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What Are the Things to Check in Your Health Insurance Policy Document?

how to review health insurance policy document

When you’ve finally gone through the process of choosing and buying your health insurance policy, especially for the very first time, you might be confused by all the legal language and insurance jargon in your policy documents.

But that’s no reason not to go through your policy, as it is important when it comes to understanding your coverage and raising a claim. But, don’t worry, we’re here to help you make sense of what you’re reading, and if you need further help you can also go through our insurance dictionary where you can learn more about all the terms used.

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Things to Review in Your Health Insurance Document

1. Terms and Conditions of the Policy

Go through the policy wordings to see if there are any requirements or conditions for you to follow, for example, while making claims you make have to pay a certain co-payment amount, or a deductible out of pocket. Additionally, you may have to complete certain waiting periods to get coverage for some pre-existing diseases, or certain other conditions.

2. Coverage of the Policy

Remember to check what health conditions or treatments are covered by your health insurance policy. Look out for important coverages such as pre and post hospitalization related expenses, daily hospital cash, psychiatric benefit, annual health checkups, critical illness coverage, etc.

A list of all the add-ons you have purchased with the policy and their coverage would also be clearly stated.

3. Exclusions and Limits

Another very important thing to check in your policy is the exclusions, or those instances where you will not get coverage from your health insurance. In other words, this will tell you what you cannot make a claim for. For example, most health plans in India generally exclude coverage for hospitalization without a doctor’s recommendation, certain diagnostic expenses, or cosmetic or plastic surgery among others.

Additionally, it is also important to check the sub-limits applied to different parts of your policy, such as on hospital room rent, treatment of certain diseases, ambulance charges, and more.

4. Sum Insured

The policy should include the details of your sum insured amount, or the maximum amount that you will get in case you make a claim due to a medical emergency. Note that in the case of a family floater insurance, the sum insured amount mentioned will be used to cover the entire family during the policy period.

5. Claim Process

Check the particular claim procedures for your health insurance. Knowing the claim process, the documents required to file a claim, as well as time limits within which you can do so, is important. This is because you never know when there will be an emergency. Also, make a note of the cashless network hospitals that are offered by your insurer, as you can head there and avail yourself of medical services without paying out of pocket.

6. Personal Details

One of the first things to do when you get your policy is check your personal details. Ensure that your name, contact number, email id, and residential address are all mentioned correctly in the document. This way there will not be any confusion at the time of claims, and any messages sent to you will not be lost.

7. Insurer Details

You must also look for a section that details all the contact information of the insurer, including their phone numbers, addresses, and email ids. This is very important in case you need to get in touch with your insurer at the time of a claim, if you need help, or have further queries about your policy.

8. Nominee Name

In the case of certain health insurance policies, such as personal accident or a critical illness cover, you must ensure that you have included the correct nominee details. A nominee is a person chosen by you (the policy holder) who will get your sum insurance amount in case a covered illness condition proves fatal.

9. Insurance E-card

When you get a cashless health insurance policy, your insurer is required to issue you with an insurance card within 15 days of the policy being issued. This card will need to be shown at network hospitals to avail yourself of cashless hospitalization or treatment, and share the same with the Third Party Administrator (TPA).

10. Policy Duration

In the health insurance policy document, you will also find the start date and end date of the policy. It is important to know these dates, especially the expiry date so that you can be sure to renew the policy in a timely manner.

While some insurers might send reminders or a renewal notice, it is important not to rely on these in case it is missed once year. Thus, you can set up your own reminder system and set aside enough funds so that you can always pay your health insurance premium on time.

11. Policy Number

It is very important that you check your policy number, or the unique number that is associated with your particular insurance policy. Insurance companies use this number to store your policy details, and it is also used at the time of claims, support requests, and more. While you don’t need to memorize your policy number, just make sure it’s somewhere you can quickly access it when needed!

12. Tax Deduction

In your policy you will find the complete break-up of your premium amount, which is essential in calculating how much you can get as tax returns as per Section 80D of the Income Tax Act. In some cases, this amount will also be mentioned in the document itself.

Conclusion

When you get a new health insurance policy, it is important to read the document in detail and verify all the information mentioned in it. That way, if there are any errors, you can take immediate action! Additionally, it will also help you know exactly what is and is not covered by your policy, so you won’t have any surprises at the time of making a claim.

Frequently asked questions

All

What should I keep in mind before buying a health insurance?

Always check for what is covered and not covered in your health insurance policy by reading through the terms and conditions.
Choose the right plan and sum insured based on your age, your healthcare needs and number of people you’re covering in your health insurance policy.
Don’t hide any critical information or medical history from your insurance company.
If you can, customize your health insurance plan, with different add-ons for better coverage.
Buy your health insurance early in life, so you will have more reasonable premiums and get through waiting periods faster.

What are the documents required before getting a health insurance policy?

For some people you don’t require any documents to purchase a health insurance policy. However, for older people or those with certain pre-existing diseases, you might need to get a doctor’s certificate of the conditions and your state of health following a health check-up before getting your policy.

Can you add members to the policy after buying it?

Yes, in most cases you can add new members to a family policy at the time of renewal. However, if case you wish to add a newborn baby, you can do so a few weeks after the birth.

Can you increase your sum insured amount?

There are many ways that you can increase your sum insured. Most commonly, you can ask your insurer to do so at the time of renewal, or purchase a super top up plan for the same. Otherwise, some insurers will increase your sum insured as part of your cumulative bonus.

Why do health and term insurance both ask for medical tests?

Because both need to understand your health condition, health insurance needs it to price your premium and cover existing conditions. Term insurance checks your life expectancy. It helps them decide the risk and avoid future claim disputes. Never hide facts during medicals.

If I have life insurance, do I still need health insurance?

Yes, absolutely. Life insurance pays your family if you die. But if you get sick or hospitalised, it won’t help with medical bills. That’s where health insurance comes in—it covers those expenses while you're alive. You need both to stay fully protected.

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Go Digit General Insurance Limited | Corporate Office Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru 560095 | Registered Office Address: 1 to 6 floors, Ananta One (AR One), Pride Hotel Lane, Narveer Tanaji Wadi, Shivaji Nagar, Pune-411005, Maharashtra | Trade logo of Go Digit General Insurance Ltd. displayed above belongs to Go Digit lnfoworks Services Private Limited and is provided and used by Go Digit General Insurance Ltd. under license.