Lesser-known features of health insurance

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March 22, 2021 10:59 AM

Even though many people are now aware of how to check a policy's features, benefits and also make a comparison before buying a policy, there are still a few lesser-known facts that one needs to know.

health insurance, standerdisation of health insurance policies, renewal premium, increase in health insurance premium, Insurance Regulatory Authority of India, IRDAI, IRDAI changes norms, Novel Coronavirus Covid-19, nationwide lockdown, health insurance, Covid-19 vaccine, health insurance claim, Covid-specific policies, Corona Kavach, Corona RakshakMost health insurers provide this offer once every 3-4 years but policyholders are usually not aware of it.

Having a health insurance policy is the first step of financial planning, as suggested by experts before an individual starts to save. With the COVID-19 pandemic, buying health insurance online has also seen a rise, especially due to the focus on health care costs.

Even though many people are now aware of how to check a policy’s features, benefits and also make a comparison before buying a policy, there are still a few lesser-known facts that one needs to know.

Pre-existing diseases

Usually, health insurance policies cover pre-existing ailments after 36 or 48 months of buying the policy. However, it will only be applicable if the policyholder discloses them at the time of applying. If the policyholder hides any important medical information and existing ailments while buying the policy, the claim settlement could get delayed. Not disclosing them could also lead to claim rejection in the future.

Sub-Limits

Various elements depending on the cover include sub-limits. Usually, the room rent has a sub-limit which is determined by the sum insured in the health insurance policy and is linked to the claim during hospitalization. For instance, if the sum insured is Rs 5 lakh, the room rent is capped at 1 per cent per day which is Rs 5,000. If during hospitalization the room rent is higher, the medical expenses in the hospital bill of the policyholder could get proportionately reduced. He/she might have to end up paying from their own pocket even with a cashless medical insurance plan.

Tax benefit

Only when the premium of a health insurance policy is paid through cheque, net banking or any other digital mode, the premium qualifies for tax benefit. If the health cover is bought by paying cash, you will not get tax benefits on it. Having said so, if payments are made towards preventive health check-up up to Rs 5,000 tax benefit is allowed even if it in cash.

Medical tests

Insurance companies conduct medical tests of the buyer before issuing a health insurance policy, but mostly for those who are above age 45. However, insurers could also ask for a medical examination even for those who are below 45, in case of a larger sum insured. Hence, experts say one should always disclose all their medical and family history in the application form while opting for a policy.

Free health check-ups

Most health insurers provide this offer once every 3-4 years but policyholders are usually not aware of it. It will only be applicable if there is no claim made on the policy. Experts say one could use it to get a full-body check-up. The amount, however, is generally capped at 1 per cent of the sum insured of the policyholder.

Note that, under section 80D on the premium paid for preventive health check-up there is a tax benefit up to Rs 5,000 within the overall limit of Rs 25,000 or Rs 50,000 depending on the age.

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