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Top 10 Questions to Ask your Health Insurer


From whooping medical bills to loss of pay due to an inability to perform your job, an unexpected health crisis can lead to devastation of your financial plans. This is why it is important to choose a policy that can effectively protect you against the unforeseen losses and give you peace of mind. However, while choosing health insurance, it is also important to figure out the best insurance plan for yourself and your family. Here is a list of the primary questions that you should be asking your health insurer before taking a health insurance plan.

Health Insurance FAQs

Q 1. What are the benefits under the health insurance policy?

It is important to know whether it is a benefit policy or will the policy pay you for the actual expenses at the time of the claim. You need to ask about the primary benefits under the policy and how the claim payments will happen. Also ask for the various options under benefits and coverages while taking a health insurance plan that is being provided.

Q 2. What is the Sum Insured (SI) that the insurer has to offer and what is the SI that you would recommend for my particular needs?

Instead of just saying that I need health insurance policy, you should be telling the insurer whether you would need health insurance for yourself, your spouse and your children and a separate policy for your parents or would you need one policy for all my family members. Based on this, the insurer should tell you about the different SI options available for your family size and family type.

Q 3. Till what age is this policy renewable? Is there an exit age for the policy?

You should ask the insurer about the age till which the policy can be renewed and the exit age. For example, if an insurer says that we will not give you a policy beyond 65 years of age then this is not allowed. In India, a health insurance policy can be renewed lifelong.

Q 4. What about pre-existing conditions?

Any medical condition that you had before applying for insurance, including health problems such as diabetes and heart problems, would be classified as pre-existing conditions. Based on the health condition, the insurer may decide on the premium and the coverage.

Q 5. Based on the Sum Insured (SI) that they are offering, what is the premium?

You need to ask the insurer whether the premium will continue year-on-year or whether there will be a change on the premium as the age advances.

Q 6. In event of claim, will I continue to pay the same premium or will there be a loading on the premium?

You should ask the insurer about the change in the premium (if any) after making a claim. Sometimes insurers may charge a loading on the premium after making a claim. This should be clarified at the time of buying the health insurance

Q7. Are there any additional benefits that the customer will get along with the health insurance policy?

While buying the policy, check the additional benefits such as value-added services, discounts, health checkup, etc.

Q 8. Who is the service provider?

One of the most important questions to ask is who the service provider is. Is it in-house or outsourced to a Third Party Administrators (TPA)? Bajaj Allianz is one of the few insurance companies with its own highly qualified Health Administration Team and in-house claims team. This reduces the Turn Around Time (TAT) for resolving a query.

Q 9. What is the network coverage under the policy?

Check the co-payment, deductible, or a penalty clause for utilizing a non-network hospital before buying a health insurance plan. For example: there could be co-pay option for using a non-network hospital. It is important to check the specific conditions about the network hospitals in the policy.

Q 10. Are there are any sub-limits for the condition?

Typically for specific common illnesses there will be a limit in terms of treatment including conditions such as hypertension or cataracts. For example, even if the SI is for 2 lakhs, there could be sub-limits for cataract, piles, tonsils, knee replacement, etc. This means that you would have to pay out of your pocket at time of the claims. The list of ailments and the restrictions in treatment varies from one company to other.

There are different types of health insurance policies to suit individual needs. To find the best cover for yourself, check out our health insurance plans.


This article was authored by Dr. Renuka Kanvinde, Assistant Vice President, Health Administration Team, Bajaj Allianz General Insurance Co. Ltd.

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Published on:4 Sep, 2014

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