Health Insurance has been a must thing these days for you and your family. Market and internet are flooded with different health insurance schemes and plans, holding different benefits and covers. One should take it not just for tax exemption but what it really stands for or holds value for. However one has to be cautious while a buying a health insurance plan. Equal attention should be paid to the terms and conditions, exclusions and other unrevealed facts about the plan you are being told about. Most of the claimers receive a ‘Big NO’ board from the insurers just because they submit the claims out of ignorance and misconception about their policy covers, terms and conditions. Adhering the substantial factors pertained the health insurance will result into hassle-free claim process. Let us understand and take a deep insight into these significant elements which are likely to be ignored or degraded in the most of the cases.
Insured firstly, should understand the concept of cooling or waiting period. It is the time post taking the policy, when the insurer is not liable to settle any claims. Insured should finely evaluate the waiting period for the policy. This cooling period or waiting period depends on Exclusions and Pre-existing disease. As per industry norms, no claim is payable for initial 30 days after the purchase of the policy except an emergency or an accident. Nevertheless, this cooling time may also differ from insurer to insurer. As per the exclusions, sometimes, insurer also put a cooling time condition for specific illnesses which get covered after a waiting period of one or two years. This cooling period is applicable for pre-existing diseases. Insured should clear these inclusion and exclusion of these diseases or cooling period concept before buying the policy. Pertaining exclusions, Injuries resulting from war, cosmetic surgery, abortion, treatment for pregnancy, diagnostic charges are generally not covered in health insurance policies. Insured should check these things to avoid rejection of claim at a later stage.
Generally pre-existing diseases are not covered in the policy for first four years of the policy depending on the terms. Potential buyer should declare the pre-existing diseases while opting for a health insurance policy. If these diseases are accepted by the insurer, buyer should confirm the waiting or cooling period for these diseases to avoid the rejection of the claims for pre-existing diseases submitted in the waiting period.
Checking the sub-limit is equally important. Sub-limit is the upper limit for specific expenses that can be incurred. This sub-limit generally applies on room rent, specific procedures and surgeries. It also depends on the percentage of the sum insured as specified by the insurer in the clauses.
Co-pay is also one of the deciding factors in the claim process. It is the payment component, needs to be divided between insured and insurer (Not necessarily in equal proportion) in a particular expense. This ratio generally ranges from 10-25%. Get this cleared while buying a policy. Deductibles play an important role here. It is the voluntary expense paid by the insured before insurer pays the balance payment. Mostly, this is voluntary. However, this factor lowers the premium of the policy.
Intricacies of these health plans should be well understood by the potential buyers before taking the policy for positive claim settlement.