Question 1

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 2

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 3

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 4

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 5

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 6

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 7

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 8

Can I claim hospital bills under two insurance policies?

Accepted Answer

Yes, you can split a claim across two policies if the first one does not cover the full cost. You cannot profit from the claim, but you can use both to ensure your total expenses are covered.