Health Insurance – Are You Missing the Fine Print?

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Most of us must be having a life insurance plan but not all of us go in for a health plan popularly known as a Mediclaim policy. However, those who have ever been hospitalized and have had to settle a huge medical bill from their own pocket, at any point in their lives, would understand the need of a health plan. With the new-age, cutting-edge medical science, there is a cure for most diseases. Only hindrance being the cost of treatment! The average life expectancy has increased and along with that the cost of medical treatment and facilities have also become pretty steep. So, although most of us would undermine the importance of a health plan and find it an utter waste, let me inform you it’s just as important as your life insurance plan.

Understanding the types of Policies

Basically, there are two types of policies that are available in the market

1. Individual plans

2. Floater plans

Individual plans can cover the individual’s medical expenses for up to 10 lakhs but if you have a family to take care of then its makes more sense to take up a floater plan where the Mediclaim is extended to the whole family. So, now you can insure your baby who is barely a couple of months old to your parents who maybe touching 70 years. These days there are plans that are market linked. These invest in the market as well as cover you against the medical contingencies. Another kind of Health Insurance would be the Group Health Insurance or Corporate Health Insurance that is engaged by companies for its employees.

Before taking up any plan, go through the plan carefully. It is important to know what all diseases or illnesses the plan would cover. Find out if pre-existing illnesses and maternity expenses would be covered under a certain plan! You can also add on riders to a basic health plan to avail additional benefits at a minimal cost.

Understanding the Flip Side

The picture is far from perfect as most companies do not cover chronic illnesses like arthritis or long term illnesses like TB. Also, routine medical care and medicine costs or even fee for an OPD consultation, are not met with in some plans. Most companies only settle the claim if the person has been hospitalized for at least one day. Pregnancy and its related ailments and few of the illnesses are also excluded in most policies. Age limitations (usually 65 years for elderly) can pose as an obstacle while procuring a health plan. Despite its limited scope, a good Mediclaim policy will be of substantial help in any which way.

Understanding Claim Settlement

In India, companies usually settle the claim in two ways.

1. By cashless hospitalization in hospitals associated with the insurance provider through a TPA (Third Party Administrator) that’s engaged by the insurance company. The TPA essentially protects the insured person’s interest. It helps to find out how extensive the TPA network of a company is before taking up a policy.

2. By reimbursement where the insured pays upfront to the hospital on admission and the company reimburses it on bill submission, within a fortnight.

It is important to define your requirement as there are different types of health plans available in the market to suit your budget and needs. New India Assurance, Oriental, Star Health, ICICI Lombard, HDFC Insurance, Apollo Munich, Cholamandalam and Royal Sundaram amongst others are a few respectable names in the medi-claim world! Health hazards are just round the corner so be prudent and act now!



Source by Ashok AK Kumar