Faq - Health Insurance Basics

Yes. You will need insurance. Even if you're young, healthy and haven't had to see a doctor in years, you will need coverage against unexpected events like accidents or an emergency.

No one knows when a medical emergency might strike. It is best to buy health insurance, to save money when an emergency strikes.

A health insurance policy is what you buy to protect yourself and your family against unforeseen medical expenses. The company that sells you the policy is called the insurer and you are the insured. When you buy a policy, you pay an amount every year, called a premium, against which you are assured to a sum of money for the treatment of any injury/illness/hospitalization. This sum of money is called the sum insured or health cover and can be used for your treatment or by an insured family member, depending on the kind of policy you have purchased.

Health Insurance takes care of hospitalization expenses. Whether the hospitalization required is for more than 24 hours or less than 24 hours (called Day Care treatments like Cataract, Angioplasty, and Chemotherapy), the expenses for these treatments can be covered under a health insurance policy.

For example, you can pay a premium of Rs. 15,500, to secure a health cover of Rs 5 Lakh for you, your spouse, and your child. This will imply, that should you undergo any surgery, you can claim up to Rs 5 Lakh from your policy and cover the cost.

1. Illnesses/injuries and other hospital costs are largely unforeseen/unknown, and you need to plan for these
2. Current sedentary lifestyle along with mental stress, and poor eating habits has resulted in people at young age prone to lifestyle diseases like diabetes, hypertension & even heart-related illnesses.
3. Medical costs are increasing at a very high rate year-on-year and having a health insurance policy helps you finance these expenses & get access to quality treatment without worrying about cost
4. The premiums paid for Health insurance gives tax benefits under Section 80D of the Income Tax Act, 1961.
5. Having a health insurance policy saves you from burning a hole in your pocket due to medical expenses.

Yes, you can. However, you will need to disclose the details of the pre-existing diseases/treatment in the proposal form & may need to undergo medical tests/submit previous reports etc. There could be a waiting period of 24-48 months before the policy pays for such pre-existing illnesses. The waiting period varies as per the type of policy bought, the type of illness you have, also on the insurer.

As the name suggests, this policy is bought for your family members, in addition to yourself. Your spouse, children and parents are included in the family floater plan. For example, if you have a health cover of Rs 5 Lakh, it means that in a year, your full family is eligible to claim medical expenses up to Rs 5 Lakh. Scenarios can be plenty, such as:

- Your spouse needs to claim Rs 5 Lakh for his/her surgery

- You claim Rs 2 Lakh and your spouse claims Rs 3 Lakh

- Your kid needs Rs 4 Lakh and you need Rs 1 Lakh

Benefits Circle recommends having a family floater plan for you, your spouse and your kids, and a separate health insurance plan for your parents. This ensures that each family member has sufficient coverage.

They sound similar but are different. A life insurance policy helps you to secure your family against your unfortunate demise, whereas a health insurance plan secures you and your family against unforeseen medical costs. A health insurance cover can be claimed when an insured member of the family is hospitalized or undergoes treatment, whereas a life insurance cover is claimed when the insured has passed away.

Yes, you can if they live in India.

Yes, a NRI can buy health insurance for their parents residing in India.

If you apply online for a health insurance policy on Benefits Circle’s portal, there are no documents required. However, CKYC will have to be completed & a medical test might be needed by the insurer depending on your age and your medical history .

Any plastic or cosmetic surgeries are excluded from the health cover unless they are a necessary part of your recovery treatment as recommended by your doctor, for example in case of burns or accidents.

Health insurance covers hospitalization costs, alternative treatments, cashless home health care, pre-and post-hospitalization expenses (30 days before and 90 days after), lifetime renewability, and a host of other features and benefits.

Feel free to contact us at +91 8879960000 or send an email to [email protected] for any assistance you need regarding insurance. We are here to help.

Insurance premiums depend on factors like coverage type, risk level, policy term etc. The insured person’s age, gender, health history, occupation and location also influence the premium amount.

If the dental treatment is a result of an accident, then accidental dental coverage is provided by the insurer. Also, any dental surgery that requires a hospitalization of a minimum of 24 hours, is typically covered.

In such an unfortunate condition, there is an option of having the policy transferred to the next eligible adult. However, since the number of members has now reduced, so should the premium amount. Hence, it is advisable to talk to the insurance provider and get details.

Your medical condition will be treated as pre-existing as the diagnosis has already happened. You may have to wait for a specific period before any claim about this condition is honored by the insurance provider. Also, because of this pre-existing condition, the insurer may charge you a higher premium.

Situations such as suicide attempts, terrorist attacks, substance use, injuries due to adventure sports etc. are typically excluded from health insurance policies. However, the list of exclusions may vary from one policy to another and is a very important document to read before you buy one. Some common exclusions are:

• Injury or Diseases directly or indirectly attributable to War, Invasion, Act of Foreign Enemy, War like operations.
• Cosmetic, aesthetic treatment unless arising out of accident.
• Cost of spectacles, contact lenses and hearing aids
• Dental treatment or surgery of any kind unless requiring hospitalization
• Charges incurred at Hospital or Nursing Home primarily for diagnostic, x-ray or laboratory examinations, without any treatment.
• Naturopathy or other forms of local medication
• Intentional self-injury / injury under influence of alcohol, drugs
• Diseases such as HIV or AIDS
• Expenses on vitamins and tonics unless forming part of treatment for disease or injury as certified by the attending physician.
• Convalescence, general debility, run-down condition or test cure, congenital external diseases or defects or anomalies, sterility, venereal disease

Yes, many health insurance plans allow you to include your spouse, children, and sometimes parents too as dependents. Please refer policy terms

Consider your health needs, budget, and preferred network of hospitals and doctors. Consulting with Benefits Circle can also help you make an informed decision.

Some health insurance plans may cover alternative treatments like Ayurveda or Unnai, but it varies. Check your plan details for coverage specifics.

Yes, maternity coverage is often included in comprehensive health insurance plans. Be sure to review the coverage terms, waiting periods, and any associated costs.

Treatment from non-network providers is covered, but processed under Reimbursement claim. It is best to choose a network hospital so that claims can be processed on cashless basis.

A medical test is usually not requested by the insurer unless you have a pre-existing disease or basis any declaration in proposal form. Benefits Circle team will team will connect with you & update if medical test is required or not.

No. Health insurance cannot be bought individually by a minor, however parents can cover the child under their family floater health insurance.