Individual Health Plans

Using the Policy (Making a Claim)

If you need medical care, you can use your health insurance to cover the costs. There are two main ways to make a claim:

• Cashless Claim: This is the most common and convenient method. If you are admitted to a hospital that is part of your insurer's network, you simply present your health insurance card. The hospital and the insurance company handle the billing directly, and you don't have to pay anything out of pocket (unless there are non-covered expenses or deductibles/co-pays).
• Reimbursement Claim: If you are admitted to a hospital that is not in your insurer's network, you must first pay all the medical bills yourself. After you are discharged, you collect all the original bills, reports, and documents and submit them to your insurance company. The insurer will then review the claim and, if approved, reimburse the money to your bank account.

The Role of Co-pays and Deductibles

Some health plans have a deductible, which is a set amount you must pay for your medical expenses before the insurance coverage begins. For example, if you have a ₹5,000 deductible, you must pay the first ₹5,000 of your medical bills, and the insurance will cover the rest (up to your sum insured). A co-pay is a small percentage of the total bill that you are required to pay, even after the deductible is met.

Renewing the Policy

Health insurance policies are typically valid for one year. To continue your coverage, you need to renew your policy by paying the premium before the renewal date. Many policies offer lifelong renewability, which means you can continue to renew them regardless of your age, as long as you pay the premium on time.