Knowledge Centre

Common FAQs About Your Health Insurance Policy

When buying a health insurance policy, it is important you know its fundamentals to ensure you are rightly covered. Blindly purchasing health insurance from an agent or online can lead to great disappointment at the time of claim. What if your claim gets rejected due to your own negligence? What if the insurance company does not provide you with coverage for the disease you are diagnosed with? Sounds frightening, right? It’s better to feel safe than sorry and be aware of all the things that you should know when purchasing a health insurance plan. Read on the most commonly asked questions on health insurance that could help you stay aware of your purchase.

Frequently asked questions on health insurance

Is health insurance policy valid all over India?

Generally, a health insurance policy is valid all over India. However, it is always a good choice to check on this with your insurer since medical emergencies can arise anytime, anywhere. Insurance companies also offer health plans that provide international coverage too. However, there could be policies with co-pay for certain geographies.

Whom to connect with in case of an emergency situation?

When your loved one or you are hospitalized, you are sure to be in a state of panic. At such times, it is important for you to understand the claim process of the company. If you are hospitalized in any network hospital, then you can avail cashless treatment. In case you are hospitalized in a hospital that is not covered under the network of the hospital, then you can call the company’s customer care and inform them about your hospitalization. Don’t forget to carry your cashless card or policy documents with you at the time of hospitalization.

What are the documents required for making a health insurance claim?

In case of a cashless claim, you are not required to submit any documents except for your cashless card or policy number and identity proof. Whereas, in case of reimbursement claim, you will have to submit the below documents:

  • Duly filled and signed Claim Form with HDFC Ergo policy number Claim Form
  • Original Discharge Summary
  • Original final bill with detailed breakup, payment receipt and, original pharmacy invoices supported by prescriptions
  • Original Investigation reports (eg. blood reports, X-Ray, etc)
  • Implant sticker/invoice, if used (eg. for stent in angioplasty, lens cataract, etc.)
  • Past Treatment documents, if any
  • In cases of Accident, Medico Legal Certificate (MLC) or FIR
  • Other relevant documents, if any
  • NEFT details for payment: Cancelled cheque in the name of the Proposer or passbook copy attested by bank6) For all claims amounting 1 lakh and above: KYC form along with photocopy of any one KYC document (eg. aadhar card, passport, driving license, voter ID, etc)
  • For all claims amounting 1 lakh and above: KYC form along with photocopy of any one KYC document (eg. aadhar card, passport, driving license, voter ID, etc) KYC Form

Can I cancel my health insurance policy and get the premium back?

You can get the premium back only if you cancel the policy anytime during the free-look up period. Insurance companies offer you free-look period of 15 days from the date of receipt of policy documents to understand its terms and conditions. In case, if during the free-look period you feel that you are not satisfied with the coverage provided by the insurer, then you can cancel the policy and ask for a refund. On cancellation of the policy, you will receive the premium minus the deduction of the cost of stamp duty, medical checkup and the proportionate risk premium. Also, you will not be eligible to receive the refund if you file a claim anytime during the free look period.

Can I claim for more than one health insurance policy?

No, you cannot claim for more than one health insurance policy at the same time. You will have to choose the policy you want to claim. However, if the claim amount is higher than the sum insured of the first policy, then you can opt for a second policy to claim the remaining amount.

Disclaimer: The above information is for illustrative purpose only.For more details, please refer to policy wordings and prospectus before concluding the sales.

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