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Demystify Health Insurance Hangout – Queries and Answers (I)

Our Google+ Hangout on Demystify Health Insurance aimed to clear every doubt that viewers had about health insurance, regardless of the company offering it. However, due to time constraints, not every query could be answered live. That’s why, we’ve compiled a list of every query that was submitted to us during and before the Hangout, along with the answer to each.

Here’s part 1 of this list.


Q. How does top up plan work for a corporate employee?

-  Amit Singhaniya

A. The corporate employees can take the top up policy with continuity from their base policy, the sum insured of top up policy can be utilised in case of sum insured exhausts of base policy.


Q. What are the situations under which one may be denied cashless hospitalization?

- Manobala

A. There can be no of situations under which the cashless can be denied for e.g. the hospital is not on our panel, the disease is not under the scope of policy, fraud, misrepresentation, etc.


Q. During the course of my treatment, can I change the hospitals?

- Manobala

A. Yes the hospitals can be changed for higher/better treatment.


Q. How does one get reimbursements in case of treatment in non- network hospitals?

- Manu Kaushal

A. In case of reimbursement one can send the claim documents along with the claim form to the local office/HO.


Q. Health insurance companies should explain the terms.

- Madhusudan Reddy

A. All the product information is available on website for reference, you can go through the details of the product, we have an online chat facility, and you can also call our toll free no. for product information. Our customer service executives will help you with the product details.


Q. Whom should I call up immediately if I meet with an accident, the emergency call centers?

- Specter

A. Yes, you can call our customer care nos. for further assistance.


Q. Cost of health insurance cover is rising exponentially, how are you/industry trying to keep it under control?

- Deepak Arora

A. The rise in health care costs is the result of inflation, however we negotiate the charges with hospitals to reduce the claim cost.


Q. How about keeping a centralized health history of each person, it’s going to help every insurer and avoid people taking undue advantage.

- Deepak Arora

A. Our customers can check their claim status online with the policy number and card number.


Q. If somebody already has a health problem, will health care insurance make it easier for them to get coverage?

- Rachh

A. The member can approach the insurance company with all the details of his health, the insurance company will suggest a suitable plan to take better care of the disease. Medicals may be advised based on the health history to review the current health status.


Q. What are the steps Bajaj Allianz has taken to ensure that there is no mis-selling of health insurance by its advisors?

- Prof Matuknath

A. We as a company do not advocate mis-selling. We use a combination of education, awareness, proper trainings and clear instructions to our advisors help in avoiding mis-selling.


Q. Will the premium increase every year or remain constant? What does it depend on?

- Manobala

A. The premium is calculated based on the age of the insured member and the sum insured opted. The premium would change if there is any change either in the age slab or the sum insured opted.


Q. What is Cashless Hospitalization?

- Sweta Saraf

A. In cashless hospitalization the client will fill the pre-auth form from the TPA counter of the hospital and the same is sent to the insurance company’s cashless department. The insurance company will settle the amount directly to the hospital as per the policy terms and conditions.


Q. Is Indian health insurance industry ready to cover medical expenses the way it happens in US?

- Deepak Arora

A. In the US 80% to 90% of the population is insured hence it becomes easier for them to experiment with new coverages and hence there is broader coverage. In India the insured population is limited hence difficult to experiment and there is limited coverage. But the Indian health insurance has evolved a lot in last 10 years and looking ahead we might be able to provide the coverages as in the US.


Q. Can I take 2 health insurance policies? How will I make a claim in that scenario?

- Manobala

A. In case of multiple policies, you have the benefit of choosing the policy to claim, you can also claim from both the policies proportionately. The maximum payable amount under both the policies will not exceed the claimed amount or sum insured whichever is lower.


Q. Does everyone offer cashless facility or do we have to specifically ask for it?

- Amit Ranjan

A. Every insurance company offers cashless facility.


Q. What is the maximum number of claims allowed over a year?

- Archit Srivastava

A. The limit is up to the sum insured.


Q. Please discuss why group health policy offered by employer is not a sufficient alternative to individual standalone health policy.

- Harshvardhan Bhusari

A. The group policy one has is offered by the company which might have many limitations such as sum insured, coverage of family members, the premium discounts, etc. Also in view of resignation or retirement from the company the continuity is lost.  Hence it is better to have standalone health cover along with the group policy, so that you are adequately covered even if the company policy is not active.


Q. I have got two ideas for you:

1. Design a policy to include reasonable dental treatment cost covering 90% of the dental problems.

2. Issue health checkup coupons to all the customers at your approved PAN India based diagnostics, which will not only encourage people to be aware of their health but also reduce the cost of treatment as the disease/ailment is detected at early stage, hence treatment cost and pain/trauma is reduced drastically.

- Soumitra Kanti dey

A. We should be coming up with a new product covering dental treatment and also offer free health checkups every year irrespective of claim.


To read part 2 of this list, please click here.

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Published on:10 May, 2014

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