Essentials of health insurance!

by BankBazaar.com Desk on 13, July, 2012   0 |

• Tweet
• Sharebar

• Tweet

A health insurance policy is a mandatory requirement for most middle class working professionals given the uncertainty of modern living and stressful lifestyles coupled with the spiraling cost of health care in the country. However many health insurance policy holders are often caught unaware of the exact coverage as mentioned in the fine print and therefore do not get the expected benefits when they need it most. Additionally there is widespread lack of information on the rights that a policy holder is entitled to when he buys a health insurance policy. Both the features of your policy and the rights as a customer must be understood categorically in order to avail maximum benefits from the policy.

Cover for Hospitalization

This element caters for a major part of the expenses during a critical health condition and is covered by the health insurance policy in most cases. Expenses which include room rent, nursing charges, doctor’s fees, cost of medicines, diagnostics and surgical procedures will be paid for by the insuring company. However, most policies have a certain capping which is maintained in the policy document on the amount that can be paid by the insurer towards these charges. Additional expenditure if any will have to be borne by the customer.

There is some confusion among most customers regarding the 24 hours hospitalization clause. One needs to check out the provisions in the policy regarding day care procedures and treatment which does not entail 24 hours hospitalization. In most cases the policies clearly state the procedures which are covered even if there is no 24 hour hospitalization needed.

In most policies the expenses incurred hours before the hospitalization and typically up to a period of three months post hospitalization date are covered through the insurance. However the exact provisions must be carefully studied for each policy.

Pre Existing Diseases

This is yet another grey zone for most of the health insurance policy holders. Typically most policies exclude the pre existing diseases or ailments whose symptoms are present at the time of buying the policy from the insurance cover. There was great deal of disparity on this issue among various insurance companies. However from 2009 onwards the IRDA has clarified that pre existing conditions are those whose symptoms were present or for whom treatment had been initiated within a period of 4 years prior to taking the policy. After a period of 4 years these conditions or diseases can be covered.

The Waiting Period in Health Insurance Policies

It has to be clearly understood that the health insurance cover doesn’t commence immediately after taking the policy. There is minimum stipulated waiting period of typically one to three months before the cover is activated. However the insurer will pay for situations arising out of accidents during this period and not for naturally occurring ailments or diseases covered under the plan.

Exclusions from the Health Insurance Policies

Every policy has a list of diseases, conditions and medical services that are not covered by the insurer. Some of the commonly excluded cases include internal congenital disease, cosmetic surgeries, dental treatment, weight loss and alcohol abuse. Some other conditions such as cataract, piles, hernia and gallstone removal have a waiting period of typically two years after which they are included in the cover.

Co-payment Clause

In certain plans such as those catering to senior citizens there is a co payment clause which requires the insured to pay a part of the cost along with the cover provided by the insurer. In some cases the co payment clause is applied to particular diseases or conditions. New policies have come up the provision of additional premium to avoid co payment.