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Mar 27, 2017 10:15 AM IST | Source:

Nine lesser known facts of health insurance you should not miss

Health insurance has become a more transparent means to secure your family financially against all health issues.

Anuj Gulati

Anuj Gulati

Over a decade-and-a-half ago, a study by the World Bank (2001) pointed out that at least 24 percent of all people hospitalised in India in a single year slipped below the poverty line because they were hospitalised. A more recent report on out-of-pocket healthcare expenditure in India, published about a year ago, suggested that 70 percent of healthcare expenses incurred by Indians are from their pockets, of which 70 percent is spent on medicines alone, leading to impoverishment and indebtedness. Despite these startling facts, less than one-fifth of Indians are covered under health insurance.

Here are some interesting lesser known facts about health insurance products in India that could motivate many to go ahead and purchase a policy:

Individual policies and floaters with no maximum entry age: It’s not uncommon to be covered by the health insurance policy of one’s employer. But what happens when one retires and needs health insurance the most? Well, these days you can find policies that are happy to cover you irrespective of your age. In fact, even a couple in their golden years could opt for a floater that covers them both.

Cashless treatment and Reimbursement claims –There is a misconception that cashless claims force one to depend only on the list of networked hospitals for claiming on their insurance. The fact is that if one chooses a non-networked hospital, the option to pay and file a reimbursement claim remains open. Further, in the case of a cashless claim, if the claim is rejected due to incomplete paperwork, there is always the option to claim later, once the paperwork is complete.

Day-care treatments and Treatment at Home: Traditionally, health insurance could be claimed only after at least 24 hours of hospitalisation. Keeping up with the times, some insurers cover as many as 500 Day Care treatments.

In addition, if one suffers from a disease or injury that would normally require hospitalisation, which is not possible owing to one’s state of health or the unavailability of a room, insurers now cover what they call "domiciliary hospitalisation" or treatment at home, subject to certain conditions.

Recharge of the Sum Insured: Some insurers offer the facility to refill your sum insured, if it gets exhausted from claims made earlier. This refilled/recharged sum insured can be used to cover future claims that are unrelated to those made earlier in the term. Moreover, some insurers offer this facility an unlimited number of times during a policy year.

Quick Claims: Claims processes keep getting simpler and faster. There are instances in which cashless discharges have taken place in a span of a couple of hours. All it takes is being regularly in touch with the help desk from admission to the prospect of discharge.

No pre-policy medical check-ups for prospects of all ages and across sum insured options: Today, a few companies offer policies specially designed for the large faction of people who go uninsured or are underinsured owing to the results of pre-policy medical tests or because they have certain pre-existing illnesses or are relatively progressed in age. These companies do not insist on pre-policy medical check-ups for prospects of all ages and across all sum insured options.

Alternative forms of treatment are covered: In 2013, the Insurance Regulatory Development Authority of India issued guidelines that allow insurers to cover non-allopathic treatment such as Ayurveda, Unani, Sidha and Homoeopathy (AYUSH). Today, there are a host of health insurance companies that offer policies which cover a range of alternative treatments.

Policies designed to cover maternity expenses –There are companies that offer health insurance policies, which are specially designed to cover maternity expenses with respect to hospitalisation for the delivery of the child, pre-natal (examinations, tests and medication, etc. and even the ambulance service, in an emergency) and post-natal expenses (follow-up visits, medication, related confirmatory tests, etc.). Such policies even cover the medical expenses of the newborn from birth till the completion of 90 days. Most importantly, these policies have a waiting period of just nine months.

Other lesser known attractive features: A little shopping around could get you a policy that covers medical treatment anywhere in the world, on a cashless basis, for certain illnesses; a hike in the sum insured of up to 50% as a "no claim" bonus for a period of five claim-free years; daily allowances in the form of a lumpsum for each day of hospitalisation towards "non-medical" expenses such as consumables, transportation, etc. and the list goes on. The cherry on the cake is being able to compare, buy and renew policies online, offering transparency and the opportunity to find a policy that is the best fit in terms of both price and coverage. That itself is motivation enough to reach out and ensure that your health care is insured.

The writer is MD & CEO of Religare Health Insurance.
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