Moneycontrol
Last Updated : Jan 28, 2014 03:57 PM IST | Source: Moneycontrol.com

Health Insurance: Understanding what's not covered is vital

No health insurance company covers all diseases. So read the list of covered diseases very carefully. Your decision should be based on the kind of lifestyle you lead—sedentary or active, and you should also consider health complications that run in the family.


Yashish Dahiya
Policybazaar.com


Do you read the fine print on health insurance policies before buying them? Or do you find the reams of terms and conditions so intimidating that you just don't buy them? If the latter, you are among many who steer clear of health insurance and prefer to pay for medical expenses from the pocket. Not because they are rich, but because the idea of being snubbed by the insurance company while settling the claim hurts. Fine prints though trivial but form an important part of your claim approval or rejection process. Keep a couple of the following aspect of fine print in mind to make a wise decision regarding health insurance.


What’s covered and what’s not covered: No health insurance company covers all diseases. So read the list of covered diseases very carefully. Your decision should be based on the kind of lifestyle you lead—sedentary or active, and you should also consider health complications that run in the family. Diabetes, kidney stones, heart diseases are known to be passed on through the generations.

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Pre-existing disease: Be very upfront about your existing illness and your medical history. You may have undergone a heart surgery or transplant years ago and may be leading a normal life, but it is still important that the insurance company knows about this. Concealing information is usually the ground for most claim rejections.


Cashless or not: This question cannot be answered with a simple yes or no. All health insurance contracts have a list of hospitals where cashless facility can be availed, but there is also a larger list of hospitals where the cashless facility will not be offered. More importantly, there is also a list of blacklisted hospitals, where no claim is payable by the insurer. So go through the list very thoroughly.


When does the cover begin: No health insurance policy will cover you from the date of purchase of insurance. The cover usually begins after 45-60 days. Therefore, in case you undergo treatment anytime during this period, you will not be entitled to any claim. Also remember that a health insurance contract, unlike a life insurance contract, has to be renewed every year with an annual premium. So failing to pay the premium on time will mean that the policy has lapsed, and you may again have to live with that no-claim window. You may also risk a minor increase in premium because you would have aged. A hospitalization in the previous year would push up costs further.


Individual or floater plan: A family floater plan covers the whole family and is usually cheaper than individual plans. However, it is important to check what happens when the proposer of the plan, the person in whose name the policy is taken, dies. Some policies may lapse, some won’t. Also, taking a floater plan when you have ageing parents would mean most of the cover is likely to go into their treatment, and this would reduce the cover for the rest of the family. If you are planning to have children, do check with the insurer the extra premium you would have to pay. The same applies if your parents are planning to move in with you.


The fact is that there are a certain standard set of exclusions that are expressly stated by all health insurers, these include:



  • 2-year waiting period exclusions: cataract, gall stones, kidney stones, basically ailments that cannot have a sudden progression/development/occurrence.

  • 4-year waiting period exclusions: pertaining to treatment expenses for complications arising out of preexisting ailments, i.e. ailments that existed at the time of enrolment of the insured.

  • Permanent exclusions: cosmetology-related treatments, maternity treatement/expenses, non-allopathic treatments.

  • It is pertinent that customers pay heed to these exclusionary clauses as well as the fine print while filing their claims; however, in case of any further discrepancy they must contact their insurer for clarification.

The author is a CEO and co-founder, www.policybazaar.com .

First Published on Jan 28, 2014 03:57 pm
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