First, there is a mandatory minimum 30 days waiting period in all health policies, and two to four years waiting period for pre-existing diseases.
Health insurance should be part of the savings portfolio that one builds to ward off any financial emergency. Here, we will discuss certain myths that surround health insurance.
Health insurance is not important at an early age
There are strong reasons to go for health insurance at an early age. First, there is a mandatory minimum 30 days waiting period in all health policies, and two to four years waiting period for pre-existing diseases. Since most critical diseases surface all of a sudden, the waiting period becomes a major hurdle in getting insurance money. It is always advisable to buy health insurance when one is young and can pass the waiting period in good health. Health insurance premium is directly related to age—the younger you are the less premium you have to pay.
Hospitalisation expenses are covered from Day 1
All health policies have a minimum 30 days period of waiting, barring cases of accident. If you need to get hospitalised soon after buying a health policy, don’t expect any help from your insurer. Health policies have two to four years waiting period for pre-existing diseases and some exclusions as well. So, it is imperative to compare online different health policies available in the market and then decide on the most suitable one. That way, you will be aware of all the terms and conditions of your policy from Day 1, and would not have to face disappointment after making a claim not allowed in your policy.
Minimum 24 hours of hospitalisation must for claim
This was true earlier, but not now. Due to the advancement of medical sciences, more than 100 types of treatments can be done within a few hours and the patient can go home the same day. These are called day-care treatments and include cataract surgery, lithography, dialysis and chemotherapy. Therefore, almost all health insurance companies now allow claims for treatments which require less than 24 hours hospitalisation. Some insurance companies also allow the claim for treatments which fall under Out Patient Department (OPD) such as dental care, but there are certain limits to such claims.
All pre-existing diseases are covered after waiting period
All health insurance policies cover pre-existing diseases, some cover after 24 months, some after 48 months. However, coverage of pre-existing diseases depends upon your honesty. It is paramount to disclose all your medical conditions at the time of buying the insurance policy. If you are unaware of any disease that you have and announce yourself medically fit, your insurance will cover such diseases after the prescribed waiting period. But if the insurer suspects that you did not disclose your medical conditions honestly and willingly at the time of buying the health policy, your insurer will decline your claim. So, you must give whatever information your insurer wants at the time of applying for a policy so that you can be spared of any embarrassment later.
Insurer pays full amount of hospital bill
A health policy is supposed to pay the actual amount incurred on treatment of an ailment. But, in reality, this is not the case and your insurer will honour only partial claims. One reason for this is that consumables are not covered by your health insurance policy. These consumables are oxygen mask, thermometer, nylon gloves, crepe bandage, face mask, etc. Some policies have certain predefined sub-limits. For example, some policies have a cap on room rent, while some others pay the actual room rent without any limit.
So, if your policy has a room rent cap at Rs 4,000 day, and you take a room of Rs 4,500 day, then Rs 500 will have to be paid by you, while the rest of the amount will be paid by your insurer. Similarly, some policies have limits on some other hospital expenses and, in fact, may exclude certain kind of medicines from the claim list. So, it is important to know right from the beginning the non-admissible list of expenses. It is always better to be aware of your entitlements rather than face embarrassment at the time of making a claim.
By: Vaidyanathan Ramani
The writer is head, Product and Innovation, Policybazaar.com