A clean bill of health

Written by Saikat Neogi | New Delhi | Updated: Aug 13 2014, 07:22am hrs
Health insuranceSince health insurance is a long-term contract, one must carefully read the policy wording, premium and exclusions. (Illustration: Shyam)
Buying a health cover can be tricky as there are multiple products in the market from life, non-life and standalone health insurance companies. Since health insurance is a long-term contract, one must carefully read the policy wording, premium and exclusions. The sum insured under the policy is the total amount of liability that the insurer will bear annually.

A policy can be either individual or floater, and one can increase the sum insured at the time of its renewal. The option of upgrading the health cover at a later stage in life can be expensive and one may have to go for various medical tests.

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While premium for health insurance increases with age, there is a steep rise in premium after the age of 45 years and, in some cases, it can increase by as much as 50%.

Analysts say one must look at a basic product that covers all the members of the family, and if a policyholder is not satisfied with the insurer, one has the option to port the policy to some other company. A policyholder who wishes to port his policy to another company will have to apply at least 45 days before the premium renewal date of his existing policy.

The insurer may not be liable to offer portability if the policyholder

fails to approach the new insurer at least 45 days before the premium

renewal date.

At present, all health insurance policies provide for entry age of up to 65 years and do not have any exit age once the proposal is accepted, provided the policy is continuously renewed without any breaks.

Insurance companies cannot load charges on an individual insurance policy at the time of renewal, even if the policyholder has made a claim in the policy year.

For all health covers, insurers allow access for treatment in network provider, or in any hospital that is not part of the network provider across the country, except hospitals excluded from providing health care services for such covers. In fact, in 2010, some leading public sector insurance companies had a major standoff on treatment costs with hospitals, following which the insurers de-empanelled many network hospitals from their existing list. later, they restored it by forming a preferred provider network for cashless medical cover.

Experts say one must look at the treatment-wise limit for amounts one can claim under a health insurance policy. In such a case, if the claim amount exceeds the amount set by the insurer, one has to pay the balance despite having a bigger policy cover. There are certain health insurance policies that provide daily cash benefit for each day of hospitalisation. One must also note the terms and conditions of pre- and post-hospitalisation offerings, no-claim bonus and waiting period for specified ailments, which vary from company to company.

For senior citizens, the regulator has made it mandatory that the premium charged for health insurance products be transparent and disclosed upfront, and any loading charged on the premium informed to the policyholder. To make the claims process of senior citizens hassle-free, most insurers and third-

party administrators have set up separate channels.

While buying a health insurance policy, one must ensure that the cumulative bonus is stated explicitly in the prospectus and even in the policy document. Also, look at the product information on the company's website, which will include a description of the product, clauses and premium rates inclusive and exclusive of the service tax payable.

After receiving the lab reports, final bill with break-up and the discharge summary from the hospital, it is mandatory for insurance companies to settle the claim within 30 days. Also, if there is any delay in the filing of documents by the insured, the insurers will not deny such claims unless the delay was deliberate.

In case of any pre-insurance health check-up of the policyholder, half of the cost will have to be paid by the company, provided the proposal is accepted and results in a policy. Policyholders with multiple health covers can claim from multiple insurers if the benefits covered are fixed in nature. The contributory clause will not be applicable in this case.

If the insurer wants to withdraw a particular product from the market, the policyholder should not panic. The insurer will have to take an approval from the Insurance Regulatory and Development Authority by giving the reasons and complete details to the existing policyholders. And, if the product is withdrawn, the existing customers will be

given the option to switch to a similar product offered by the same or any other insure