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Health Insurance Interview Questions & Answers - Learning Mode

Health Insurance Interview Questions & Answers - Learning Mode

Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider. Health insurance is a way to pay for health care. It protects you from paying the full costs of medical services when you're injured or sick. Just like car insurance or home insurance, you choose a plan and agree to pay a certain rate, or premium, each month.

Try Health Insurance Interview Questions & Answers - Exam Mode

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Health Insurance Interview Questions & Answers - Learning Mode
Try Health Insurance Interview Questions & Answers - Exam Mode
Question: What is Coinsurance for health insurance policy?

Answer: Coinsurance: Instead of, or in addition to, paying a fixed amount up front (a co-payment), the co-insurance is a percentage of the total cost that insured person may also pay. For example, the member might have to pay 20% of the cost of a surgery over and above a co-payment, while the insurance company pays the other 80%. If there is an upper limit on coinsurance, the policy-holder could end up owing very little, or a great deal, depending on the actual costs of the services they obtain. Source:
Question: Is there Any Difference between Health insurance and Mediclaim Policy?

Answer: Health insurance and mediclaim are often confused for the same thing especially by a lot of new people not having much knowledge about health insurance. A Mediclaim policy offers cover for hospitalization expenses for a certain pre specified illnesses till a specific limit as per the sum assured.

The maximum cap however for all claims under a mediclaim policy is fixed at Rs. 5 Lakhs. A mediclaim policy works on the principle of indemnity where hospitalization is a definite requirement to Source:
Question: My father's age is 54, central government employee and my mother is a house wife, 47 years old. I'd like to take health insurance for both of them. So which financial institution would be better to apply for health insurance? Do my parents fall under the senior citizens category?

Answer: Health insurance is very important for your parents, especially in old age. There are schemes available from many insurance companies like Bajaj Allianz, Apollo Munich, Star health insurance and many others (the names are just a sample. Please do talk to the insurance agents before you take it).

Usually when you take insurance at old age, the expenses are much higher. Hence it is important that you carefully study the insurance companies? proposal and the support provided. Moreover, you s Source:
Question: I have a health insurance policy covering myself and my family. Should I need to buy a personal accident insurance policy? What is the benefit of a personal accident insurance policy?

Answer: A personal accident insurance policy is a type of insurance, which insures you for death or disablement due to accidents. Unlike a term insurance which insures you in case of your death and a health insurance which reimburses you only for hospital expenses, a personal accident policy takes care of disablements as well and gives better cover than the accidental riders usually available with term and health insurance.

The Sum Assured in a personal accident insurance policy usually depends o Source:
Question: What is Capitation for health insurance policy?

Answer: Capitation is an amount paid by an insurer to a health care provider, for which the provider agrees to treat all members of the insurer. Source:
Question: Can you tell me what does cumulative bonus means in a health insurance plan?

Answer: Just like a no claim bonus offered for car insurance, a cumulative bonus is offered for health insurance. The sum insured is increased by a specified percentage for every claim free year. Depending on your health insurance company either you can get an increase in the sum insured or get a discount on the annual premium or at times a combination of both.

The cumulative bonus can mean an increase in the sum assured by as much as 5% and can go as high as 50% of the basic Sum Assured. In case Source:
Question: Is it good to take insurance through banks?

Answer: If the insurance company is linked to your bank, chances are that it will offer your health insurance at a lower premium compared to other companies. Most of these health policies have a very small premium to attract the vast customer base of the bank. One of the biggest downside of bank associated low premium health care policies is the fact that banks have no active role in any decision making. Neither can the banks help the consumer in case of claim settlement. Once you have opted for a healt Source:
Question: Can you please tell me what a restore option is in a health insurance plan?

Answer: The restore option is a relatively new feature being included by health insurance service providers to attract more people. Under such a plan, in case the opted health cover gets exhausted the cover amount gets renewed to the extent of base cover amount subject to some terms and conditions.

While restore option is generally beneficial for the insurer, most health insurance companies do not allow restoration amount to be used for same illness because of which the cover was exhausted in the Source:
Question: What is Co-payment for health insurance policy?

Answer: Co-payment is the amount that the insured person must pay out of pocket before the health insurer pays for a particular visit or service. For example, an insured person might pay a $45 co-payment for a doctor's visit, or to obtain a prescription. A co-payment must be paid each time a particular service is obtained. Source:
Question: What is NCB retention add-on cover for car insurance? Is it useful to go in for such an insurance add-on?

Answer: NCB retention is a relatively new add-on cover offered by general insurance companies. No claim bonus, commonly known as NCB is a reward offered by insurance service providers to their clients in case they do not file for any insurance claims. As a reward, insurance companies offer discount on the annual premium for policy renewal. Car owners can get as much as 50 percent discount on the own damage part of the insurance premium using no claim bonus.

No claim bonus retention is an add-on c Source:
Question: Will a general health insurance policy cover costs for my ENT treatment? I know dental treatment is usually excluded but what about ENT?

Answer: General treatment for ear, eye, nose and throat are not covered under a general health insurance policy. Dental and ENT treatments are considered to be part of a cosmetic procedure and do not impact the health of an individual directly and hence excluded from general health insurance cover. You will need to check with your health insurance company if they offer any policy covering ENT treatment. Source:
Question: What is the new plan of IRDA for entry based pricing for insurance premium?

Answer: Currently premium is based on the age of the policyholder and does not matter if it is the first health policy of the applicant. As per the new guideline proposals, if two people of the same age buy a health policy at the same time, an individual who has already had a health policy should be charged a lower premium compared to the other person applying for the health plan for the first time. Source:
Question: Do health insurance plans cover charges if one were to opt for a second opinion?

Answer: Health insurance policies have various exclusions that are not covered under the ambit of the policy. Most policies also exclude any charges for second opinion from the health insurance cover. Source:
Question: Is there any advantage of getting health check before taking insurance?

Answer: Yes firstly Insurance policies that do not come with a pre approved medical checkup have a higher premium term compared to policies with a pre approved medical. Secondly once you have undergone the medical tests, the onus is on the insurance company to prove your disease was pre existing while denying any claim. Source:
Question: Is 5 Lakhs a good amount for health insurance? How much health insurance should I have ideally?

Answer: There is no one fixed amount or a minimum threshold limit on the amount you should have as health insurance. Health insurance is a very individual centric product and the overall cover will depend on your health, your age, your risk factors, your geographical location and your financial plan. Mostly people have health covers ranging between Rs. 5 to Rs. 10 Lakhs irrespective of their age, earnings and risk factors. While a cover of Rs. 10 Lakhs may be sufficient for a general health ailment, tre Source:
Question: What is meant by the term Pre-existing diseases in health insurance? Is malaria a pre-existing disease?

Answer: Pre existing diseases mean any condition or ailment which you may have had signs or symptoms or was diagnosed and received medical treatment. Usually the tenure for defining existing diseases is fixed at 36-48 months prior to your taking up the health insurance policy.

Infectious diseases like Malaria, fever, flu etc are usually not included in policy exclusions, for a waiting period. But if you happened to have complications out of it, it will be. It is recommended that you check with yo Source:
Question: What is the new health insurance portal announced by the government? Is it functional yet or just an announcement?

Answer: The IRDAI promoted Insurance Information Bureau (IIB) has come up with a portal known as the Registry of Hospitals in Network of Insurer or Rohini. The portal is functional and available at The treatment facilities on offer, the cost of treatment and cost of claims for each hospital is also provided on the portal. So you can compare health insurance details of various plans and make a call on which one to opt for. The portal currently has a database of 35,000 hospitals Source:
Question: With so many cases of accidental deaths in bomb blasts all over the news, do the health care policy offer protection for death in such a situation?

Answer: Sadly the rise of terrorism has left no one safe in any corner of the world. A terrorist attack can happen just about anywhere. As far as health insurance is concerned, health insurance companies offer no cover for any medical costs that may arise because of treatment due to any act of terrorism like bomb blasts or any non conventional war attack like chemical or nuclear weapon. Source:
Question: Is Claim Settlement Amount received under mediclaim taxable? If yes, then at what rate?

Answer: Claim settlement receiving from mediclaim policies are not taxable. These are the expenses incurred by you for treatments, and the settlement received is therefore not taxable. As it is in the nature of a re-imbursement of the expenses, there is no element of income in the claim that you've recd from the company and thus should be tax-free. Source:
Question: Can anyone tell me what is Sub Limit in health insurance?

Answer: Sub limit means that the insurance policy will put a maximum cap limit for various disease types and surgeries. For example if the policy offers a sub limit for say cataract surgery you can claim only up to a certain amount for cataract surgery claims even though the total sum assured may be higher. It is always good to know the insurance sub limit in detail for various diseases before taking any health insurance policy.

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