Essential questions to ask while taking health insurance

What are the questions that one should ask? What are the most essential things that one should at the time of buying the health insurance plan? Cheap Life Alliance has made the things easier for the readers to get the essential the health FAQs.


Most health plans fall into one of two categories such as Copay-based plans or Health Savings Account (HSA) based plans. Copay plans typically cost more per month and have lower deductibles. HSA plans have cheaper monthly costs and higher deductibles. The deductible is a fixed amount you have to pay before your insurance company starts contributing. Your monthly premiums don’t count toward this total. Say your deductible is $2,000. This means you’ll need to pay the first $2,000 for your medical costs before your insurance company starts contributing to your bills. Expenses incurred after the deducible are covered by your insurance company at varying coinsurance rates. Be sure to research what costs count toward the deductible.

The Open Enrollment will be here before we know it, giving you and your family the green light to enroll in a new health plan. If you’re like me and enrolled based on what your daily horoscope recommended, this is exciting news. But, where do we start? Read the 10 questions and ask them at the time of buying your policy?

About out-of-pocket maximum?

Out-of-pocket maximum is the most you can expect to pay before your health expenses are covered in full by your insurance plan. Deductibles, coinsurance, and copays for covered services all count toward the maximum. Monthly premiums do not.

If you are expecting a year with very high healthcare expenses (for example, if you are having a baby) then the out-of-pocket maximum is an important factor in selecting a health plan.

Understand about coinsurance?

Coinsurance is the percentage you are required to pay after you have met your deductible for healthcare expenses. Your insurance company will cover the remainder. Typically, the coinsurance percentage you see on your EOB refers to the amount your insurance company pays, and you are responsible for the remainder.

For example, say you have a plan with 80% coinsurance. After you have met the deductible, you have a $100 service done. Your plan would cover the 80%, or $80. You would be responsible for paying the remaining 20% of this cost, or $20.

Are there copays?

A copay is a fixed amount you pay for a healthcare service like a doctor’s visit or a prescription drug. Depending on your plan, this amount can differ based on the service. For example, plans have different rates for tiers of prescription drugs. Some generic drugs may only cost you $5 while name brand drugs will be much more expensive.

If you take prescription drugs, pricing these costs out on different plans is a wise way to select a health plan. You don’t want to pick a plan and then discover your drugs are more expensive than you are used to.

Network hospitals in your vicinity?

To avail a cashless settlement of your claim, you should be admitted in a network hospital. A company has a list of such hospitals and you need to find out whether the hospital in the company’s network is your preferred choice of hospital and/or located in your area.

Blindly buying a plan because your friend bought that too or your agent asked you to would be a foolish practice. Most people do not understand the right ways to go for the full process and find an easy way out.

Is my policy valid?

This is a one of the most important health insurance questions to be considered because medical emergencies may arise anywhere. Usually, health plans cover treatments anywhere in India but you should make sure of this clause.

Find out whether the claim settlement in your policy has any geographical limitations or not. There are some medical insurance plans that offer international coverage too. There are many ways to check whether you policy is rightly valid or not.

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You can also learn about the top healthcare insurance companies in 2018.

Ask about pre-existing illnesses?

Every insurer excludes coverage on the pre-existing illnesses for certain tenure at the starting of the policy. You need to find out what this waiting period for your pre-existing illness is and how soon can you be covered for your pre-existing illnesses

The thing is not at all complex. Basically, you need to understand whether your pre exiting condition is temporarily not covered or is it completely excluded from the scope of coverage.

About emergency hospitalization?

An emergency situation involves a lot of stress and you don’t need the additional burden of finding out the claim settlement process. If your policy facilitates cashless settlement of claims, find out the policy of emergency hospitalization.

Ask about the documentation and, most importantly, whom to contact at the time of such emergency hospitalization. Good brokers have a customer service desk or a specifically appointed representative who would help at the time of claim.

Go for non-network hospital?

In an emergency situation, you might be admitted in a non-network hospital and knowing the claim protocol at that time is imperative. Always remember that treatment in a non-network hospital would be on a reimbursement basis only where you would have to shoulder the medical bills.

Then get them reimbursed from your insurer and also find out the reimbursement process, the documents required in this case, and the deadline for informing the insurance company, etc. for this situation.

Documents required for claiming?

This is one of the most common health insurance queries, and knowing the answer from the get-go makes the claims process much smoother. Essentially the company asks for the identity proof of the members covered, the health card, the hospital bills, etc. at the time of a claim.

A pre-authorization form is required in case of cashless claims which are to be submitted to the TPA. Other documents might also be required and you should have the knowledge of the required documents so that you can get your claim processed smoothly.

Method of claim processing?

The claim settlement process is the true test of your health plan. You should ask about the company’s claim settlement process to assess whether the process is simple or ambiguous. In addition to that, go for the best option which is available for you.

Moreover, take special care to notice whether the company settles the claims through cashless facility or by reimbursement. A cashless facility is your best bet to avoid any financial burden of medical bills.

Things to Remeber:

So, you have learned about the questions to ask. Hopefully, these questions will set you on the right track to choosing the best health plan for you and your family. If insurance still reads like a foreign language and you want help crunching the numbers, make an appointment with one of our noncommissioned advisors. We’ll do the heavy-lifting for you and present you with the best plans for your situation. Knowing the answers to these health insurance questions is very important if you want your claim under the plan to be settled without much harassment. Your broker would be the best party to answer these questions by virtue of their immense experience in handling health insurance claims. So talk to your broker, get your health insurance queries answered and only then buy your health plan!