Frequently Asked Questions On Health Insurance


Whenever people opt for a health insurance policy, they usually have a set of common questions to ask their insurance companies. These questions may range from the coverage provided to the premium amounts and claiming options to name a few. Here are some of the frequently asked questions asked by health policy buyers.

Coverage

The most common query is whether a health insurance covers accident, surgery and normal hospitalisation. Health insurance does cover everything, provided a person has been hospitalized due to an accident, illness, or disease. So for instance if a person meets with an accident and is hospitalised, his Mediclaim policy will help him pay for his bills.

Claim

The other question asked is about claiming a policy in case of emergency and planned hospitalisation. In order to make the process smooth, all the documents should be up to date. Any past history of illness must have been documented and presented properly because the third party administrators, or the middle men between the insured and the insurer, will come to know whether any illness struck the aspirant insured long ago.

Regarding planned hospitalisation, the Mediclaim Company should be informed in advance so it can arrange for settling the medical bills without the policyholder being required to submit any documents.

Document check

The most important aspect one should look for in policy documents is to check what the exclusions are. As insurers provide information only on what is covered but not on what is excluded, problems could crop up while making claims.

Conflict redressal

In case of a conflict with the insurer regarding a claim, a person can approach the Grievance Redressal Cell (GDR) of the Insurance Regulatory and Development Authority (IRDA). The GDR acts as a facilitator and takes up complaints with the respective insurers. Policyholders with complaints should first approach the Grievance/Customer Complaints Cell of the concerned insurance firm. If their grievances are not addressed properly, they can then approach the GDR of the IRDA.



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