Question 1. What Is Coinsurance For Health Insurance Policy?
Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain.
Question 2. My Father’s Age Is 55, Central Government Employee And My Mother Is A House Wife, 43 Years Old. I’d Like To Take Health Insurance For Both Of Them. So Which Financial Institution Would Be Better To Apply For Health Insurance? Do My Parents Fall Under The Senior Citizens Category?
Health insurance is very important for your parents, especially in old age. There are schemes available from many insurance companies like Bajaj Allianz, Star health insurance and many others (the names are just a sample. Please do talk to the insurance agents before you take it).
Usually when you take insurance at old age, the expenses are much higher. Hence it is important that you carefully study the insurance companies ,proposal and the support provided.
Question 3. What Is Co-payment For Health Insurance Policy?
Co-payment is the amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor’s visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained.
Question 4. Does Health Insurance Offer Any Other Benefits Other Than Coverage Of Hospital Expenses? If I Am Opting For Some Additional Coverage, Should I Pay More Premium?
Many people think that health insurance policies cover only hospitalisation expenses. However, most plans offer additional benefits apart from hospitalisation expenses. Additional covers vary for different plans / companies, however most of them are offered without additional premium charges. Other covers offered by health insurances are:
Daily hospital cash allowance: Some policies allow a daily allowance when hospitalised which cover food, refreshments and other expenses which is normally a pre-fixed amount on a per-day basis.
Recuperation benefit: Some policies treat post-hospitalisation as the period of recovery, and allow claims for related expenses incurred upto a certain time period. Policies also promise a lump-sum amount in case of a prolonged stay at the hospital.
Attendant allowance: Some policies grant a fixed amount on a per-day basis to adults who look after an insured child at a hospital.
Critical illness: Some policies offer a higher sum insured limit for certain critical illnesses.
Ambulance charges: Health policies even cover ambulance charges
On buying the health insurance policy, it is important to go through the fine print in detail. Many benefits of health insurance go unused simply due to the lack of knowledge of what is covered in the policy.
Question 5. Is There Any Difference Between Health Insurance And Mediclaim Policy?
Health insurance and mediclaim are often confused for the same thing especially by a lot of new people not having much knowledge about health insurance. A Mediclaim policy offers cover for hospitalization expenses for a certain pre specified illnesses till a specific limit as per the sum assured.
The maximum cap however for all claims under a mediclaim policy is fixed at Rs. 5 Lakhs. A mediclaim policy works on the principle of indemnity where hospitalization is a definite requirement to consider any claim. Also the mediclaim policy holder needs to spend the money from his own pocket during the hospital stay and is compensated or reimbursed later.
A health insurance policy on the other hand offers a comprehensive coverage covering both pre and post hospitalization expenses. Depending on the health insurance riders, a health insurance policy can also provide adequate coverage for ambulance charges, compensation of lost income and others. The upper limit of a health insurance policy can go as high as Rs 60 Lakhs. Health insurance policies offer the chance of getting a discount on annual premium after specific period of the policy depending on the insurance company.
Another difference between mediclaim policy and health insurance policy pertains to the availability of tax deduction. While Health insurance premium paid towards a health insurance policy offers tax exemption under section 80D of Income Tax Act, the money paid towards mediclaim premium paid for self or spouse or children is eligible for tax exemption of Rs 15,000 under section 80D.
Question 6. Can You Tell Me What Does Cumulative Bonus Means In A Health Insurance Plan?
Just like a no claim bonus offered for car insurance, a cumulative bonus is offered for health insurance. The sum insured is increased by a specified percentage for every claim free year. Depending on your health insurance company either you can get an increase in the sum insured or get a discount on the annual premium or at times a combination of both.
The cumulative bonus can mean an increase in the sum assured by as much as 5% and can go as high as 50% of the basic Sum Assured. In case a claim is made, specified percentage of Sum Assured is deducted from the cumulative bonus in the subsequent year. An important point to keep in mind is the fact that your policy should be renewed without a break to be liable for a cumulative bonus.
Question 7. What Is Ncb Retention Add-on Cover For Car Insurance? Is It Useful To Go In For Such An Insurance Add-on?
NCB retention is a relatively new add-on cover offered by general insurance companies. No claim bonus, commonly known as NCB is a reward offered by insurance service providers to their clients in case they do not file for any insurance claims. As a reward, insurance companies offer discount on the annual premium for policy renewal. Car owners can get as much as 50 percent discount on the own damage part of the insurance premium using no claim bonus.
No claim bonus retention is an add-on cover attracting a number of car insurance seekers. Under this, add-on claims made by the individual under a specific pre defined limit do not alter the NCB bonus thus allowing the car owner to avail full discount on annual premium. Hence NCB retention is a good way to exercise claims while keeping your no claim bonus intact.
Question 8. Can Anyone Tell Me What Is Sub Limit In Health Insurance?
Sub limit means that the insurance policy will put a maximum cap limit for various disease types and surgeries. For example if the policy offers a sub limit for say cataract surgery you can claim only up to a certain amount for cataract surgery claims even though the total sum assured may be higher. It is always good to know the insurance sub limit in detail for various diseases before taking any health insurance policy.
Question 9. Is It Good To Take Insurance Through Banks?
If the insurance company is linked to your bank, chances are that it will offer your health insurance at a lower premium compared to other companies. Most of these health policies have a very small premium to attract the vast customer base of the bank. One of the biggest downside of bank associated low premium health care policies is the fact that banks have no active role in any decision making. Neither can the banks help the consumer in case of claim settlement. Once you have opted for a health insurance policy, the bank is simply an intermediary and you will have to deal insurance service provider directly. Hence choose your health insurance plan wisely.
Question 10. Will A General Health Insurance Policy Cover Costs For My Ent Treatment? I Know Dental Treatment Is Usually Excluded But What About Ent?
General treatment for ear, eye, nose and throat are not covered under a general health insurance policy. Dental and ENT treatments are considered to be part of a cosmetic procedure and do not impact the health of an individual directly and hence excluded from general health insurance cover. You will need to check with your health insurance company if they offer any policy covering ENT treatment.
Question 11. What Is The New Plan Of Irda For Entry Based Pricing For Insurance Premium?
Currently premium is based on the age of the policyholder and does not matter if it is the first health policy of the applicant. As per the new guideline proposals, if two people of the same age buy a health policy at the same time, an individual who has already had a health policy should be charged a lower premium compared to the other person applying for the health plan for the first time.
Question 12. What Is Premium For Health Insurance Policy?
Premium is the amount, the policy-holder or their sponsor (e.g. an employer) pays to the health plan to purchase health coverage.
Question 13. Do Health Insurance Plans Cover Charges If One Were To Opt For A Second Opinion?
Health insurance policies have various exclusions that are not covered under the ambit of the policy. Most policies also exclude any charges for second opinion from the health insurance cover.
Question 14. What Is Prior Authorization For Health Insurance Policy?
Prior Authorization is a certification or authorization that an insurer provides prior to medical service occurring. Obtaining an authorization means that the insurer is obligated to pay for the service, assuming it matches what was authorized. Many smaller, routine services do not require authorization.
Question 15. What Is Capitation For Health Insurance Policy?
Capitation is an amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer.
Question 16. Do Health Insurance Policies Offer Protection For Expenses Incurred During Pregnancy And Childbirth?
Pregnancy and childbirth related medical coverage is not extended to all health care policies. However some policies have this as an add-on cover. If you wish to take this add-on cover, I suggest you to check with 3-4 leading insurance providers about the coverage offered for pregnancy related expenses. Make a good comparison; you can do it online. This is because the features / coverage may vary a lot.
Some policies may also have a waiting clause for pregnancy for a period of one to two years while others exclude all pregnancy and child birth related medical expenses from general medical insurance. If you are looking for any specific protection against pregnancy and childbirth related expenses, like for example, cesarean fee, post-delivery care etc, you can also check out pregnancy specific healthcare policies instead of a general health insurance policy.
Question 17. Is Day Care Eye Surgery Covered By Health Insurance?
These days health insurance policies cover a large number of day care and OPD procedures. For your exact case you will have to seek advice of your insurance company but usually eye and dental surgeries that are done on OPD basis are by and large covered under most health insurance schemes.
Question 18. Is There A Claim Settlement Deadline For Health Insurance Claims?
Yes all health insurance companies need to settle all duly filled claims within a stipulated period of 30 days. If the insurance company is unable to process your claims within 30 days of receipt of all required documents and claim form, the policy holder has the legal right to seek interest in the claim amount for the delayed period.
Question 19. What Is The New Health Insurance Portal Announced By The Government? Is It Functional Yet Or Just An Announcement?
Coverage Limits: Some health insurance policies only pay for health care up to a certain dollar amount. The insured person may be expected to pay any charges in excess of the health plan’s maximum payment for a specific service. In addition, some insurance company schemes have annual or lifetime coverage maxima. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs.
Question 20. What Is Exclusions For Health Insurance Policy?
Exclusions are the services which are not covered. The insured are generally expected to pay the full cost of non-covered services out of their own pockets.
Question 21. What Is In-network Provider For Health Insurance Policy?
In-Network Provider is a health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or co-payments, or additional benefits, to a plan member to see an in-network provider. Generally, providers in network are providers who have a contract with the insurer to accept rates further discounted from the “usual and customary” charges the insurer pays to out-of-network providers.
Question 22. What Is Deductible For Health Insurance Policy?
Deductible is the amount that the insured must pay out-of-pocket before the health insurer pays its share. For example, policy-holders might have to pay a $1000 deductible per year, before any of their health care is covered by the health insurer. It may take several doctor’s visits or prescription refills before the insured person reaches the deductible and the insurance company starts to pay for care. Furthermore, most policies do not apply co-pays for doctor’s visits or prescriptions against your deductible.
Question 23. Is Opting For A Surgical Plan Better Than General Health Insurance?
To get cover for a surgery you can opt for a surgical protection plan instead of a general basic cover. A general policy may deny your claim for the same surgery on various counts but with a surgery centric policy you get paid a fixed amount for each surgery depending on the surgery grade. Health insurance companies list surgeries on a rating scale depending on the complexities involved. So depending on the grade or rank of the surgery involved the policy will pay you a fixed stipulated amount irrespective of your hospital bill.
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