You must have come across any relative or friend of yours slipping in the bathroom and getting bed ridden for weeks with a slip disc or simply diagnosed with a kidney problem. While the incident set them back emotionally, it also takes a toll on their financial health. The rising inflation has spread it wings to the medical treatment as well. A three to four day stay in a hospital can cost you in thousands. And if there are further complications, the bill can run in lakhs. It is needless to say that your overall financial plan goes in for a toss due to such contingency. Therefore it is important to hedge your risk by insuring yourself.
Health insurance is an important part of overall insurance portfolio. Such an arrangement can save you a fortune and help to keep your overall financial planning intact without affecting any of your goals. While some insurers offer lifelong renewability under their health plan, an insurance doesn’t guarantee settlement for any claim raised.
There are exclusions as well which are necessary for you to be aware of. Here are some fine prints attached to the health plans. Let’s take a look
Waiting period
If you think the insurer would accept your claim from the very first day of taking the policy, you are mistaken. Most insurance policies have a 30-day waiting period after which only it can accept your claim. In case of critical illness cover this limit goes upto 90 days. It differs across the insurers. This is a very important condition to be met by the insured.
Pre-existing ailments
Ailments which are present at the time of the policy or the complications arising from those ailments are classified as pre-existing ailments. Health insurance policies do not cover you for such diseases even after a waiting period of 30 or 90 days. Its only after a long period has passed would you be entitled to make a claim. The times ranges anywhere between 2 and 4 years after taking the policy. However, some insurers like National insurance provide coverage against diseases like diabetes and hypertension at the time of subscribing the policy but only by way of additional premium.
Pregnancy cover
Pregnancy is the most beautiful phase in a woman’s life. While insurers are taking steps to make a provision for it under their health plans, they are also bundling restrictions along in terms of waiting period. Those who do have limits and waiting period attached to it. Star Health, for example, provides coverage against pregnancy but the limit is set for a maximum of 2 deliveries. Also for first claim there is a waiting period of 36 months from the inception of the policy. It is a tad lower at 24 months for the second delivery after having the first. In Max Bupa’s heartbeat plan too you have to wait for 2 years to get the maternity cover benefit. Some insurers also provide for vaccination expenses in the first year of the child. Compare various health plans on this clause too. You might have to shell out extra premium but it is worth it.
Alternative treatments
Due to many side effects of allopathic medicines, many people prefer traditional or alternative treatments like Ayurveda, Naturopathy or Unani. Though health insurance sector has evolved, some insurers still hesitate to pay you the claim if you go for treatments other than allopathy. Its important to check this clause thoroughly in your policy. Though public sector insurer like National insurance do recognize such treatments for claim but only when it is undertaken at the hospital. Some insurers simply put a cap on the sum insured.
Sublimits
Though you might have taken insurance of any limit, you would be provided according to the limits set by the insurance company. Insurers have sub-limits for different parts like room rent, doctor fees, anesthesia etc. There are certain diseases like cataract, kidney stone which have sub-limits attached to them. So even if the cataract operation cost comes around Rs 25000 when the sum insured is Rs 2 lakh, you would be only provided with Rs 20,000 with a sublimit of 1%. The rest of the amount you have to bear from your own pocket. Check the sub-limits before taking the policy to avoid nasty surprises later on.
Surgeries
Insurance companies do not pay if you undergo surgeries which are cosmetic in nature. This also includes plastic and dental surgery. In case of hernia and piles treatment you have to wait for a year.
Geographies
While taking a health insurance policy, keep in mind that it has geographic limits too. Unlike a life insurance policy, it doesn’t provide you with cover outside the country. In such a scenario you have to take a travel insurance that takes care of your medical contingency in case of visit to abroad. Your normal health cover would be declared null and void.
Domiciliary treatment
The treatment taken at the house due to factors like non-availability of bed in the hospital or medical condition of the patient requiring home treatment is known as domiciliary treatment. But the definition is wider in scope. The treatment done should have a minimum duration of minimum 3 days in order to be termed as domiciliary treatment. However, insurers do not accept claim for any disease for such a treatment. There are diseases clearly specified. Oriental Insurance, for instance, have a list of diseases including asthma, bronchitis and psychosomatic disorders that can be treated at home and eligible for claim amount too. Apart from this, some insurers have made an arrangement for paying a fixed percentage of the claim amount. National insurance, for instance, let you avail 20% of the sum insured for treatment taken at home. This limit is 10% of the sum insured if we go by health insurance plans of Reliance General insurance.
Hospital definition
In order to take the advantage of your health insurance policy, it is necessary to get admitted in a hospital with 15 beds at least. The doctors and nurses should be qualified enough and meet certain acceptable standards. Otherwise, you have to incur huge cost despite an insurance policy in place. Also, you have to stay for a minimum of 24 hours in hospital.
Did you missed any thing while taking your insurance.
