Question 1

Is FinResp an insurance company or broker?

Accepted Answer

No. FinResp is an independent research platform. It is not a licensed insurance broker, agent, or intermediary, and does not sell insurance policies, process applications, or earn commission from any insurer. Compare Plans, Cover Check, and Rate My Plan are informational tools — actual purchases happen directly with an insurer or a licensed advisor.

Question 2

Why do insurance claims get rejected in India?

Accepted Answer

Claims are most commonly rejected due to non-disclosure of pre-existing conditions at the time of purchase, treatment during a waiting period, exclusions buried in the policy document, or incomplete claim documentation. IRDAI data shows 8% of health claims were rejected or partially disallowed in FY 2024-25. The single most effective protection is reading the actual policy wording before you sign — not just the agent's summary or brochure highlights.

Question 3

What is a claim settlement ratio and why does it matter?

Accepted Answer

The claim settlement ratio (CSR) is the percentage of insurance claims an insurer settled out of all claims received in a financial year. IRDAI publishes this for all registered insurers annually. A higher CSR means the insurer approved more claims — making it one of the strongest objective, publicly available indicators of insurer behaviour before you commit to a policy.

Question 4

What should I check before buying any health insurance policy?

Accepted Answer

Start with the claim settlement ratio from IRDAI public data — not the premium. Also verify the cashless hospital network (check if your nearest hospital is included), read the waiting periods for pre-existing diseases and specific conditions, understand what is excluded, and check how claims need to be reported and within what time limits. Premium should be the last comparison point, not the first.

Question 5

What is a waiting period in health insurance?

Accepted Answer

A waiting period is a defined time after policy purchase during which you cannot claim for a specific condition. There are typically three types: an initial waiting period (usually 30 days), a pre-existing disease waiting period (typically 24–48 months), and a specific-disease waiting period (12–24 months for conditions like hernia or cataracts). Understanding these before purchase prevents the most common claim dispute in India.

Question 6

What's the difference between cashless and reimbursement claims?

Accepted Answer

In a cashless claim, the insurer settles the bill directly with the hospital — you don't pay upfront. In reimbursement, you pay first and then claim it back. Cashless is only available at network hospitals empanelled with your insurer, and even then can involve co-payments or partial approvals on non-payable items — cashless doesn't always mean zero out-of-pocket cost. IRDAI mandates cashless pre-authorisation within 1 hour of request.

Question 7

What's the difference between individual and family floater insurance?

Accepted Answer

An individual policy covers one person with a fixed sum insured — each family member needs a separate policy. A family floater covers the entire family under one shared sum insured, usually at a lower combined premium, but one large claim can exhaust the shared limit and leave others uncovered for the rest of the year. Families with senior citizens are often better served by individual policies for this reason.

Question 8

What's the difference between Cover Check and Rate My Plan?

Accepted Answer

Cover Check answers "is my sum insured enough" — it's a needs-based adequacy check using your profile and real treatment cost benchmarks, useful whether or not you already have a policy. Rate My Plan scores a specific policy you already hold (or are considering) across features like room rent, co-pay, and restoration benefits. Use Cover Check to size your cover, and Rate My Plan to grade a specific plan's quality.

Question 9

Does Tejas recommend or sell a specific insurer?

Accepted Answer

No. Tejas is a decision-tree recommendation engine that suggests plans based on your stated profile and published plan data — it doesn't earn commission and has no incentive to favor any insurer. Suggestions are a starting point for research, not a substitute for reading the actual policy document.

Question 10

Is my data safe if I upload my policy PDF?

Accepted Answer

Your uploaded policy PDF is stored so you can download it again and isn't shared with any insurer or third party. If you're logged in, it's tied to your account; research tools used without logging in don't require any personal information at all. See the Privacy Policy for full details on what's collected and how to delete it.

Question 11

What is co-payment and why does it matter?

Accepted Answer

Co-payment is the percentage of a claim you pay from your own pocket, with the insurer covering the rest — for example, a 20% co-pay on a ₹10 lakh claim means you pay ₹2 lakh. Co-pay is often mandatory for senior citizens or for treatment at hospitals outside a preferred network. A lower or zero co-pay is generally better, but it can trade off against premium — always check this figure specifically rather than assuming a plan has none.

Question 12

What is a restoration or reload benefit?

Accepted Answer

Restoration automatically refills your sum insured if it gets exhausted during the policy year, so a second unrelated hospitalisation isn't left completely uncovered. Some plans restore only once a year, others offer unlimited restoration, and a few only restore for a different illness than the one that used up the original sum insured — the exact condition matters, so check the policy wording rather than assuming "restoration" always means the same thing.

Question 13

What is No Claim Bonus (NCB) in health insurance?

Accepted Answer

NCB increases your sum insured (or reduces your premium, depending on the insurer) for every claim-free year, typically by 5–50% depending on the insurer and plan. Some insurers offer NCB that resets or reduces after a claim is made, while others guarantee it regardless of claims in a given year — this distinction is worth checking since it affects how much your effective cover grows over time.

Question 14

Is a bigger sum insured always better?

Accepted Answer

A higher sum insured reduces the chance of exhausting your cover during a major hospitalisation, but it isn't the only factor that matters — a large sum insured with a low room-rent sub-limit or a high co-pay can still leave you with significant out-of-pocket costs. Cover Check estimates a reasonable sum insured for your city and family situation using real treatment cost benchmarks, rather than a generic rule of thumb.

Question 15

What's the difference between a top-up and a super top-up plan?

Accepted Answer

Both kick in only after a threshold (called the deductible) is crossed, offering additional cover at a lower premium than a full base policy of the same size. A top-up plan applies the deductible per individual hospitalisation claim, while a super top-up applies it to your total claims across the whole policy year — meaning a super top-up can still pay out even if no single claim alone crosses the deductible, as long as your cumulative claims do.

Question 16

Am I eligible for a government health scheme instead of buying a private policy?

Accepted Answer

Eligibility for schemes like Ayushman Bharat (PM-JAY) is typically based on income and socio-economic criteria defined by the government, and coverage is generally more limited in scope and hospital network than a private policy. It's worth checking government scheme eligibility first since it's free or heavily subsidised where applicable, but most working professionals will still need private cover for broader hospital access and higher sum insured.

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