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Frequently Asked Questions On Health Insurance – III

​​​What is pre-existing condition in health insurance?
Most of the people suffer from one or other disease before a policy is bought. So pre-existing condition is broadly defined as a condition or a disease which existed before the health insurance policy​ is bought. It is important because most health insurance do​​ not cover pre-existing conditions, for a period of  4 years from purchase of the first policy.

Can the policy expire if it is not renewed on time?
There is a grace period of 15 days available to pay the premium from the date of expiry of the policy. However, coverage would not be available for the period for which no premium is received by the ​insurance company​. The policy will become non existent if the premium is not paid within the specified grace period.

Can policy be transferred from one insurance provider to another provider without losing the benefits?
Of course. The Insurance Regulatory and Development Authority ( IRDA ), the sole body looking after the insurance sector in India, has issued a circular which directs the insurance companies to allow transfer from one insurance company to another and from one plan to another, without making the insured to lose the renewal credits for pre-existing conditions, enjoyed in the previous policy. However, this credit will be limited to the Sum Insured (including Bonus) under previous policy.

What is the term “Waiting Period” for claims under a policy?
When you opt for a new policy, there will be a waiting period of 30 days from the date of inception of the policy. Any type of hospitalization whether planned or emergency will not be covered by the insurance provider during the span of this waiting period. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal.

What happens to the policy coverage after a claim is filed?
If the policy is insured for a sum of Rs 1,00,000 from January to December and if you file a claim for Rs 50,000 in the month of June, and after the claim is settled, the policy coverage will be reduced to Rs 50,000 for a period from June to December. This means that whatever claim you have received, that amount will be deducted from the sum insured for the remaining period of the policy.

What are the maximum number of claims allowed over a year?
A policy holder can claim any number of claims under a policy, within a year. But the claim amount cannot exceed the maximum amount for which the policy has been insured.

What do you mean by Family Floater Insurance policy?
Family plan is one single policy that covers all the members of a particular family. It takes care of the family members hospitalisation expenses. The policy has one single sum insured, and one single premium is paid for the policy. The advantage of having a ​family floater policy is that all members of the family are covered and there is no need to buy individual policies for each member of the family and there is no need to pay different amount of premiums for different policies. Family Floater plans takes care of all the medical expenses during sudden illness, surgeries and accidents.​