Question: Tell me something about the Third Party Administrator?
Answer: The Third Party Administrators are commonly known as TPA. Basically, these TPA's are the BPO's of the insurance companies. Their core responsibility is to coordinate with the policyholders and resolve all the matters related to the claim settlement and health insurance policies. Usually, these TPA's are authorized by the Insurance Regulatory and Development Authority (IRDA). To receive the licence from IRDA, these companies need to have:-

  • State-of-the-art communication and telecom structure and a number starting from 1600.
  • Computerised system maintaining the data.
  • Adept Medical experts, so that they can assess the requisite medical assistance required to pass the bills of the claim.

The TPA's are also coordinating with the hospitals to take the updates regarding the treatment and also to pass the bills. All the bills are actually paid by the insurance companies; however, the details vary from policy to policy and are confidential in nature.

The TPA will issue an ID card for the insured person, which will be needed when the insured person will get hospitalized.

Question: Do these health insurance policies also cover naturopathy and homeopathy?
Answer: Naturopathy is not covered in all the policies. However, some insurance have started covering homeopathy, but, the treatment must be taken in an authorised Homeopathy hospital and must be empanelled with the insurance company. During the post hospitalization phase, the Star Health permits use of Homeopathic medicines. Hopefully in the future, more an more insurance company will include naturopathy and homeopathy as well.

Question: Do I need a critical illness cover?
Answer: Critical illness cover is actually intended to cover some specific diseases such as cancer or cardiac. Generally, it covers 8 to 12 diseases but if a company want they can raise the number up to 35. On happening of the diseases, you will be given two options, either to go for the lump sum amount or you can opt for the treatment.

Question: Does my health insurance policy also cover my mental illness?
Answer: For now, the medical insurance policies in India are not covering the mental illness. Although, we do hope that in the coming future the insurance companies will add something regarding this in their policies.

Question: Is my health insurance coverage Clinical Trials?
Answer: It is if your treatment is:-

  • Actually a part of your hospitalization in any of the prominent hospitals in India.
  • If you are under the supervision of a reputed doctor
  • If the clinical trials are approved by the Medical Council

Aforementioned are the conditions under which it will be payable. Otherwise, you will struggle a lot to get the compensation for the treatment as well as for the medicines.

Question: What is the basic difference between Co-insurance and Co-pays?
Answer: Copayment actually contemplates the percentage you will have to pay to the insurance companies and the balance which the companies ought to pay you. On the other hand, Co-insurance is not related to you individual health insurance policy. It actually involves in large policies which includes premium of Rs. 20 lakh and wherein more than one company take the risks and do the insurance.

Question: Which medical test I've (as I'm above 45 years) to undergo if I want a health insurance policy?
Answer: The tests will be specified by the insurance companies. Generally, it comprises the following:-

  • ECG
  • Blood Test, and
  • Urine Test

If you are above a limited age, the list will comprise more tests to be done. If you are around 60 or 70 ears old, the list will include some more formality tests.

Question: Currently, I'm covered under my husband's health insurance policy which he has got from his company. Now, we have decided to get divorced. What will happen to my health benefits?
Answer: You need to get another health insurance policy because you will lose the benefits after the divorce.

Question: Is there any health insurance covering pet animals as well?
Answer: Well, it depends which pet you have. However, it is not the part of your health insurance policy because that is only meant for the human beings. If you have a cow or buffalo, you can certainly go for the Cattle Insurance. And for more precise answer, you need to specify the category of your pet.

Question: Is Critical Illness policy synonymous to the Mediclaim policy?
Answer: No, both the products are different from each other.

Question: Who is eligible for the overseas mediclaim policy?
Answer: Those who are planning to have an overseas trip, they are entitled to an overseas medical policy. Your current policy is applicable in India, not in abroad.

Question: Can I pay my premiums through my agent to the company?
Answer: You can do that if your agent is ready to facilitate you with that facility. However, you have to ensure that your cheque should reach to the respective place on time. Whether you do it through an agent or by yourself, you need to pay your premium on time otherwise you might end you losing the benefits of the policy.

Question: Is there any disadvantage associated with the Group Insurance?
Answer: No, there is no disadvantage as such. But you must keep in mind that you won't be able to enjoy the benefits of that policy once you are detached from the group.

Question: Currently, I'm covered under a health insurance policy. Should I go for a life insurance policy as well with the riders?
Answer: You go with it or not. You must understand the benefits that both these insurance policies offer to you. Health insurance policy will cover all your hospitalization expenses and the other supplementary chargers. But a life insurance policy covers your retirement needs. Including the riders will give you the critical illness benefits. Both the products are different in nature and comprise varied benefits. You must research on both the products and make a good decision.

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