Health Insurance: Coverage, Exclusions, NCB, Reimbursement & more

Whether you are healthy or not – we’ve been told numerous times that keeping good health is very essential. But in our quest for healthy life we also need to opt for health insurance (also known as medical insurance). This is because there is no guarantee that your body will remain always fit.

Health insurance covers medical expenses during hospitalization. Not just an individual but health insurance can cover entire family by paying a premium. This can be paid every month, quarter, or annually. And the medical insurance policy can be purchased online, app, visiting in-person at the insurer or through agents.

Health insurance comes handy during difficult situations. However it is very essential to know as many details possible in a health policy for a better claim process:

Financial support: The most important benefit of health insurance is that it safeguards you and family from financial burden which often leads to mental stress when you are ill. If there is no health insurance policy taken then the person has to use his/her hard earned income to meet various expenses.

Coverage: Most of the policies cover medical and hospitalization expenses including surgical operations, nursing care, doctor’s fees, pathology and diagnostics test, hospital accommodation and other pre and post hospitalization expenses.

Exclusions: There are however, some exclusions in health insurance like pre-existing diseases, cosmetic surgery, abortion and alternative therapies. Certain conditions have a minimum waiting period such as pregnancy, heart ailments and others. All these exclusions are detailed in the policy document. This is the reason why it is recommended to buy health cover when you are young and fit. The chances of developing diseases are low compared to when you are aging. Also the premium is high when buying at old age.

Claims during 30 days of buying the policy: Not all medical claims are accepted, if they are claimed within first month of purchase. This also includes pre-existing ailments which are covered after the expiry of a specified period.

No claim bonus: By making regular renewal payments and keeping yourself fit with no claim made, you increase the chances of better claim experience. Most importantly, insurer will reward you with reduced premium if no claim is made in previous year. This however, varies with each insurer. If you fail to renew the policy then any treatment cost incurred during the uncovered period will not be accepted by the insurer.

Policy transfer: If you are not happy with the existing insurer then you can transfer the policy to another insurance company. Other reasons leading to porting are – lack of features, job change, lesser number of network hospitals, poor claim process or settlement history and many others.

Read about 7 types of health insurance policies

Hiding medical problems: Hiding any existing condition is never recommended. This is because, if you make a claim and insurer comes to know that you did not disclose this condition intentionally while buying the policy, then claim will be rejected. This is clearly mentioned in the policy document. Remember that settling a claim is loss making for any insurer. And they will list out every reason to deny a claim. So be true when it comes to any insurance policy. If you disclose the condition before buying, then pre-existing disease will be covered after a certain period. This is known as waiting period. Typically the period is 36 or 48 months, as specified in the policy document.

Increase coverage by making higher premium: If at any point of time, you feel that existing policy is not sufficient to cover yourself or your family then you can always pay higher premium and raise the coverage.

Get claim if hospitalized for less than 24 hours: Certain procedures such as dialysis, eye surgeries and others does not need hospitalization for one full day. This is the reason many insurers settle claims in such cases. One more advantage is that many treatments that do not fall under day care or which do not require the insured to be hospitalized for one complete day, are also covered by insurers. However the list of procedures covered is very limited. And you should be aware of the same while before purchase the policy.

Not every expense is reimbursed: Remember that, buying a policy by paying high premium doesn’t mean entire bills will be reimbursed. Sub-limits are applied on various expenses. Certain medical bills are also not reimbursed if they fall under non-admissible expenses. When a insured person is ill and hospitalized, then there could be many other expenses which are not covered in the plan. And you will not get reimbursement for the same.

Multiple claims: You can take as many claims possible in a year. However the maximum amount is limited to the sum insured. This amount is as per the chosen plan.


Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.