9 Things No One Tells You About Buying Health Insurance
Health insurance has become a necessity, especially since the onset of COVID-19. Many people, who up till now refrained from taking health insurance, have understood its importance. However, before buying health insurance, certain factors (such as special clauses and riders) influence your decision about selecting a suitable policy. Here, we will discuss a few essential things that no one informs you about before buying health insurance.
Most health insurance policies include a daily hospital cash clause. This clause specifies that if the hospitalisation exceeds 24 hours, you will be provided with a fixed sum per day. The fixed sum varies for different companies and might be restricted to a fixed amount, such as Rs. 1000 per day. It might also be based on a percentage of the sum assured. This clause is particularly inserted to compensate you for the loss of income due to hospitalisation.
Organ transplants
Your policy also covers the cost of organ transplants. The coverage may vary among different policies. Some health insurance policies provide complete coverage of organ transplant expenses, while others cap those expenses. Some insurers also cover the expenses incurred by the donor. However, one should go through the terms and conditions of the policy to get an exact idea of the expenses covered and to what extent.
Portability
Changing your insurer may have consequences like a waiting period for existing diseases and health conditions to be considered in your insurance. The waiting period is when the company does not provide coverage for hospitalisations due to existing health conditions. This waiting period varies for different companies and may also vary as per different diseases. Usually, it ranges from a year to three years. Therefore, instead of changing the insurer directly, you may prefer porting your existing policy to maintain the continuity in benefits. However, you must be aware of whether your policy provides a portability option or not.
Higher premiums in certain cases
Usually, for lower ages, the premiums of health insurance are lower. This is because younger people are less prone to getting infected with life-threatening and chronic illnesses and pose a lower risk to the insurance companies. However, if you are habitual to smoking and drinking, the premiums will increase as these habits increase the chances of getting infected with diseases like cancer, liver failures, etc. Also, to underwrite their risks, many companies mandate pre-policy medical checkups before providing health insurance. However, the conditions of the same are subjective as some companies even exempt the mandatory pre-policy medical checkup in cases of larger sum assured.
Rejection rates and co-pay clauses
No company ever discloses its claim rejection rates. The relief here is that the company usually does not reject the entire claim. It deducts a certain amount that is not eligible for reimbursement as per your health insurance policy. Certain policies also have a co-pay clause, particularly in the case of health insurance of senior citizens aged 60 years and above. Here, the insured person shall bear a certain percentage of medical expenses, and the company shall bear the rest. Therefore, for a co-pay rate of 10%, the insured person shall bear 10% of the medical expenses while the insurance company will bear the rest 90%.
Capping of charges
Health insurance policies usually provide cashless coverage. This means that the insurance company will directly pay the hospital, and you will not have to pay a single penny. However, the catch here is that these cashless facilities are available only if you are admitted to hospitals that have a tie-up with the insurance company - also known as 'network hospitals'. If you are hospitalised anywhere else, then you can only avail reimbursement of medical expenses. In the case of a cashless health insurance scheme, there is usually no capping on the expenses. However, in case of reimbursement, major expenses like room rent, ICU rent charges, OT charges, etc., are capped and only reimbursed up to a certain limit. You have to bear the rest.
Maternity, operations, surgeries, etc.
You should check certain special coverages like maternity charges, cosmetic surgery, etc., as only a few companies cover these. Some may even refrain from providing those. Also, if you have purchased a new policy, you need to check for the coverage of operations and surgeries as these are not covered in the initial one-two years of the policy.
Diseases not covered
The health insurance policies do not cover all diseases. Some of the chronic diseases may remain uncovered as they pose an increased risk to the insurance companies. Therefore, go through the list of diseases that are not covered by your insurance policies. If you need coverage for the same, then consider opting for an add-on or else switch your insurance company if possible.
Additional features
Some insurance companies provide additional benefits to ensure quality services. These may include services like routine health checkups, full-body checkups, etc. Most of these additional services are provided on a free of cost basis and form part of preventive health care. This, in turn, benefits the insurance companies as the diseases are identified at an initial stage itself, thereby reducing the risk of the company and yours.
Conclusion
We discussed certain special points that you should be aware of while buying a health insurance policy. These points may decide the fate of your claims, i.e., approval or rejection thereof.
