Health Insurance has become an important thing in one’s like in the recent past due to the uncertain times we are living in. It is important to safe guaurd your health by choosing the best available health insurance. But choosing health insurance is a difficult task and most of the times the Broker will cheat people with some unknown terms in the Insurance which the Insured will not be aware of.
Whenever you are taking a health insurance policy, it is important to carefully check all the details and understand different terms in the policy. So that you will face a situation in future with a point which you have not aware of while taking the policy.
Choosing the best health insurance is a tiresome and a difficult task. Importantly when you have little or no idea about the details about the health insurance. In this article, we have discussed a few of the must-have things to check when taking a Heal Insurance.
Must Check Things in Health Insurance
Pre Hospitalization and Post Hospitalization Charges:
These are the charges that are incurred by the Insured before admitting to the hospital and after admitting to the hospital. For example, you have a Health insurance policy for ₹ 5,00,000. At some point, you have gold cold and fever with body pains. On visiting the doctor, the doctor advised a few medicines and blood test. After completing all the tests you have come back home. But within 2 days, you started to feel lazy and increased body temperature. You visit the doctor and this time the doctor advised full body scan. after a lot of scans, the doctor advised a few medicines and you came back home and took some rest. but by the next day, you started feeling vomitings and high fever. this time the doctor asked you to admit to the hospital. You have stayed in the hospital for almost 1 week and got discharged.
Now the bill charged for 1 week is ₹20,000. And also before admitting in the hospital you have undergone many tests for two times. These cost you ₹20,000 extra. During Discharging from the hospital doctor advised you to take a test after 1-week rest at the home to confirm that you have completely recovered. This test costs you another ₹2,000.
Now you are not worried much because you are of the view that all these tests will be covered by your insurance.
But when you approach your insurer, they inform you that the costs of tests performed before hospitalization are not covered in your insurance and it is clearly mentioned in the policy details. you have missed this point while taking the policy.
Remember that most of the times, you won’t be admitted to hospital without some pre-hospitalization tests. Any doctor first advises you to undergo tests and based on which you will be admitted. Only in very serious cases(Like accidents) you will be admitted first and then tests are performed.
So considering this it is important that your Insurance policy must have Pre Hospitalization and Post Hospitalizations costs also.
Period to wait
Many a time, the health insurance policy you take won’t be effective right from the day you have taken the insurance. For example suppose you have taken a Health Insurance policy, and the very next week you have a heart attack. In this case, you might be of the view that the policy will cover your claims.
But this is not true with most of the Insurance policies. It will be clearly mentioned in the policy that if there is a situation that is arising with a specified period like 1 year, in that case, the claims are not entertained.
For example, take a COVID19 insurance policy for ₹1,00,000. Now in these policies, it will be mentioned that the policy will be only effective after 14days from the day of premium payment. This simply means that if you got the policy today, and if you tested positive for covid19 with 1 week. then your claims are not valid and not covered in the policy as the waiting period is 14 days.
Practically, all health insurance policies will have a waiting period. This is mostly to avoid claims from any pre-existing illness. the only thing the insured have to focus is to choose the policy with a least waiting period.
This means that even though your Insured amount is very high, you cannot claim the entire amount for a particular disease. In the policy document, it will mention if any, the limits for the claims for each type of disease.
For example, if you have taken an insurance policy with insured amount ₹10,00,000 and it has hidden disease limits. Now at some point in the future, you have a surgery and you are admitted to hospital. You after completing the treatment are discharged from the hospital with a bill of ₹6,00,000. Now you are chill as this amount is within the total insured amount of policy which is ₹10,00,000.
But when you approach your Insurer, he rejects the entire claim and tells that you are eligible for only ₹2,50,000. And you are shocked that there is actually a point which is mentioned in the policy documents.
See carefully for such disease limits. there will be limits for each type of disease and the maximum amount you can get for each type of disease or treatment.
Usually, when there are disease limits, the premium amount to be paid is very less. That is the main reason people will take attracted by the high total insured amount for a low premium unaware of the disease limits hidden in the policy document.
Most of the policies includes a point in the policy document that they won’t cover day care treatment. What it means.
For example, assume on one day you while eating your lunch suddenly started feeling a lot of stomach pain. Looking at you, your family immediately took you to hospital and doctor admitted you to the hospital. after a few tests and treatment, you are discharged by evening. Now since the tests and treatment, you have undergone is costly, the bill amounted to around ₹1,00,000. But you are already insured for ₹5,00,000 and hence need not worry.
But the next day when you approach your insurer, your claims are rejected by the insurer saying that you are not eligible for not even a single rupee. You are awestruck by that. But he showed you the point in the policy document that the policy won’t cover daycare treatment, Which directly means that if you are admitted for less than ₹24 hours, then the claims cannot be covered by the policy.
this is an important point to check in the policy document because some of the serious and costly treatments like Chemotherapy, Dialysis, appendicitis might be called as daycare treatment and your claims might be rejected.
Hence always focus on a policy that even covers day care treatments.
Limits on Room Rent
One a particular day you have undergone a specific operation and you are about to shift to a room. You have two specific room option, one costing ₹5000 and another costing ₹10,000. But your insurance policy covers a maximum of ₹5,000 per day. But considering the fact that you will be staying only for 2 to 3 days, you have decided to chose the room which costs ₹10,000 and decided that you will bear the extra ₹5,000 on your own.
If you stayed in the room for two days, you will be billed ₹20,000 for the room and your policy covers ₹10,000 per two days. Hence you have to pay only ₹10,000 extra. And also other charges in the bill amount to ₹1,00,000 and you are of the view that you can claim this entire amount as your Insured amount is ₹5,00,000.
When you approach your Insurer, you are surprised that you can claim only ₹50,000. He specifically tells this because if you have chosen a high costly room that the maximum amount per room allowed by the policy, in such case you have chosen some premium treatment and hence you will not be paid for that premium treatment.
The insurer claims that since you have chosen room which costs ₹10,00, but your allowed amount is only half of this, all other treatment charged incurred will also be halved. Hence you have to now bare ₹50,000+₹10,000 on your own and claim ₹50,000+₹10,000.
A simple point choosing a room which costs ₹5,000 higher made you pay ₹70,000 higher.
Hence always chose policies which do not include a cap on the room rent.