Health insurance can be a challenging product for many of us to properly understand, especially given its various technicalities and clauses. However, for those who need it, there is no shortage of information on health insurance and its various aspects, all of which is available on the internet. As competition continues to increase, more and more insurers and third party aggregators are making information available to customers at the mere click of a button, which is helping clear the mistaken beliefs peoples hold regarding health insurance. Here are some misconceptions that people usually have regarding health insurance, which we will help rectify, so you can make an informed decision when it comes to purchasing health insurance for yourself or your family.
Myth 1: Employer Provided Health Insurance Is Sufficient
Truth: Many organizations cover their employees under corporate group health insurance policies as a part of their employee welfare program. However, if you are covered under your employer-provided health insurance plan, don’t ignore the importance of having an individual health insurance. While corporate policies are useful, they might not extend cover to your aged parents / dependents, require you to make a co-payment, etc. Additionally, your policy will only be applicable until the time you are employed with your current organization. Purchasing a health insurance early on is wise as health insurance only becomes costlier as you grow older and your health generally deteriorates. Also, if you are between jobs and do not have an individual policy cover, you will essentially be without any health insurance cover.
Also Read: Converting Group in to Individual Policy.
Myth 2: Smokers Are Not Be Eligible For Health Insurance
Truth: According to a survey carried out by a health insurance provider, nearly 49% of individuals who consumed alcohol or smoked were unsure about whether or not they’d be eligible for a health insurance policy. While such individuals may be at a significantly higher health risk, they are not ineligible for health insurance. However, given that the risk associated for such individuals is high, they may be required to pay a slightly higher premium and also undergo stricter health tests before the health insurance is offered to them.
Myth 3: Those Who Are Fit Don’t Need Health Insurance
Truth: While being fit is great, it doesn’t not shield you unforeseen incidents like illnesses or accidents. Illnesses like malaria and dengue can be contracted by the fittest of individuals. Accidents can gravely injure anyone, the hospitalization for which can easily run into lakhs, depending on the severity of the injuries.
Myth 4: You Are Paid Only If You’re Hospitalized
Truth: It is a myth that only surgeries which are followed by hospitalization are covered under a health insurance policy. Thanks to technological advancements, it is not always necessary that an individual be hospitalized to undergo a surgery. Day care procedures like a cataract operation, kidney stone removal, etc. do not require patients to be hospitalized and patients can easily go back home after a few hours. Day care procedures are covered under health insurance. Some health insurance companies also extend cover towards for related expenses like dental treatments, doctor consultation charges, ayurvedic and even Unani treatment expenses under a health insurance policy.
Myth 5: Health Insurance Can Be Purchased to Cover an Immediate Surgery
Truth: Health insurance policies include a clause which allow individuals to make a claim only within the first 30-90 days. Also, a part of health insurance policies is the waiting period, applicable on selected ailments like hysterectomy. Most health insurance policies have a waiting period of 2-3 years for pre-existing diseases. At the time of purchasing the policy, ensure that you reveal all medical details to your insurer to avoid having your claim rejected altogether by your insurer if it is discovered that your disease was pre-existing before the purchase of the policy.
Myth 6: The More the Better - Network Hospitals & Day-care Procedures
Truth: In order to attract customers, health insurance brochures often lay emphasis on advertising about their widespread network of empanelled hospitals. However, the truth is that the hospitals included in the network matter far more than the numbers. This is because the list of hospitals falling under an insurer’s network is likely to change each year, which can lead to your preferred hospital going off the list any year. The same logic applies to day-care procedures which are also given significant weightage when one chooses a policy. If your insurance policy has an exhaustive list of day-care procedures that it covers, then chances are high that that there will be an equally exhaustive list of restrictions and conditions applicable to claims being raised and accepted for those surgeries.
Myth 7: Significant Differences Between Online & Offline Health Insurance
Truth: More than ever, online purchases have become the order of the day and insurance purchase is no exception. For the convenience of customers, insurers are now offering insurance policies online which carry the same terms, conditions, benefits, etc., as those offered by policies purchased offline. However, online policies may often provide the advantage of a lower premium as there is no agent or commission involved. This advantage is automatically passed on to the customer who can enjoy a lower premium on purchasing their policy online. Also, the customer care will be ready to answer all your queries and you are expected to read your policy document thoroughly to ensure you know what you will be paying for.
Myth 8: Purchasing Health Insurance for Tax Saving Reasons
Truth: In India, most individuals view an insurance policy more as a tax saving instrument than one which can provide coverage in times of a medical emergency. Before you purchase a policy just for tax benefit purposes, it is advisable that you read through the policy document carefully to avoid facing surprise at the time of making a claim.
Myth 9: An Agent Will Get You the Best Policy
Truth: Many customers still believe that an agent can get them the best deal on a health insurance policy, which is not true. An agent who has helped you purchase a particular policy may not be engaged with the same insurer at the time you have to make a claim. Also, the protection that a policy provides is solely based on the terms and conditions of the policy, rather than the agent via who you purchased it. Though an agent may emphasize on having your best interests in mind, in the end, no one but you will be responsible for being fully aware of what the policy covers and what doesn’t.
Also Read: Agent or Broker - Which is Better?
Myth 10: Comparing the Waiting Period for Pre-Existing Diseases
Truth: Most health insurance policies feature a clause pertaining to the waiting period for pre-existing diseases. You must keep in mind that only if you are suffering from an existing disease at the time of purchasing a policy will this clause even be applicable to you. Many customers spend considerable time in comparing the waiting period included in different policies, which might not even be applicable to them. In case you do have a pre-existing disease at the time of purchasing a policy, keep in mind that most policies will only begin hospitalization cover after 2 or 3 policy years.
Myth 11: 24 Hour Hospitalization
Truth: Similar to the point mentioned above regarding payment only upon hospitalization, many policy holders hold the misconception that in order to make a claim, a person must be hospitalized for a minimum duration of 24 hours. Again, this is not true, especially keeping in mind day-are procedures which do not require patients to be hospitalized. Day-care surgeries like dental treatments, cataract operations, do not require patient to be admitted in the hospital. Read your policy brochure to find out which day-care procedures are covered under your policy. Also, ’24 hour hospitalization’ will be mentioned as necessary and for which ailments or conditions it I required, for you to make a claim.
Myth 12: Cashless Payments Make Everything Easier
Truth: A common myth prevalent among people is that cashless payments can ease all your worries. However, that is not entirely true. Cashless payments are dependent on a few factors. To begin with, the hospital you may be admitted in must be an assured partner in your insurer’s cashless hospital network, in which case you can benefit from the facility. The second reality in the cashless scenario is 24x7 operation. This means that the insurance desk of the hospital you are admitted in may not be open 24x7, like the hospital staff. In this case, if you have to make your payment at such a time when the desk is not operational, you will have no choice but to make the payment yourself, before you can settle the same with your insurer later.
Also Read: Health Insurance Claims Procedure.
Myth 13: Health Insurance Doesn’t Cover Pregnancies
Truth: This myth is not entirely untrue, as it was relevant until a few years ago when many health insurance companies seldom covered pregnancies which were considered sure-shot claims in a majority of cases. The trend has changed as now insurers have begun including pregnancies under the policy cover. While there may be certain conditions governing the cover provided for pregnancies like a waiting period of a certain number of years before the policy covers pregnancy related claims, coverage only for the 1st pregnancy, etc. Therefore, when hunting for a suitable policy, do check if it provides cover for pregnancies, despite the conditions.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.