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Feb 14, 2013, 07.27 PM IST | Source: Moneycontrol.com

Does your health insurance really cover everything?

All critical illnesses are covered under a health insurance policy but only after the policy has completed a stipulated amount of time.

Yashish Dahiya

I was recently diagnosed with a mild heart attack and was advised by my doctor to get admitted to perform certain routine tests and medication. I decided it was time that I utilise my newly bought Health insurance Policy. So I got admitted into the hospital and submitted all my insurance documents at the admission counter and looked for the best room my health insurer would cover. On the day of my discharge I was handed over a bill of Rs. 60,000 by the hospital to which I looked cynically and asked them, doesn’t my health insurance cover this?

The Spiel:

‘All you need to do is go and get admitted in the hospital. Your health insurance covers everything.’

The Catch:

Bought a Health Insurance plan recently, read the terms and conditions as soon as you receive the policy document. All major Health Insurers today have added a Waiting Period clause in their health insurance policies. By the word waiting period they mean, that until your health insurance policy has completed an XX number of years a few particular illnesses will not be covered under that policy.

All critical illnesses are covered under a health insurance policy but only after the policy has completed a stipulated amount of time, taking an example of a Cardiac Arrest, all major insurers have a waiting period of between 2 3 years before they start covering you for all financial losses caused due to hospitalisation in case of a cardiac arrest.

What you should do:

All customers should mandatorily read the policy document booklet at the time the policy is issued to them. The policy document is the final word against which the insurer will settle all claims as made by the policyholder. Hence, it is mandatory for a policyholder to read the policy document as soon as he receives the same.

All insurers also offer a Freelook period to a customer, which states if the customer finds anything wrong in the policy sold to him or any difference between what was communicated to him by the agent and what the policy document says, the customer can opt to discontinue the policy immediately and the insurer will bound to return the policyholder his money less of any medical check up charges, if incurred any. The freelook period is available to the customer for 15 days beginning from the time he receives his policy document. If the policy holder fails to respond in stipulated 15 days, he would not be able to discontinue the policy

A short list of illness and their corresponding waiting period

Illness

Waiting Period

Any Illnesses or  Ailments or Surgery Procedure

30 Days

Hepatitis of any kind, Tuberculosis of any kind

Six Month

Tonsillitis, Arthritis; any Back, Spine or Spinal Chord Disorder

One Year

Cancer of any kind , Kidney Stone, Cataract, Hernia

Two Years

*This is an indicative list and waiting period would depend from insurer to insurer. 

 

 

 

 

 

 

 

 

In Brief:

Waiting Period is majorly included as a clause by health insurers to reduce the number of false claims and false submissions by the policyholder at the time of filling up a health insurance proposal form. At the time of filling up the health insurance proposal form a policyholder should always correctly disclose all details as failure to do so may also lead to claim being denied.

Waiting Period are always for those illnesses which are of non regular in nature and take time to develop as a disease unlike a normal viral cough and cold. Hence it is imperative that a policyholder always go through the policy document in detail as soon as he receives the same.

Yashish Dahiya is the Co-Founder and CEO of PolicyBazaar.com

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