A health insurance policy bought is no good if it does not serve the purpose of providing timely financial relief in the event of a calamity. Customers find themselves in a state of despair when their claims are rejected or they do not receive the full sum assured. This happens because the insurance agent did not provide complete information of the medical policy and/or the customer did not bother to understand its features and benefits at the time of purchase.
The wide variety of health insurance policies in the market confuse the customers who then invariably end up comparing premiums alone to buy an affordable product. It is the right and the responsibility of customers to make pro-active efforts to read the fine print of the policy document and try to avoid inconvenience during settlement.
Following are the guiding points you as a customer should know before buying health insurance:
Make complete disclosures:Besides understanding the terms of the policy, what is even more crucial is to make full disclosures to the insurer about your health and other personal details. If you fail to give any information as required by the insurer at the time of issue of policy, intentionally or otherwise, you may later face problems in claim settlement.
Form of settlement: Check whether the health insurance company facilitates cashless settlement of claims. Though most companies nowadays offer this facility, it is prudent to enquire beforehand. Enquire about the insurer’s network of hospitals for cashless settlement of claims. A big network of the insurer would help in case you have a preference for a specific hospital where you might have been seeking treatment in the past.
In case you happen to be admitted in a hospital which is not in the network of your insurance company, you will have to make all payments on your own to the hospital. Then you can get it reimbursed from the insurance company after the submission of the necessary claim documents.
Pre-existing diseases: Health insurance companies have a waiting period when it comes to pre-existing illnesses that the insured has prior to buying a health insurance policy. This means that one cannot claim compensation in the event of a medical emergency till the waiting period is over. It normally ranges from 1-4 years and varies from company to company. Read about it in the fine print before buying a health insurance policy.
Exclusions: Health insurance policiescontain a list of exclusions, i.e, medical conditions that are not covered for reimbursement by health insurance companies. There are permanent exclusions like AIDS, dental surgery, cosmetic surgery, maternity, etc but the list varies from company to company. Make sure you understand the inclusions and exclusions properly before buying a health insurance product. This is not only in terms of specific illnesses but also the applicable reimbursement expenses. For e.g, doctor’s consulting fees and medical test expenses are not covered in some policies.
Policy Sub-limits: Enquire about sub-limits imposed by most insurers for various kinds of expenses on specific illnesses. This implies that the amount you can claim on these ailments is capped, irrespective of the amount of sum insured and you have to bear the balance expense.For instance, many health insurance companies have a cap on the room rent, i.e, they will pay an X amount and the balance expense will be borne by you.
6. Loading: Loading usually refers to the percentage increase in your premium in the event of a claim. This means claims made by you are likely to affect the subsequent year’s premium payable. Most insurers come with this clause and companies may differ in the way they calculate this amount. Thus, make sure you compare, among other things, the loading structure of various companies before you choose a policy best suited to your needs.
Renewal Age: Check the maximum renewal age in health insurance policies. This is the age when your policy will discontinue. While most companies follow the cut off rule in renewal age, there are few policies available which can be renewed for lifetime.
Free look period: If any discrepancy is spotted with regards to the above mentioned issues in the proposal form, then the customer has a window of opportunity to cancel the policy within a free look period of 15 days. In other words, if you are not happy with the insurance policy you bought, you have a right to cancel it within 15 days and get your entire money back.
Even after the due-diligence, if you are not happy with the health insurance product being bought, you have the freedom to switch to other insurers without losing the continuity benefits. This includes credit gained for pre-existing diseases and time bound exclusions. Ensure that you get existing benefits and additional benefits while porting your health insurance policy.