Personal Finance

Insurance uncovered

| Updated on June 02, 2019

The following are some of the frequently asked questions on health insurance compiled from the Insurance Regulatory Development Authority of India’s website:

What is cashless facility?

Insurance companies have tie-ups with several hospitals all over the country as part of their network. Under a health insurance policy offering cashless facility, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills, as the payment is made to the hospital directly by the third party administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits allowed by the insurance policy or expenses not covered under the policy have to be settled by you directly with the hospital. Cashless facility, however, is not available if you take treatment in a hospital that is not in the network.

Can I transfer my policy from one insurance company to another without losing the renewal benefits?

Yes. The IRDAI has issued a circular effective October 1, 2011, which directs the insurance companies to allow portability from one insurance company to another and from one plan to another, without making the insured lose the renewal credits for pre-existing conditions, enjoyed in the previous policy. However, this credit will be limited to the sum insured (including bonus) under previous policy. You can check with the insurance company for details.

What is the maximum number of claims allowed in a year?

Any number of claims is allowed during the policy period unless there is a specific cap prescribed in any policy. However, the sum insured is the maximum limit under the policy.

What is pre-existing condition in health insurance policy?

It is a medical condition/disease that existed before you obtained health insurance policy, and it is significant, because the insurance companies do not cover such pre-existing conditions, within 48 months of prior to the first policy. It means pre-existing conditions can be considered for payment after completion of 48 months of continuous insurance cover.

Is there any waiting period for claims under a policy?

Yes. When you get a new policy, generally, there will be a 30 days waiting period starting from the policy inception date, during which period any hospitalisation charges will not be payable by the insurance companies. However, this is not applicable to any emergency hospitalisation occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal.

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Published on June 01, 2019
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