Question 1

What is health insurance?

Accepted Answer

Health insurance is a financial protection tool that helps cover medical expenses arising from illness, accidents, or hospitalisation. You pay a premium, and the insurer either reimburses you or directly settles eligible medical costs, as per the policy terms.

Question 2

Why is health insurance important?

Accepted Answer

Health insurance is important because it helps protect you against rising healthcare costs, enables access to quality medical care, and reduces financial stress during medical emergencies. Health insurance premiums may also qualify for tax benefits as per applicable tax laws.

Question 3

What is the meaning of sum insured?

Accepted Answer

Sum Insured is the maximum amount payable by the insurer for covered medical expenses during a policy year, subject to sub-limits and policy conditions.

Question 4

What is an Electronic Insurance Account (EIA)?

Accepted Answer

An Electronic Insurance Account (EIA) is a digital account that stores all your insurance policies in electronic form. It makes your policies easier to access, manage, and keep track of in one place.

Question 5

How do I apply for a new Prudential Health insurance policy?

Accepted Answer

You can apply for a new Prudential Health insurance policy online through the [official website](https://prudentialhealth.in/health-plans) or via an authorised agent. Submit the proposal form, KYC documents, and make the premium payment. You may have to undergo medical tests depending on the information provided.

Question 6

What is a proposal form and why is it important?

Accepted Answer

A health insurance proposal form is the application document where you provide personal, medical, and lifestyle details to an insurer, to help set the terms for your policy. This form must be filled accurately and honestly for accurately to avoid any potential denial of claims in future.

Question 7

What documents are required to buy health insurance?

Accepted Answer

The documents required to buy health insurance are KYC documents and recent medical reports (if applicable).

Question 8

Is KYC mandatory for buying health insurance?

Accepted Answer

Yes. KYC (Know Your Customer) is mandatory for purchasing a new health insurance policy, as per IRDAI guidelines. Completing KYC helps verify your identity and is also required for certain policy changes and endorsements.

Question 9

What documents are accepted for KYC?

Accepted Answer

Documents accepted for KYC are identity proof (Aadhaar, PAN, Passport, Voter ID ) and address proof (Aadhaar, Utility Bill, Passport, Driving License).

Question 10

How can I pay my premium?

Accepted Answer

You can pay your premium via net banking, credit or debit card, UPI, or cheque/DD. For assistance contact us through WhatsApp by sending "Hi" from your registered phone number or call on Toll-free number 1800 268 2000.

Question 11

What happens if I miss my premium payment?

Accepted Answer

If you miss your premium payment, your policy may lapse after the grace period of 30 days. You can revive it as per the terms and conditions of the insurance policy.

Question 12

Is there any penalty for late payment?

Accepted Answer

Yes, receipts are available immediately after payment via email. You can also download it through PRUAssist on our website www.prudentialhealth.in or WhatsApp.

Question 13

What if my claim is rejected?

Accepted Answer

You will receive a detailed reason for rejection of claim via e-mail. You can appeal within 30 days. If you are still not satisfied, and the claim requires consideration, you may escalate to Ombudsman forum.

Question 14

If the Ombudsman passes an award, by when must it be implemented?

Accepted Answer

Insurers must implement within 30 days or pay ₹5,000/day penalty until implemented; penal interest as applicable. Regulatory turnaround time is 30 days.

Question 15

Does my health insurance policy cover me for COVID-19 treatments?

Accepted Answer

Yes your health insurance policy covers you for COVID-19 treatments. As per the Insurance Regulatory and Development Authority of India (IRDAI), every indemnity-based health insurance policy will cover you for expenses related to treatment required due to positive diagnosis of COVID-19, as an in-patient.

Question 16

What are some common exclusions under health insurance plans?

Accepted Answer

Common health insurance exclusions may include cosmetic or aesthetic procedures, dental treatments not caused by an accident, injuries arising from adventure sports, self-inflicted injuries, and certain alternative therapies that are not covered under the policy. Coverage and exclusions can vary by insurer and plan, so it is important to review the policy terms carefully before buying.

Question 17

What is a network hospital?

Accepted Answer

We tie-up with several hospitals across India where you can avail of cashless treatment as covered under your health insurance policy. These hospitals are known as network hospitals.

Question 18

Do I get a discount on the renewal of the policy with Prudential Health?

Accepted Answer

Under some health insurance plans you may be available to avail of a cumulative bonus or renewal discount based on your policy.

Question 19

Will my health insurance policy expire if not renewed on time?

Accepted Answer

Yes. Health insurance policies have a fixed validity period and must be renewed before they expire. Most insurers offer a grace period of up to 15 days, allowing you to renew and retain continuity benefits. If you do not renew within the grace period, the policy may lapse, resulting in the loss of benefits such as waiting period credits and No Claim Bonus.

Question 20

If I want to cancel my health insurance policy after purchasing, can I do so?

Accepted Answer

Yes. You can cancel your health insurance policy within 15 days of receiving the policy documents under the free-look period. If no claim has been made during this period, you may be eligible for a refund as per the insurer's terms and conditions.

Question 21

How much health insurance coverage do I actually need for my family?

Accepted Answer

Your insurance cover should ideally be 10 to 15 times your annual income. For a family floater health plan in India, ₹10–25 lakh is a good starting point to manage rising medical costs and hospital insurance needs.

Question 22

How does age affect my health insurance premium?

Accepted Answer

Age directly impacts health insurance premium because younger buyers are seen as lower risk. Buying insurance early helps secure low premium medical insurance and ensures you complete waiting periods while you are still fit and healthy.

Question 23

What is the difference between individual and family plans?

Accepted Answer

An individual health insurance policy covers one person, whereas a family medical insurance plan covers multiple members under one sum insured. Family plans are usually more affordable than buying several separate mediclaim policies for each person.

Question 24

What are the benefits of buying health insurance at a young age?

Accepted Answer

The benefits of buying health insurance at a young age are lower insurance premiums and shorter waiting periods. It helps you qualify for the best health insurance plans in India while securing long-term savings and comprehensive medical insurance coverage.

Question 25

What does pre-existing disease mean?

Accepted Answer

A pre-existing disease is any illness or medical condition diagnosed before you buy a health insurance policy. Coverage for these conditions usually begins only after a defined waiting period, provided you declared them honestly during the purchase.

Question 26

What is a waiting period in health insurance?

Accepted Answer

A waiting period is a specific timeframe during which certain treatments or conditions are not covered. This typically applies to pre-existing diseases, maternity cover, and specific planned illnesses. Once this period ends, you can claim those treatments.

Question 27

Should I buy separate insurance if I already have company health cover?

Accepted Answer

Yes, because employer group health insurance often provides limited coverage that ends when you leave the job. A separate individual mediclaim policy ensures continuous protection, higher coverage, and personal control over your insurance needs.

Question 28

Can a person have more than one health insurance policy?

Accepted Answer

Yes, you can hold multiple medical insurance policies. You can even claim hospital bills under two insurance policies if the cost exceeds the limit of one, provided you follow the insurers’ coordination rules.

Question 29

Is there a right age to buy a health insurance policy?

Accepted Answer

The best age and time to buy health insurane is as early as possible. You can ideally buy a plan in your 20s. Buying early leads to cheaper health insurance premiums, better long-term benefits, and ensures peace of mind against a possible medical condition in the future.

Question 30

Can health insurance be bought by a minor?

Accepted Answer

Minors cannot buy a policy independently, but can be covered under family health insurance plans or child-specific health policies. Usually, a parent or legal guardian must act as the primary policyholder for the medical insurance.

Question 31

What does portability mean in health insurance?

Accepted Answer

The meaning of portability in health insurance is the option to switch your health insurance policy from one insurance company to another without losing the benefits you have already earned.

Question 32

What does migration of health insurance policy mean?

Accepted Answer

Migration of health insurance means switching from one health insurance plan to another offered by the same insurer, while retaining benefits like waiting periods and continuity of coverage. It differs from portability, which means moving to a different insurer.

Question 33

Can I port my health insurance policy to Prudential Health from another insurer?

Accepted Answer

Yes, you can port your health insurance policy to Prudential Health. We accept portability requests from other insurers as per IRDAI guidelines. Provided you have at least 45 days to renew your current policy and it has been active without breaks in renewal.

Question 34

Will I lose my waiting period benefits if I change my insurer?

Accepted Answer

No, you will not lose your waiting period benefits if you change your insurer. As per IRDAI’s portability rules, your new insurer must give you credit for the waiting period you have already completed under your previous policy. This means you do not have to restart the waiting period as per the terms and conditions of the new policy.

Question 35

Can I port my policy within the same insurance company?

Accepted Answer

Yes porting your policy within the same insurance company is called migration. You can move from one plan to another within the same health insurance company. For example, you can switch from a basic plan to a higher coverage plan without losing your waiting period benefits, though other terms like premium and coverage may change.

Question 36

When can I apply for portability?

Accepted Answer

You can apply for portability at the time of policy renewal. You must submit your request to your existing insurer at least 45 days before policy expiry, informing the company that you want to switch to another insurer.

Question 37

What conditions should I meet to port my policy successfully?

Accepted Answer

You must meet the following conditions to port your policy successfully:
- There are no gaps in your previous renewals
- You applied for the policy at least 45 days before the expiry of your current plan
- You have completed all the documentation and shared your health and claim history with the new insurer

Once approved, your new insurer will continue your coverage without loss of key benefits.

Question 38

Will my new insurer offer the same coverage and premium as my old insurer?

Accepted Answer

Not necessarily. The new insurer can decide the premium, terms, and coverage based on their policy rules and underwriting process. However, the minimum requirement is that the insurer must at least match your current sum insured. Other coverage terms will be shared with you.

Question 39

What happens if there is a delay in the porting process?

Accepted Answer

If your portability request is in process, you will still get a 30-day grace period to renew your existing policy with your current insurer. This ensures your coverage continues until the new insurer finalises your policy.

Question 40

How does the data transfer work between two insurers?

Accepted Answer

The IRDAI has a centralised an online system where all insurers upload health insurance policy data. This system allows your new insurer to securely access your policy and claim history, which makes the portability process faster and more transparent.

Question 41

Why should I consider portability instead of buying a new policy?

Accepted Answer

Portability helps you retain all your accrued benefits like waiting period credits, continuity of coverage, and no-claim bonuses (if applicable). Buying a completely new policy means you start over with fresh waiting periods and lose your previous benefits. Portability gives you the freedom to choose a better plan without losing what you have already earned.

Question 42

Can I move from a Group Policy to an Individual Policy?

Accepted Answer

Yes. You can move from a group health insurance policy to an individual or family floater policy. The waiting periods you have already completed will be carried forward. However, the new insurer may assess your health details before issuing the policy.

Question 43

If I increase my sum insured while porting, do waiting periods reset?

Accepted Answer

You can increase the sum insured while porting your plan. However, waiting periods may apply on the increased part of the sum insured.

Question 44

What is a co-payment in health insurance?

Accepted Answer

A co-payment means you share a small portion of the hospital bill with the insurer. For example, if your policy has a 10% co-payment and the bill is ₹1,00,000, you pay ₹10,000, and the insurer pays ₹90,000. This helps keep premiums lower while still providing strong financial protection.

Question 45

Is co-payment mandatory in all health insurance policies?

Accepted Answer

No, co-payment is not mandatory in all health insurance policies. Many standard health insurance plans do not have a co-payment clause unless you choose one to reduce your premium. However, some senior citizen policies include co-payment as a standard feature due to higher medical risks with age.

Question 46

Can I choose my co-payment percentage?

Accepted Answer

Yes, you can choose a co-payment percentage at the time of purchase or renewal. Common options include 10%, 20%, or 30%. A higher co-payment usually lowers your premium.

Question 47

What is the difference between co-payment and deductible?

Accepted Answer

A co-payment is a percentage of each approved claim that you pay. Whereas a deductible is a fixed amount you must pay in a policy year before the insurer starts covering the approved expenses.

Question 48

What is a deductible in health insurance?

Accepted Answer

In health insurance, a deductible is the amount you need to pay from your own pocket before your insurance starts covering your medical expenses. Once your expenses go above this amount, the insurer pays the covered costs. Deductibles are often used in top-up and super top-up plans to make premiums more affordable.

Question 49

Can I remove or change the co-payment or deductible from my policy?

Accepted Answer

These terms are set when you buy the policy. Some health insurance policies may allow changes at renewal, depending on the plan chosen. You can contact your Advisor or support team to check the options available for your policy.

Question 50

Does a higher co-payment mean a lower premium?

Accepted Answer

Yes. A higher co-payment means you agree to pay more during a claim, which lowers the insurer’s risk and reduces your premium. It is best to choose a co-payment level you are comfortable paying if you or an insured member need hospitalisation.

Question 51

Does co-payment or deductible affect claim approval?

Accepted Answer

No, co-payment or deductibles do not affect claim approval. They only determine how the claim amount is shared after approval. If the claim is valid and covered, it will be settled as per policy terms and conditions.

Question 52

Do co-payments and deductibles apply to all types of claims?

Accepted Answer

They usually apply to most hospitalisation claims. However, some policies may waive them for specific situations, such as accidental or emergency treatments. Always refer to your policy document for exact details.

Question 53

How does co-payment impact senior citizen policies?

Accepted Answer

Senior citizen policies often have co-payment clauses because medical costs may increase with age. This helps keep premiums affordable for older policyholders. For example, a 20% co-payment on claims ensures you share part of the expense while still enjoying a strong financial protection against covered medical events.

Question 54

How can I decide whether a co-payment or deductible policy is right for me?

Accepted Answer

If you prefer lower premiums and are confident you can manage smaller medical costs, a plan with a co-payment or a deductible might be a good fit. If you want complete protection and minimal out-of-pocket expenses, choose a policy with no co-payment or deductible.

Question 55

How will health insurance pay for my emergency medical expenses?

Accepted Answer

Your health insurance can help cover eligible emergency medical expenses through cashless hospitalisation at network hospitals or by reimbursing expenses you have paid, subject to your policy's terms and coverage.

Question 56

What happens to the policy coverage once the claim is filed?

Accepted Answer

Suppose a health insurance policy is issued for a sum insured of Rs. 3 Lakh from January to December and the insured files a claim of Rs. 50,000 in the month of March. Then, once the claim is approved and settled, the amount of benefit availed will be deducted from the total sum insured amount. This means that the coverage will now be left of Rs. 2.5 Lakh for a period from March to December.

Question 57

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

Accepted Answer

There is no limit to the number of claims that can be made during a policy term. But the claim amount should not exceed the sum insured amount for which the insured had purchased the policy.

Question 58

What if I miss the premium renewal date?

Accepted Answer

In case of missed health insurance renewal due date, you will be given a grace period of 15-30 days. If you again miss making the premium payment during the grace period, you may be denied coverage, denied policy renewal, lose out on no claim bonus, or asked to serve with waiting periods from the start.

Question 59

How many times can medical insurance be claimed?

Accepted Answer

Yes, you can claim multiple times during the policy year as long as the total does not exceed your sum insured. Once the limit is reached, claims can continue if your plan includes the restoration benefit, which restores your coverage.

Question 60

Can we claim medical bills in health insurance?

Accepted Answer

Yes, medical bills can be claimed through either cashless or reimbursement modes. Whether it is a major surgery or pre-hospitalisation tests, you can get these costs covered by your health insurance company in India.

Question 61

How does a cashless claim settlement work?

Accepted Answer

When you go to a network hospital, the insurer gives the green light for your treatment and pays the hospital directly. This means you do not have to pay the bill out of your own pocket.

Question 62

What happens if I get admitted to a non-network hospital?

Accepted Answer

If the hospital is not in your insurer’s network, you must pay the bills upfront yourself. Afterwards, you can file a reimbursement claim with your insurer to get the money back, subject to policy terms.

Question 63

Why do claims get rejected?

Accepted Answer

Claims often get rejected due to the non-disclosure of pre-existing diseases, trying to claim for policy exclusions, or using an expired policy. Always be honest when buying and keep your paperwork up to date.

Question 64

How long does it take to settle a mediclaim?

Accepted Answer

Cashless claims are usually approved within a few hours. For reimbursement claims, the process is a bit slower, typically taking between 15 and 30 days once you have submitted all the necessary documents to the insurer.

A quick introduction to health insurance.

All the basics you need to know about health insurance.

What is health insurance?

Why is health insurance important?

What is the meaning of sum insured?

What is an Electronic Insurance Account (EIA)?

How do I apply for a new Prudential Health insurance policy?

What is a proposal form and why is it important?

What documents are required to buy health insurance?

Is KYC mandatory for buying health insurance?

What documents are accepted for KYC?

How can I pay my premium?

What happens if I miss my premium payment?

Is there any penalty for late payment?

What if my claim is rejected?

If the Ombudsman passes an award, by when must it be implemented?

Does my health insurance policy cover me for COVID-19 treatments?

What are some common exclusions under health insurance plans?

What is a network hospital?

Do I get a discount on the renewal of the policy with Prudential Health?

Will my health insurance policy expire if not renewed on time?

If I want to cancel my health insurance policy after purchasing, can I do so?

How much health insurance coverage do I actually need for my family?

How does age affect my health insurance premium?

What is the difference between individual and family plans?

What are the benefits of buying health insurance at a young age?

What does pre-existing disease mean?

What is a waiting period in health insurance?

Should I buy separate insurance if I already have company health cover?

Can a person have more than one health insurance policy?

Is there a right age to buy a health insurance policy?

Can health insurance be bought by a minor?

Health Insurance FAQs

A quick introduction to health insurance.

All the basics you need to know about health insurance.

What is health insurance?

What is health insurance?

Why is health insurance important?

Why is health insurance important?

What is the meaning of sum insured?

What is the meaning of sum insured?

What is an Electronic Insurance Account (EIA)?

What is an Electronic Insurance Account (EIA)?

How do I apply for a new Prudential Health insurance policy?

How do I apply for a new Prudential Health insurance policy?

What is a proposal form and why is it important?

What is a proposal form and why is it important?

What documents are required to buy health insurance?

What documents are required to buy health insurance?

Is KYC mandatory for buying health insurance?

Is KYC mandatory for buying health insurance?

What documents are accepted for KYC?

What documents are accepted for KYC?

How can I pay my premium?

How can I pay my premium?

What happens if I miss my premium payment?

What happens if I miss my premium payment?

Is there any penalty for late payment?

Is there any penalty for late payment?

What if my claim is rejected?

What if my claim is rejected?

If the Ombudsman passes an award, by when must it be implemented?

If the Ombudsman passes an award, by when must it be implemented?

Does my health insurance policy cover me for COVID-19 treatments?

Does my health insurance policy cover me for COVID-19 treatments?

What are some common exclusions under health insurance plans?

What are some common exclusions under health insurance plans?

What is a network hospital?

What is a network hospital?

Do I get a discount on the renewal of the policy with Prudential Health?

Do I get a discount on the renewal of the policy with Prudential Health?

Will my health insurance policy expire if not renewed on time?

Will my health insurance policy expire if not renewed on time?

If I want to cancel my health insurance policy after purchasing, can I do so?

If I want to cancel my health insurance policy after purchasing, can I do so?

How much health insurance coverage do I actually need for my family?

How much health insurance coverage do I actually need for my family?

How does age affect my health insurance premium?

How does age affect my health insurance premium?

What is the difference between individual and family plans?

What is the difference between individual and family plans?

What are the benefits of buying health insurance at a young age?

What are the benefits of buying health insurance at a young age?

What does pre-existing disease mean?

What does pre-existing disease mean?

What is a waiting period in health insurance?

What is a waiting period in health insurance?

Should I buy separate insurance if I already have company health cover?

Should I buy separate insurance if I already have company health cover?

Can a person have more than one health insurance policy?

Can a person have more than one health insurance policy?

Is there a right age to buy a health insurance policy?

Is there a right age to buy a health insurance policy?

Can health insurance be bought by a minor?

Can health insurance be bought by a minor?

What is health insurance? 

Why is health insurance important? 

How do I apply for a new Prudential Health insurance policy? 