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FAQS

HEALTH INSURANCE FAQS

Everything you wanted to ask about health insurance

TEST MY POLICY FAQS

Got questions about Test My Policy? You’ve come to the right place

1. How does Health Insurance Work?

Health insurance is a type of non-life insurance that covers your medical expenses arising out of hospitalisation following sickness or accident. A health insurance policy is a contract between an insurance company (called the insurer) and the persons insured or their families. This contract, usually detailed in the Health Insurance Policy, lays out the terms and conditions under which the insurer agrees to provide health insurance cover at a specific “premium” – or the cost of the contract you need to pay.

Health insurance as defined by Wikipedia is “insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons.” In other words, it’s an insurance policy that covers an individual or a family against medical expenses where the policyholder chooses a coverage under an insurance plan and he/she will be reimbursed the expenses incurred for treatment of an injury or illness.

2. What are different kinds of Health Insurance in India?

Health insurance policies in India cover the expenses incurred on treatment that requires hospitalization. However, many specialised health policies are now available which offer a range of medical insurance covers, depending on the specific need of the customer. Indian insurance companies provide health insurance in one of these three forms:

• Direct payment to the hospital (also known as cashless feature)
• Reimburses expenses associated with hospital bills and receipts
• Fixed benefit on the occurrence of an illness (e.g., critical illness policies)

The type and amount of health care costs that are covered by the health plan are specified in advance.

3. What factors determine Health Insurance premiums?

The age of the insured is a major factor that determines the premium. The older you are, the higher your premium will cost, since the older you get, the more likely you are to fall ill and claim insurance.

If you have a pre-existing medical condition (like hypertension, diabetes, etc), it impacts your premium and you may have to pay a higher amount to get suitable coverage.

The number of years a health policy remains claim-free is also a factor in determining the cost of the premium. You get lower premium rates or a discount for a higher number of claim-free years.

Health insurance companies classify cities into zones and premiums can also vary, depending on which city you live in. Those staying in a Metro or Tier I city usually have to pay higher premiums.

4. Can an individual have multiple Health policies?

Yes, one person can have multiple health insurance policies, but you can claim only from any one of the policies at a time. A typical example of this is group medical policies provided by employers to their staff. Many employees choose to have their individual or family floater policies in addition to the employer’s group policy. Customers can also opt for additional Top-Up insurance plans to bolster their base policies.

5. Why is Health Insurance Important?

Given the current cost of healthcare, and the sharp rise in these costs every year, everyone needs to have health insurance for themselves and their family members without exception.

Irrespective of your economic or social standing, you can choose from a health plan that suits your needs and pockets. Health insurance can protect your family from financial troubles from unexpected expenses of hospitalization or treatment of a critical illness.

Everyone is exposed daily to various health hazards and lifestyle illnesses and medical emergencies can strike anyone without any prior warning. Importantly, the cost of healthcare is also increasingly expensive, with emphasis on technology, new procedures, and more effective medicines that have increased the costs of quality healthcare. Health insurance makes expensive healthcare possible, for a fraction of the cost of hospitalisation.

Family Floater is a type of health policy that covers the medical expenses of an entire family under a single sum insured. The premise being (except in the Covid scenario) that every member of the family doesn’t need to utilise the available insurance in each policy year.

So a family floater is a policy for the entire family, which can be utilised by any/all insured, subject to the maximum of policy sum insured. Often family floater plans are better (and cheaper) than buying separate individual plans. Family Floater plan is an ideal option for families where the eldest member of the family is under 45 years old since premiums in family floater policies are calculated basis the age of the oldest person covered.

Most insurance companies have a designated network of hospitals across the country in partnership with their Third Party Administrator (TPA). For policyholders who undergo treatment in these network hospitals, the insurer’s TPA makes arrangements for the payment directly to the hospital and there is no need for the insured person to pay hospital bills. This is known as a cashless treatment facility.

In a cashless settlement, a policyholder needs to pay for expenses not covered by sub-limits under specific clauses mentioned in the policy. These are paid directly to the hospital at the time of discharge. For health policies, a cashless facility is only available at Network Hospitals. In case the policyholder opts for treatment in a non-network hospital, they need to settle the bills and then submit them for reimbursement from the insurance company.

Here are some key features and benefits you should consider before buying a health insurance plan. To know more about these features, you can read up insurance blogs and

refer to help articles available online. You can also test your current health policy benefits on www.testmypolicy.com •Exclusions under the policy for specific diseases •Room Rent & Treatment Sub-Limits •Pre-existing Disease Waiting Periods •Restoration Benefit especially for family floater policies •Cashless Hospital Network of the Insurer •Additional benefits like Health Check-Ups offered by the insurer •Claims Settlement Ratio and Reputation of the Insurance company

Health insurance plans come in many shapes and sizes to suit the needs of a variety of customers. From micro-insurance policies in rural areas, mediclaim policies that only cover hospitalisation expenses, specialised health policies with fixed claims (like critical illness plans), group plans, and health schemes offered by the Government and Corporates.
Comprehensive Plans Most private insurance companies (operating as non-life or general insurance) offer both basic and comprehensive health policies with sum insured ranging from ₹1 lac to ₹1 crore (or more). Comprehensive policies typically offer higher flexibility, better coverage and include several additional benefits like health checks, restoration of the sum insured, no-claim bonuses, etc.
A health policy is meant to cover the actual cost of the treatment for hospital admissions during the policy period. Such policies are available for individual, multiple individual or family floater basis, where the sum insured is shared across the family members. While most health insurance policies are valid for a duration of one year, policies can also be bought for a longer duration of up to 3 years.
Top Up or Super Top Up Another type of health policy one can opt for is a Top Up or Super Top Up plan. These are useful to increase the sum insured coverage of basic health plans without the need to buy another policy. The Top Up policy only comes into force once you have exhausted the sum assured of your basic health plan, hence these policies cost much lower than basic plans with a higher sum insured.
Critical Illness Policy There are also specialised critical illness policies available to cover high costs of cardiac care, cancer treatment, or Covid risks. These policies usually provide a lumpsum amount to the policyholder when on the diagnosis of a specified illness or on undergoing a specified procedure. They help mitigate various direct and indirect financial consequences of a critical illness. Policies for specific customer groups like senior citizens are also offered by most insurance companies.

Yes, the premium you pay for health insurance offers attractive tax benefits as an added incentive. Under Section 80D of the Income Tax Act, you are eligible to claim a deduction from your taxable income up to ₹15,000 for the payment of Health Insurance premium for self, spouse, and dependent children. One can also claim a deduction of an additional ₹15,000 if they are paying the health insurance premium on behalf of their parents, assuming parents are senior citizens.

It’s important to understand what your health insurance policy covers. But it’s even more important to be aware of the exclusions or what is not covered under the health plan.

Generally, pre-existing diseases (different across insurers and plans) are excluded or impose a waiting period before they can be claimed. Specific treatments for certain diseases are also excluded from the first year of coverage or have a waiting period. These exclusions are usually listed in your policy document. To know what kind of waiting periods your policy enforces, you can test your policy at www.testmypolicy.com

There are also certain standard exclusions in most health policies such as: •Treatment of medical conditions arising due to hazardous activities
•External Congenital Anomaly
•Convalescence & Rehabilitation
•Cosmetic or Plastic Surgery
•Dental/Oral Surgery
•Eyesight & Optical Services
•Experimental Treatment
•Hormone Replacement Therapy
•Obesity and Weight Control Programs
•Reproductive Medicine & other Maternity Expenses
•Robotic-Assisted Surgery
•Sexually transmitted Infections & diseases
•Sleep Disorders
•Substance- related and Addictive Disorders
•Treatment at Non Recognized Physician or Hospital
•Cost of consumables like swabs, disposables, PPE kits, etc.

For the exact list of what your policy covers or not, you must read the policy document carefully.

Some policies offer a lower premium when you opt for the co-payment feature. Co-payment is a payment sharing clause in your policy in which the policyholder agrees to co-pay a part or percentage of the claim amount. Co-pay can vary between 15% to 30% depending on your health insurance plan. E.g., if you have a policy in which the co-payment is fixed at 20% and your claimable hospital bill is Rs. 1 lakh, you will need to pay Rs. 20,000 or 20% of the claimable amount and the rest will be paid by your insurance company.

A waiting period is the duration of time a policyholder must wait before some or all of their coverage comes into effect. You will not receive benefits for claims filed during the waiting period. There are generally different waiting periods in most health insurance policies, like 30 days waiting period at the inception of a policy, when hospitalization charges are not payable by the insurance companies, except in case of an accident. Similarly, there are waiting periods for maternity, pre-existing diseases, etc.

When you buy a health policy for the first time, the insurance companies ask you to declare if you have been diagnosed with or treated for any chronic diseases. These are known as pre-existing diseases. Most insurance companies in India exclude coverage for pre-existing diseases for a defined period, which is specified at the beginning of the policy. Treatment cost for pre-existing diseases is usually covered after a few years of insurance coverage.

While it varies from company to company, pre-existing condition coverage can be covered after 2 to 4 years, provided you renew the policy with the same insurer. Waiting periods for pre-existing medical conditions can be from 24 to 48 months, after which pre-existing diseases and any treatments arising out of such conditions are covered. Some new comprehensive health plans cover pre-existing diseases from the first year of policy purchase too. One must be aware of the waiting periods and the sum insured for treatment due to pre-existing conditions as it impacts your health coverage. One quick way to do that is to test your policy on www.testmypolicy.com

At the time of applying for a health policy, you must disclose any illnesses for which you are currently undergoing treatment or have had treatment in the past. Insurance companies refer to such health issues as pre-existing illnesses. So yes, it is necessary to disclose your existing health problems before buying a policy. Since the insurers are not liable to any of the alteration of facts later on.

No. Your medical cover is compromised if you fail to renew your policy. Ideally, your renewal premium should be paid before the expiry date of the current year’s policy. However, insurance companies offer an additional 15 days as Grace Period after the expiry date of the policy to allow payment of the renewal premium. Failure to make the premium payment even during this grace period results in the policy lapsing. Also, your health coverage would not be available for the period for which no premium is received by the insurance company.

The Insurance Regulatory and Development Authority of India (IRDAI) is a regulatory body that issues guidelines to insurance companies in India. One such guideline issued by IRDAI refers to Insurance Portability. In simple terms, insurance portability is similar to mobile number portability, which allows you to change your telecom operator without changing your mobile number. IRDAI mandates that a policyholder should have the right to port his/her health policy to another insurer without losing the benefits you have accumulated.

Before insurance portability, such a move would have resulted in a policyholder losing benefits like the waiting period for covering Pre-existing Diseases. With insurance

portability, you can port your policy to any other insurer of your choice and the new insurer “shall allow for credit gained by the insured for pre-existing condition(s) in terms of waiting period”. This applies not only when you move from one insurer to another but also from one plan to another with the same insurer.

The following policyholder rights and conditions have been mandated by IRDAI with regards to insurance portability.

Rights of the Policyholder •You can port your policy from and to any general insurance company or specialised health insurance company
•You can port any individual or family floater policy
•Your new insurer has to give you the credit relating to the waiting period for pre-existing conditions that you have gained with the old insurer
•Your new insurer has to insure you at least up to the sum insured under the old policy
•Porting by the new insurer must be completed as per the timelines prescribed in the IRDA’s regulations and guidelines

Conditions applicable for policy porting •You can port the policy only at the time of renewal, at least 45 days before renewal is due
•Except for the waiting period credit, the new policy terms (including premium) are at the discretion of the new insurance company
•To port your health policy, approach your current insurer at least 45 days before your renewal is due
•Give a written intimation to inform your old insurance company of the shift
•Specify company to which you want to shift the policy
•Renew your policy without a break (30 day grace period if porting is under process)

One of the key benefits of a health insurance policy is that it can also cover medical expenses incurred before and after hospitalisation. These include the cost of consultation, medicines, treatments, or therapies recommended by the doctor in charge of your hospital treatment.

Most policies cover pre-hospitalisation treatment cost up to 30 days and post hospitalisation costs for 60 or 90 days. Medical expenses incurred pre and post hospitalisation are considered as part of the claim provided they relate to the illness for which treatment was sought and a claim filed by the policyholder.

Insurance companies have agreements with prominent hospitals through their Third Party Administrators (TPA) for providing Cashless treatment to the policyholders. These hospitals raise the policyholder’s medical bills directly to the TPA and the insured doesn’t need to pay the hospitals for the treatment. Such hospitals are referred to as Network Hospitals.

The advantage of going to your insurance company’s network hospital is that they offer fixed and pre-decided charges for treatments/surgeries etc. and are generally better committed to quality healthcare.

With the advances in medical science, many treatments which required hospitalisation can now be treated in a day. A day care procedure refers to any minor surgery or medical procedure that can be completed in less than 24 hours and doesn’t need the patient to be hospitalised.

Since health policies usually require a min. 24 hours hospitalisation to file a claim, an exhaustive list of day care procedures has been added under medical policy coverage. Today, all insurance companies cover day care procedures, but the exact number and kinds of treatments covered vary with insurers. To see which Day Care procedures are covered by your insurer, please read your policy terms and conditions. For further information, you can always compare the benefits and features of your policy at www.testmypolicy.com

All medical insurance insurers have appointed a Third Party Administrator (TPA) to manage claims and be the first point of call for a policyholder. Some insurance companies outsource TPA duties and a few have in-house TPAs for faster settlement of claims. Your policy documents and health cards will usually have the contact details of your insurer’s TPA. If you can’t reach the TPA for some reason, you can always call the insurance company directly on their Toll-Free Assistance numbers to inform them about your hospitalisation.

1. What is Test My Policy?

Test My Policy or TMP is a specialized insurance information website that helps simplify and check your existing health insurance policy for the gaps in your coverage. Since 99% of people with health insurance are not familiar with the legal language in their policy documents, Test My Policy helps you in the following ways:
•Check for conditions and limitations your existing policy may impose
•Check whether you’re adequately covered based on your age, life stage & dependants
•Check if the premium you’re paying is optimal or not
•Recommend the actions you can take to fill the gaps in your current policy
•Recommend alternative health policy plans you can port to at similar premiums
•Enable the online purchase of health insurance policy and add-on benefits

2. How can Test My Policy help me?

Test My Policy simply makes checking your health insurance coverage easy for you. Just enter your existing policy details and we will analyse your policy for the benefits it offers and the limitations it imposes.

Our intelligent algorithm automatically makes feature comparisons with other health plans at similar price points from major insurance companies and tells you what benefits your policy offers for the premium you pay.

TMP also assists you by simplifying legal terms in your policy document. This helps you understand insurance jargon in simpler words so you know what your policy will or will not cover.

Finally, to help you make an informed choice, TMP recommends alternative plans you can consider for porting your policy up to 45 days before your next renewal and completes the purchase process online. Test My Policy’s support team is here to guide you at any and every step.

3. Why test my health policy on TestMyPolicy.com?

Good question. Unfortunately, the Indian health insurance industry is plagued with customers not having the right information or having information too complex to decode. As a result, customers find it difficult to make an informed decision based on their specific health cover needs.

Before deciding on a health policy, customers are often promised hyped up benefits or wrong benefits by the insurance seller. Since insurance sales are mainly done by individual insurance agents, over-selling of plans is a common complaint among customers. This is mainly because most agents are tied to one insurance company and therefore offer little choices amongst insurers.

Most agents also tend to sell the plans that get them the highest commissions for themselves (obviously!). Hence among agents, there is no need real understanding of what your actual insurance needs are, and which plan works best for you.

4. What details can I get about my health insurance policy?

TestMyPolicy.com runs on an intelligent algorithm that analyses your current health policy data and compares your existing policy with hundreds of health insurance plans. Based on this comparison, we distil the data to answer three simple questions you should know:

1.Is my health cover adequate?
2.Am I paying the optimum premium?
3.Does my policy impose any limits?


Besides answering the above questions, TMP details out specific benefits your policy offers and important features it may be lacking. It also recommends steps you can take to cover the gaps in your policy. TMP also gives you a list of alternative health plans you can consider porting your policy to.

5. How can I use the Policy Test Report?

After analysing your policy data with an intelligent algorithm, TMP auto-generates a detailed Policy Test Report for you. This report is sent to you via email or WhatsApp.

The TMP report helps you understand your policy better in terms of features and benefits and also gives you recommendations to plug the gaps in your current policy. E.g., if your health policy sum insured is not adequate, the report can recommend top-up plans you can add to improve your policy coverage.

TMP Policy Test Report recommendations are purely made on available customer data with no preferential bias to any insurance plan or company.

Test My Policy services are free of cost to our customers. You do not have to pay anything to test your health policy.

Test My Policy earns from service charges paid by the insurance companies you decide to buy insurance from.

You can go through our FAQs. You might find your answer there. You can also call us at +917710804888. or email us at support@testmypolicy.com and our representative will get in touch with you to help you through.

No problem, we’re happy to assist you. Our trained insurance experts offer consultation and advice for anything related to your policy. You can WhatsApp on +917710804888 or email us at support@testmypolicy.com and we will try to resolve your queries as soon as possible.

Your private data is protected using bank-level security and is totally safe with Test My Policy. Please refer to our Privacy Policy for details.

Your health policy document has the complete list of features, benefits and exclusions in your policy. As long you remember key details of your policy, you can simply fill them online on www.testmypolicy.com and we will generate the test results for you. But if you’re not sure about your plan details, it would be best to upload your policy document or email it to us. Most policy documents are emailed to you by your insurer, or sent as a physical copy within a few days of policy purchase.

You need to know your policy number at the time of claim, even if the policy document has not reached you provided you fulfil the waiting period norms as mentioned in the policy. If the policy documents have not reached you because your proposal for insurance has not been accepted, you cannot make a claim.

No. You need to present the claim to your insurance company. Although as facilitators, we can guide you with the step-by-step procedure for making a claim.

For policies with a cashless facility, you need to inform the TPA of the claims and get a reference number within the stipulated time to avail of the benefit. TPA number is given on the information booklet as well as your health cards received by you.

For reimbursements or other claims without cashless facility, you need to inform the insurance company, fill up the claims form attach necessary documents like original medical bills and invoice, etc. as the case may be, and send it to your insurance company.

Blogs and Articles

08-Jul-2021

- Team TMP

Looking for Family Floater Health Insurance? Read this first.

A family floater health insurance protects you from high medical costs that may arise from the hospitalisation of your family members. Family floater plans cover hospital bills for planned medical procedures and emergency medical care for

Read More

08-Jun-2021

- Team TMP

How to Save on the Premium Of Your Health Insurance?

Today every insurance company claims that they have the best health policy plans to offer. As customers, we also want a policy with better coverage and fewer exclusions and limitations. But we need to remember that the higher and more comp

Read More

08-May-2021

- Team TMP

A Simple Guide to Comprehensive Health Insurance

A health emergency can be a serious drain on one’s finances and resources. With the cost of quality health care and hospitalisation rising many fold in recent years, having a comprehensive health insurance policy is no longer an opti

Read More

28-Jan-2022

- Team TMP

Super-Boost your health cover with Super Top-Up

The past few years have been a period of uncertainty and a bearer of bad news. Just when we thought this catastrophe was finally beginning to terminate, we are thrown off with yet another hardball. One more variant of the Coronavirus is pr

Read More

08-Sep-2021

- Team TMP

The Importance of Health Insurance

What is Health Insurance?

Health insurance is an agreement whereby insurance company agrees to undertake a guarantee of compensation for medical expenses in case the insured falls ill or meets with an accident whi

Read More

09-Aug-2021

- Team TMP

What You Need to Know Before Porting Your Health Policy

Shantanu, a 45 year old professional, suffers from hyper-tension and when he bought health insurance, he cited the health problem as a pre-existing medical condition. When the insurer raised premiums after two years, Shantanu decided to sw

Read More

08-Jul-2021

- Team TMP

Looking for Family Floater Health Insurance? Read this first.

A family floater health insurance protects you from high medical costs that may arise from the hospitalisation of your family members. Family floater plans cover hospital bills for planned medical procedures and emergency medical care for

Read More

08-Jun-2021

- Team TMP

How to Save on the Premium Of Your Health Insurance?

Today every insurance company claims that they have the best health policy plans to offer. As customers, we also want a policy with better coverage and fewer exclusions and limitations. But we need to remember that the higher and more comp

Read More

08-May-2021

- Team TMP

A Simple Guide to Comprehensive Health Insurance

A health emergency can be a serious drain on one’s finances and resources. With the cost of quality health care and hospitalisation rising many fold in recent years, having a comprehensive health insurance policy is no longer an opti

Read More

28-Jan-2022

- Team TMP

Super-Boost your health cover with Super Top-Up

The past few years have been a period of uncertainty and a bearer of bad news. Just when we thought this catastrophe was finally beginning to terminate, we are thrown off with yet another hardball. One more variant of the Coronavirus is pr

Read More

08-Sep-2021

- Team TMP

The Importance of Health Insurance

What is Health Insurance?

Health insurance is an agreement whereby insurance company agrees to undertake a guarantee of compensation for medical expenses in case the insured falls ill or meets with an accident whi

Read More

09-Aug-2021

- Team TMP

What You Need to Know Before Porting Your Health Policy

Shantanu, a 45 year old professional, suffers from hyper-tension and when he bought health insurance, he cited the health problem as a pre-existing medical condition. When the insurer raised premiums after two years, Shantanu decided to sw

Read More

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