by analysing all the important parameters.
10.  Lifelong renewal: You can opt for lifetime renewal of your health insurance plan and thereby, avail of extended coverage. Consequently, you can enjoy healthcare benefits for your entire life by opting for renewal of your policy.
11.  Lower chances of rejection: When you are young, you have many productive years ahead of you and less health complications. As a result, chances of your health insurance policy getting rejected are miniscule.
12.  Financial planning: Buying a health insurance policy at a young age not only gives you greater coverage but also helps you plan your finances in a better way. When you have adequate medical cover to take care of any health emergencies, you can focus on making other long-term investments.
13.  Personal health insurance: In this day and age of an exponential increase in medical expenses, the importance of a health insurance policy cannot be overemphasised. The coverage provided by your employer may not suffice to cover your costs. Furthermore, you will run the risk of being uninsured at the time of any job change or loss of employment.
14.  Poor health: Inactive lifestyles have led to an increase in the occurrence of many diseases related to heart and lungs claiming lives at a young age. It is a sad truth that health insurance is now no more relegated to senior citizens. The young and salaried segment of India’s population is vulnerable to a number of diseases.

Is there any eligibility criteria for Health Insurance ? :
Normally anyone between age group of 3 months to 65 years can take Health Insurance Policy. Normally for initial coverage above the age of 45 years the Insurance Company may ask you to undergo some of the medical check-up before deciding for the Health Policy.

What is Cashless Health Insurance :
Insurance company has tie ups with network Hospitals in various cities and the Policy holder may take treatment on production of the Health Cards provided by the Insurance Company with valid identity proof to Hospitals/TPA, without payment on taking necessary approvals from Insurance Company Assigned TPA in advance in case of planned surgeries.

What is TPA?
TPA is Third Party Administrators who act as intermediary for hustle free and unbiased claim settlement between the Insurance companies, Policy Holder, and Hospitals.

What is NETWORK HOSPITALS?
Network Hospitals have tie-up with TPA or directly with Health Insurance Companies. When a policy holder takes treatment at any of the network Hospitals then he can avail cashless treatment facilities depending upon the terms of the Policy and necessary approvals.

What if there is no network hospital in my vicinity or if I choose to take the treatment at any other hospital of my choice which is not a network hospital:
You need not worry because on submission of the admit card, discharge cards and necessary medical papers with proof of bills, prescriptions and receipt/proof of payment, your Health Insurance Company shall reimburse the expenses as per the terms of the health Insurance Policy.

I have a Health Insurance Policy provided by my employer. Do I still require to buy a separate individual policy?

Normally insurance covers provided by employers are of a lesser sum insured, which seems to be insufficient in case of any medical emergency. Most group insurance policies arranged by employers have co-payment and high deductibles in-build, due to which you may require to pay from your own pocket. There is a possibility of your leaving the job and the new employer might not offer the health cover. In such case you will have to buy a fresh health policy in which you will lose pre-existing benefits that you have accrued over the period.

By buying a separate health policy, you can choose cover amount and other benefits as per your medical requirement.


Important Points for buying a Health Insurance:
Basic point of concern is obviously Premium you pay for the Policy. 
There are some other salient elements that should be taken into account while buying a health insurance policy.
(a) Adequate cover
(b) List of Network hospitals
(c) Cashless facility 
(d) Deductibles 
(e) Waiting period for specific illnesses/condition
(f) Room-rent capping
(g) Exclusions
(h) Insurer’s claim settlement ratio

Is premium paid for Health Insurance eligible for Tax deduction?
Yes. Premium paid are entitled for Income tax exemption under section 80-D of the Income Tax Act.

Is GST 18% is applied on the Health Policy ?:
Yes. GST at rate of 18% is applicable for all financial services, including Insurance Premium, with effect from July 1, 2017.

Is Health Insurance Premium exempted under Income Tax ?
Yes. The Health Insurance premium if paid by cheque or other mode (Except Cash) is exempted under section 80 D of Income Tax Act.

What are the major factors on which health insurance premium is determined?:
The premium depends upon the Sum Insured, Age, Coverage provided, Insured’s life style, Previous medical history etc.

Is there any waiting period for making a claim under Health Policy ?
Except in case of Accident there is a waiting period of 30 days when the Health Policy commences for the first time.

What are pre-existing conditions?
Is here any waiting period for these conditions to make claims? 
Pre-existing condition is the disease / illness that existed before you buy a Health Policy. Normally Insurance Companies do not cover the pre-existing conditions that had symptom or treated before 48 months of buying the 1st Health policy. After continuous claim free policy for 4 years these are liable to be covered.

Is online purchase of policy cheaper than that of the traditional mode?  
By buying online policy there is no broker or agent and no commission to be paid by the Insurance companies so premium are obviously lesser.

Can a health insurance policy from one insurer be transferred to other insurer?
Yes. As per guidelines of IRDA you can port out your existing Health Insurance Policy to another Insurance Company of your choice without losing the benefits of the existing health Insurance Policy.

What is the maximum number of claims I can make in a policy year?
You can make any number of claims but maximum overall liability for the policy period of the Insurance Company will be restricted maximum to the Sum Insured. If you have exhausted the sum Insured and if you have a separate top up or super top up policy then you can claim under that policy sum Insured

Should I include my parents in my Health Insurance Policy?
As the premium is calculated mainly taking the age of the oldest person of the family the premium will shoot up hence not a wise decision to cover parents in your Health Insurance. Instead let your parents be covered under a separate Health Insurance Policy. ---

What is a family floater plan:
It covers all the family members under one single Health Policy with common FIXED Sum Insured which could be used individually or separately by self, spouse, children and parents. The Maximum liability of the Insurance company is Sum Insured fixed for the whole family.

Why Family floater Policy?
This policy proves cheaper than buying the policy individually and a provision to add a new born baby during the policy period and newly married spouse could be added at the time of the renewal of the Policy.

What are the documents required to have a floater policy?
a.     Age proof, address proof.
b.     Duly filled proposal form
c.      Some plans may requires some of the members of family to undergo medical tests.

What happens if the eldest member of the family dies or attains the age of maximum renewability?
The next eldest member of the family can continue with the same policy and enjoy the benefits of continuity of the policy

During the course of my treatment can I change my Hospital?
Yes. You can change the hospital for better treatment after informing your TPA who will evaluate your case as per the terms of the Policy.

What are situation under which the cashless hospitalisation is denied at Network Hospitals?
a.     There is incomplete information to TPA or discrepancy.
b.     If the ailment or condition is not covered under the Policy
c.      If the pre authorisation request is not received by TPA from Insured on time
In the above situation the Insured is required to make the payment for the treatment and subsequently put a claim for reimbursement as if the treatment is not taken at network hospital

How can I check the status of mu claim?
You can contact your TPA or from the official website of TPA.

Best Reasons To Buy Insurance Online: Presented below are 5 express reasons to purchase your next insurance policy online or pay insurance premium online. As noted before, it is all about combining convenience with simplicity.
a)     Lots of Options- Whilst the offline search for insurance policies may seem convincing enough, you aren’t actually seeing the whole picture. It’s not your fault- legwork can be daunting, and you cannot convincingly check out all the available options in a defined period of time. Thus, checking out all the available options (inclusive of the pros and cons, terms and conditions, qualification factors and peer reviews) online makes for a very sensible choice.
b)     Avoid the Mind Games- When dealing with an insurance agent; you are forced to match with a fellow human being who isn’t an impartial authority with regards to what suits your condition the best. He is a salesman who is trying to sell you a product, and all the marketing tricks are in play. Thankfully, this isn’t a problem when buying insurance policy online. In light of all the information before you, an informed and accurate decision can be made instantly.
c)      Buying Online is Cheaper- Insurance companies prefer it if you buy their insurance policies and/or pay your premiums online. This is because the said companies don’t have to pay the agents any hefty commissions and the commonly incurred costs pertaining to sales, documentation and other facets of the policy are saved. Thus, the costs are kept low and all the benefits reaped are passed onto the customer. It is a win-win situation for both the insurance company and the customer.
d)     Discounts and Offers- To encourage people to purchase insurance policies online, insurers, in collaboration with partners, offer lucrative discounts and offers. For instance, some credit cards companies as the ones offered by Citibank and Standard Chartered Bank offer 5% cash-back to their cherished customers as and when they affect a credit card transaction. Why not use this facility to pay your insurance premium and avail a sizable profit?
e)     It is Faster, Safer and Simpler- Obviously, running a rat race to find the best insurance plan versus checking out the ‘one’ online are poles apart in terms of the time, energy and patience involved. Plus, insurers ensure that when it comes to safety, financial transactions on their websites are akin to the online equivalent of Fort Knox. Plus, procedures are so simple, even a child could complete them all (not a recommended proposition though).
Hence, buying the insurance policy online is totally worth it when compared to buying from the traditional sources. In this modern age of internet, fast connectivity and banking’s enhanced presence online, choosing the slower option could be considered a costly mistake