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Points to Consider When Buying Health Insurance

Points to Consider When Buying Health Insurance

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Published by kirang gandhi

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Published by: kirang gandhi on Sep 12, 2012
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There shouldn't possibly be any debate on whether you need Healthinsurance or not .Firstly the risk of falling ill is increasing daily basis. - be it on account of polluted air , pesticides in your food , strees and \ or bad lifestyle . Second ,the cost of treatment is galloping away with no end in sight . So theprobability is fairly high that you will spend a fairly large sum medicaltreatment .Now , the costs ,
the premium that you would normally have to payevery year for covering your whole family would be very nominal .So much so that even 5-10 years of premium payments may workout less than just one major problem during this period .
In case you don't make a claim during the year ,your sum insured mayincerase by 5-10%OR 100% Add on some health plan at the same premiumas a no - claim bonus . In fact , if there is no claim for 4-5 years you couldeven get the option of a free- medical check -up after this claim free period .So , it would make ample sense for you to cover you and your family formedical emergencies . Besides , given the job uncertainties nowadays , itwould be prudent to buy a policy of your own even though you may behaving one from your employer .
2. Includes And Excludes.
A typical medicaim policy
would pay practically all your actualhospitalization expenses
such as doctors' fees , opretion charges ,medicines , nurse , ambulance , blood , oxygen , room , charges , expenses. It would also cover related expenses( except any accedent injury ) 30 daysprior to and 30\60 days after the pre and post hospitalization in some plan90/180 days.The hospitalization should be for minimum 24\ 48 hours ; excepting certaincasea ( e.g. the patient can't be moved or the surgery doesn't require thatmuch stay , etc. )In certain cases called
exclusions ,
however , you would not be eligible fora claim e.g.
- Any problem within the first 30 days of the policy , except accident .- Your pre- existing illnesses ( these get covered after first 3/4 claim - freeyears )- certain specifiled diseases \ disorders may not be covered for the first 2years e.g. cataract , stones , arthritis , gout ,hernia , etc.( check the list before buying a plan )- Dental treatment .- maternity ( may be covered in some plans )Expenses arising from HIV/AIDS and related tratments.Hospitalizations due to war or an act of war or due to nuclear,chemical orbiological weaponand radition of any kind.Non allopathic treatment,congenital diseases,mental disorder,cosmeticsurgery or weight controll treatment.
3. Expense Limits
Needless to mention that the maximum amount that you can claim is theamount of sum you have insured in the place . So if you have insured in thefirst place . So if you have taken Rs . 1 lakh cover , you will at most get Rs.1 lakh from the insurer. ( In some plan you can get 100% extra sumassuredto be used with zero extra cost premium ).However , the insurer also fix sub-limits for certain expenses . for exampleyour room rent may be fixed at Rs . 3,500 \ day . If you incure say Rs.4,000 \ day on the room charges , you will not get this diffenence of Rs. 500even though your total claim may be much less than Rs. 1 lakh . ( In someplan there are no such room rent limit )Or the doctors' fees and other consulation charges may be restricted to acertain percentage of the sum insured . Or the cost of a particular surgery .may fixed . ( In some plan you can use pre and post limit with doctors feesand report etc... with samr hospital )That apart , there could also be some deductibles or co-insurance i.e thepart amount of the total expenses which you would have to bear .
You , therefore , need to cerefully check and note these sub-limitsand deductibles so that you can , as far as possible , ensure that youdon't exceed these limits unnecessarily .
However , note that for a typical mediclaim policy there is no limit on thenumber of claims you can make in a year , provided that total sum insured isnot exceeded .( exception in some plan )
4. PremiumsIt is but natural that the age would paly a key role in determing thepremium . Insurers may also consider factors such as family medicalhistory , occupation etc. to calculate the premium you have to pay .
To give you some idea about the costs -Rs . 1 lakh of cover for a person of age 30 would cost around Rs. 1200- 1600 per year . For a 45 year oldperson ,the premium could be around Rs. 1500-200 p.a .The sum insured generally varies from Rs. 1,00,000 to Rs. 10, lakh. ( 100%extra in some plan with zero cost)By paying a nominal additional premium , you can also opt for extra benefitsor riders such as critical illness, attendants to take care of the patient post -discharge , minor surgeries , maternity expenses , etc.After the age of 40-45 you may be asked to furnish a medical certificate atyour own cost when you apply for a policy . Before that , most insurers willnot insist on your medical check-up . In fact, given the high incidence of diseases in the old age , It is usually both difficult and expensive to bymedical cover bryond 55-60 .
5. Claim Procedure
There are two ways to make a claim . One is direct and the other throghThird Party Administrators ( TPAs )Under the direct method , you would first pay all your bills to the hospitaland then lodge a claim with the insurer . The insurer, after duly verifying allthe original documents , will reimburse you the expenses as per the policy .The more common aproach nowadays is to go through a TPA appointed bythe insurers . As the insurer's agents , they take care of hospital networks ,documentation and claim settlement . They also enable you to opt for acashless facillty i.e. all the bills will be settled by them . You don't have to

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