Health Insurance FAQs about Coverage

No maternity benefit is available under individual health insurance plans. However, it may be available on a group plan; this varies from company to company.

At the time of purchasing a health insurance plan, you are required to fill a form stating the illnesses suffered during your lifetime. The illnesses declared at the time of filling the form are considered to be pre-existing diseases.

It is prudent to be truthful when making disclosures about your existing health problems (even if your agent might ask you to avoid mentioning them), since the insurance company is not liable to pay for any claims in case of misrepresentation of facts.

At the time of purchasing insurance, one must be aware of the diseases or illnesses they have suffered from and the treatment they are going through, if any. Insurers refer health issues to their medical panels to differentiate between pre-existing and newly contracted illnesses.

The sum assured under critical illness insurance ranges from Rs.100,000 to Rs. 50,00,000. A few insurance companies even offer smaller sums (Rs. 50,000) as part of a comprehensive health insurance package.

Usually, the policy ceases in the event of a claim. However, certain insurance plans offer to cover the insured for the remaining critical illnesses, at a lower sum assured and a revised insurance premium.

Usually, a critical illness policy is issued for a period of one year. Some insurers offer to provide the insured for a term of two to five years while a few offer it for a period of 10 years to 30 years; with the premium remaining constant for three years or five years.

When the condition of the patient is such that she/he cannot be moved to the hospital or when there is no bed available in any of the hospitals, the treatment is administered at the patient's home. Importantly, the treatment is reimbursable under the health plan only if the treatment is comparable to that provided at a hospital or a nursing home.

Usually, the limit of compensation is low and does not apply to certain diseases, such as asthma, bronchitis, diabetes, epilepsy, etc.

An ailment for which a claim has been made already does not become a pre-existent disease if there is no break in the term of the insurance policy and it is renewed by the due date. However, the ailment becomes a pre-existent disease and exclusions will apply in the event there is a break in the term of insurance. A break of up to 7 days is allowed under certain conditions; although it may vary by company.

For an overseas journey, you need the overseas health or travel insurance plan. You should check with your office regarding the type of health insurance cover provided when you are traveling abroad on company business, and then act accordingly.

Insurers will not pay for heart ailments during the first four or five years of a health plan in force since heart ailments are considered as a complication of a pre-existing condition.

There is no limit as to how long a person can stay in hospital. There is, however, a limit to the amount that the insurer will pay as hospital charges. It is usually a room rate or a proportion of the sum insured.