How Many Times Can I Claim In A Health Insurance Policy?

Will my premium increase if I make a claim?

Health insurance premium are dependent on the age of the prospect and the coverage selected. But in some cases the health insurance premium could be increased at the time of renewal due to the heavy claim ratio that the insurance company has incurred over the past year. It means that the claims paid exceed the premium collected by the insurance company.

Why not I take a Top UP Policy instead of New India’s Mediclaim Policy?

A top up policy is an additional coverage for people already having an individual health insurance plan or employer health insurance policy. It is useful in case of a single illness which consumes the entire sum insured in the base policy. The top up policy triggers only after the sum insured in the base policy is exhausted and the deductible under the top up is crossed due to hospitalization. Having a top up policy without a base health insurance policy is like having a bike without an engine. A top up policy has a deductible amount which would be almost 20% of the top up policy sum insured. For example let us take a base policy with Rs.2 Lacs and Top up policy with Rs.5 Lacs, in case of hospitalization first the base policy sum insured will be utilised and then the top up policy kicks in.

Will the entire amount of the claimed expenses be paid?

In any health insurance policy, the amount settled by the insurance company would be the claim amount incurred or the sum insured mentioned in the policy whichever is less. The maximum liability of the insurance company in case of claim would be the sum insured mentioned in the health insurance policy copy. There are certain expenses which are incurred during hospitalization such as Laundry expenses, food expenses which are not paid by the insurance companies. Consumables expense is paid by certain health insurance policies, consumables include gloves, hand wash, sanitizers etc. The claim amount paid by the insurance company varies from case to case and it can neither be agreed nor denied that the entire claim amount being paid in case of hospitalization.

how to claim medical insurance?

To claim medical insurance, follow these general steps:

• Inform the insurance provider: Notify your insurance provider about the medical treatment or expenses you need to claim as per their specified process, which may include phone, email, or online claim submission.
• Gather necessary documents: Collect all the required documents, such as medical bills, prescriptions, discharge summaries, diagnostic reports, claim forms, and any other supporting documents as per your insurance provider's requirements.
• Submit the claim: Submit the claim form along with the supporting documents to the insurance provider within the stipulated period. This can usually be done online or by mail, depending on the insurer's process.
• Review and follow-up: Once the claim is submitted, the insurance provider will review the documents and may request additional information if needed. Follow up with the insurer for any updates on the claim status.
• Claim settlement: Upon approval, the insurance provider will process the claim and reimburse the eligible amount as per the policy terms and conditions. If the claim is denied, seek clarification from the insurer and provide additional information if required.

How to Calculate Claim Ratio in Health Insurance?

The claim ratio in health insurance is calculated by dividing the total claims paid by the insurance company during a specific period by the total premiums collected from policyholders during the same period.

The claim ratio is an important metric to assess the performance and sustainability of a health insurance provider. A higher claim ratio indicates that a larger portion of premiums collected is being paid out as claims, which may impact the insurer's profitability.

On the other hand, a lower claim ratio may indicate that the insurer can manage claims efficiently and retain more premiums as profit. It's important to review the claim ratio in conjunction with other factors such as policy features, coverage, premium, and customer reviews to make an informed decision while choosing a health insurance provider.