Health Insurance Claims FAQ’s

FAQ

Can I Claim My Dental Expenses Bills ?

No, As of now the expenses incurred on dental treatment is not covered in health insurance policies provided by insurers in India.

Can I Claim Expenses From The First Day Of My Policy ?

Normally most of the health insurance policies issued have a waiting period of 30 days, within this period you are not allowed any claims. The waiting period can vary from company to company, so please read your health insurance policy document to know the exact time.

Can I Claim Expenses Before and After My Hospitalisation ?

Yes, It is termed as Pre-hospitalisation & Post-hospitalisation expenses. Normally you are allowed to claim expenses incurred 30 days before your hospitalisation or surgery and after hospitalisation expenses till 60 to 90 days. The only condition is that all these expenses should be directly related to the illness or disease for which you were hospitalised. For more clarity please read the insurance policy document, as it may vary from company to company.

Can I Claim Hospitalisation Charges For Maternity Expenses?

If you have an Individual or a Family Floater policy , the expenses relating to maternity or pregnancy are not covered and will not be re-reimbursed by the insurer. But, If you are covered in a Group Health or Medical Policy provided by your Employer than you can claim expenses related to Pregnancy .

Can I Claim Expenses Related To My Existing Disease ?

If you are buying a new Health Insurance Plan than the expenses related to your existing disease will not be covered by the new policy for at least one year . Majority of the insurance companies do not cover your pre-existing disease for 3 to 4 years or more , will depend upon company to company. If your policy is in force to more than 4 years or more you can check with your insurance company if they are willing to cover your pre-existing disease or you can transfer your policy to another insurance company who is willing to cover your existing diseases.

Can I Claim Expenses When I Have Been Treated At My Home & Not In A Hospital ?

Yes, you can claim expenses incurred at your home provided some conditions are met. This is known as “Domiciliary Hospitalisations”

Such As :

  • The condition of the patent is so critical that he/she cannot be transfered to a hospital.
  • There is no bed or room available in a Hospital to transfer the patent.

There will be some more conditions and again it will differ from company to company. Please see the policy document for details.

Will My Expenses Be Reimbursed If I Do Not Use A Network Hospital ?

Yes, Your expenses will be reimbursed even if you do not use a Network Hospital or a Hospital Not Affiliated to the insurance company.

What Is The Advantage Of Using A Network Hospital ?

If you choose to avail a Cashless facility that it is better to use a network hospital or otherwise if you choose to use a different hospital , the chances are that they may not provide you with a cashless facility. Certain insurance companies may ask you to bear a small portion of expenses between 10 to 20% for not utilising a network hospital.

I Have Taken A Policy In Bangalore. Can I Claim Expenses In Mumbai ?

Yes, If you have taken a health insurance policy anywhere in India and you policy is still alive or in force , you can claim expenses in any city anywhere in India.

Is There Any Limit On The Number Claims I Can Make In A Year ?

No, There is no limit on the number of claims you can make within a year. But once your sum insured is exhausted by claim , you will not be getting any reimbursement form the company.




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