Medical expenses can be unpredictable and costly. Health insurance safeguards you and your family from the financial burden of unexpected medical emergencies, routine healthcare, and long-term treatments, ensuring you receive quality care without worrying about high bills.

A standard health insurance policy generally covers hospitalization expenses (including room rent, ICU charges, surgery fees, and diagnostic tests), day-care procedures, pre- and post-hospitalization expenses, and in some cases, domiciliary treatments. Policies may also offer additional benefits like cashless claims at network hospitals and coverage for alternative treatments under AYUSH.

Cashless Claims: If you are admitted to a network hospital, you can avail treatment without paying upfront. The hospital coordinates with your insurer, and the bill is settled directly.
Reimbursement Claims: When you pay the hospital bill out of pocket (typically at non-network hospitals), you can later submit a claim along with the required documents to get reimbursed by your insurer.

Pre-existing conditions are health issues that existed before you purchased your policy. Most policies impose a waiting period for pre-existing diseases, during which related expenses will not be covered. However, if you maintain continuous coverage, waiting periods might be reduced.

Deductible: A fixed amount you must pay before your insurer begins to cover your medical expenses each policy year.
Co-Pay: A percentage of the medical bill that you are required to pay for each claim, while the insurer covers the rest.
Sub-Limits: Caps placed on certain expenses (like room rent or ambulance charges), meaning even if your total sum insured is high, only a specified amount will be reimbursed for those specific expenses.

The claim process begins with notifying your insurer about the hospitalization or treatment. For cashless claims at network hospitals, the hospital obtains pre-authorization from the insurer. For reimbursement claims, you pay upfront and later submit the claim along with all necessary documents. Following notification and submission, the insurer verifies the claim and processes the payment directly to you or the hospital.

Reach out to us on our phone number, or send us an email at customercare@insurancepe.com and inform us about the claim you want to report, your policy number, contact details, address etc. Our insurance professionals will guide you through every step of the claims process.

Typical documents include:

• A duly completed claim form
• Photo ID and age proof
• Hospital registration certificate or registration number
• Discharge summary, day-care summary, or transfer summary
• Final hospital bills, original deposit and payment receipts, and refund receipts if applicable
• Doctor’s prescriptions, diagnostic test reports, and consultation papers
• Ambulance invoices (if claimed)
• Any other additional documents may be required based on the situation

A waiting period is the time you must wait after your policy’s start before certain conditions or treatments are covered.

Yes, most health insurance policies in India offer family floater options, which allow you to cover multiple family members under a single sum insured. This option is often more cost-effective and ensures that all eligible members receive coverage.

Add-on covers (or riders) provide additional benefits beyond the basic policy. They are optional and might include critical illness cover, maternity benefits, personal accident, etc. While they increase the premium, they also enhance your protection and can be tailored to your specific needs.

Yes. Under Section 80D of the Income Tax Act, premiums paid for health insurance policies are eligible for tax deductions. The deduction amount varies depending on whether the policy covers individuals, families, or senior citizens.

Most insurers allow you to upgrade your policy or change coverages at the time of renewal. Additionally, policy portability enables you to switch insurers without losing the benefits of your previous continuous coverage, such as reduced waiting periods for pre-existing conditions.

Renewing your health insurance policy is usually a straightforward process. You will typically receive a renewal notice from insurancepe and/or your insurer well before the policy expiry date. Ensure that you pay the premium on time to avoid any break in coverage. Continuous renewal is important, as it can help in reducing waiting periods for pre-existing conditions and maintaining uninterrupted benefits.

Top-up plans offer additional coverage once your base health insurance sum insured is exhausted. They have a higher threshold (deductible) before the insurer steps in. If you’re looking for extra financial protection against high-cost treatments or surgeries without significantly increasing your base premium, a top-up plan might be a good choice.

Network hospitals have pre-negotiated rates with your insurer, which simplifies the cashless claim process. Receiving treatment at a network hospital often reduces your out-of-pocket expenses and accelerates claim settlement, as the insurer directly settles the bill with the hospital.

To cancel your health insurance policy, you’ll need to submit a written cancellation request—either through insurancepe, via email, or by contacting your insurer’s customer service directly. If you're within the free-look period (usually 30 days from policy issuance), you might be eligible for a full refund (subject to minimal administrative charges). After the free-look period, cancellation may incur fees and could result in the forfeiture of benefits. Always ensure you understand any implications of cancellation, such as potential gaps in coverage or cancellation fees, before proceeding. For more information reach out to insurancepe.

Health insurance is not legally mandatory for all individuals in India. However, many employers and government schemes require coverage for their employees or beneficiaries. While there is no nationwide legal obligation, it is highly recommended to have health insurance due to the rising costs of healthcare. Having coverage protects you from potentially high out-of-pocket expenses during medical emergencies and routine healthcare needs.

The cumulative payout for all claims is capped by your policy’s overall sum insured, along with any applicable sub-limits, deductibles, and co-payments. This means you can file multiple claims, but the total reimbursement cannot exceed the maximum coverage provided by your policy. Additionally, certain treatments or benefits might have specific claim limits or conditions. To understand how multiple claims might affect features like cumulative bonuses or renewal benefits, it’s important to review the detailed terms in your policy document.