Tag: health policy

Know about sub limits in health insurance policy

Personal Finance

[ad_1]

Read More/Less


Covid-19 has made people aware that health emergencies can strike without warning. Further, with sky-rocketing medical costs, having adequate health insurance has become a necessity. Among the various factors that you must pay attention to while choosing health insurance, is sub-limits.

What they are

Sub-limit in health insurance refers to a monetary cap by an insurer on expenses against treatment of diseases/ illness, room rent and post-hospitalization and pre-planned medical procedure related expenditures. This means that the insurance company will only bear expenses up to a predetermined limit. Anything beyond that will have to be borne by the policyholder.

The sub-limit, however, varies across claims. It may be a certain percentage of the sum insured, or up to a certain specific amount. For instance, generally ICU fees and hospital room rent caps are typically 2% and 1%, respectively of the total sum assured. Further, many health insurers allow you to opt out of sub-limits for an additional premium. You can choose between the two options depending on your budget.

Sub limit types

Disease-specific: Most insurers have sub-limits on pre-planned medical treatments, in the form of a defined cost for procedures such as cataract removal, knee ligament reconstruction, kidney stone removal, tonsils, and sinus removal. The list of ailments and the treatment cost cap differs from one insurer to the next. The treatment sub-limit is not related to the sum assured, which means that even if a policyholder has a high amount assured, the sub-limit clause in the policy will prevent him from claiming all of his treatment expenses. For instance, if your policy has a 50% sub-limit clause on a certain medical procedure and your total sum insured is ₹5 lakh, you will be unable to claim more than ₹2.5 lakh for that treatment because of the sub-limit clause.

Room rent: This refers to the maximum rent or room category you are entitled to depending on your health insurance coverage. This is usually 1% of your entire insured. For instance, under a ₹10 lakh policy with a 1% sub-limit on room rent, the insurer will approve a hospital room with a maximum rent of ₹10,000 per day. If the room rent exceeds the set sub-limit, the policyholder will have to bear the rest of the cost.

There will be a cap on associated services such as physician consultation fees, anaesthetists’ charges, diagnostic tests too, because various hospital expenses are tied to the type of room one chooses and as per the sub-limit applicable on room rent.

Post-hospitalisation: In many circumstances, policyholders will be required to stay at home under medical supervision for a certain period after treatment. Many insurers cover post-hospitalisation charges with sub-limits, requiring policyholders to pay a portion of the cost.

When compared to a policy with sub-limits, health insurance policies with no sub-limits will have a higher premium. If you have a sub-limit cover, make sure that your medical expenses do not exceed the threshold level. So, before you buy a new health policy or renew an existing one, be sure to get one that covers you adequately.

The writer is Head- Health Insurance, Policybazaar.com

[ad_2]

CLICK HERE TO APPLY

Leave a comment , , ,

How to make a claim on your health insurance policy

Personal Finance

[ad_1]

Read More/Less


I retired from a job with the Andhra Pradesh State government. I am entitled to government health insurance cover for myself and my spouse. Last year, due to inadequacy of government payment, I purchased a Care Health Insurance policy covering both of us. Can you explain the procedure for making a claim on the policy?

G RAGHAVA REDDY

Unlike in the past , the claim-filing process in health insurance is hassle-free these days.

If it is a planned hospitalisation, insurers require the insured to intimate them in advance (at least 48 to 72 hours before admission). In case of emergency hospitalisation, intimation should be done within 24 hours of admission. You can reach the insurance company on the toll-free number available on the company website or through email (for Care Insurance it is customerfirst@careinsurance.com).

If the insured is are getting treated in a non-network hospital, you will not be able to avail of cashless service and need to to get the expenses reimbursed.

In case of a reimbursement claim, keep all your documents safe. Post- discharge, you will have to submit the documents, including doctor prescriptions, original bills and receipts, copies of all diagnostic reports and discharge papers, to the insurance company. This has to be done immediately after your discharge ; most insurers give a 15–30-day window for document submission. You also need to submit the claim form that can be downloaded from the company website; (available under the ‘claims’ section) with all the required information such as the policy number, details of the hospital and particulars of the procedure given by the hospital.

You can submit these documents online as well. Most insurers, including Care Health Insurance, have provisions for online submission. For this, first register yourself on the website with your customer ID . Insurance companies also give the option of submitting the documents directly at their office or by post. Note that after submitting all the required documents, it may take 30-40 days for claims to be settled.

If you get treated in a network hospital, you can avail of the cashless claim. On admission, you approach the insurance/TPA desk at the hospital. You will have to show your ID card (given by the insurer at the time of issuance of the policy). After the verification, you will get the ‘pre-authorisation’ form (can also be downloaded from the insurer’s website).

You fill the personal details and submit the form. Other details will be filled by the insurance desk and will be sent to the insurance company. After the form is reviewed, the insurer will provide guarantee to payment of the bill amount, subject to the sum insured.

[ad_2]

CLICK HERE TO APPLY

Leave a comment , , ,

All you need to know about health insurance waiting periods

Personal Finance

[ad_1]

Read More/Less


Insurance regulator IRDAI has mandated that the waiting period for pre-existing diseases should not go beyond four years (48 months) in any health policy, effective October 1. But this is not the only waiting period component in a health policy.

For instance, if you sign up for a new health policy, you will have to wait for a minimum period before your health cover starts.

Maternity covers and some other specified diseases also have a waiting period before claims can be entertained.

Waiting period ensures that insurers do not cover for claims that are certain and predictable. The clause helps prevent their losses. Waiting period is an important clause and every policyholder should be aware of its nuances to avoid unnecessary hassles at the time of claim.

Waiting period, which is applied from the date of policy commencement, varies depending on the ailments, and differs from one insurer to another.

Varying time-frames

If you buy a health plan, you have to mandatorily wait for a period of 30 days, known as initial waiting period, from the date of commencement of the policy. During this period, the insurance company will not admit claim for diseases or hospitalisation except for accidental injuries, provided the policy covers such accidental injuries.

Now, if an individual has an existing medical condition (known as pre-existing medical condition) before the commencement of health policy, he/she has to wait for a few years before the cover begins. However, excluding that particular medical condition, the policyholder will be covered for other illnesses/accidents, post initial waiting period.

The ‘pre-existing waiting period’ is usually 48 months among most insures but some insurers have only 24-36 months as pre-existing waiting period.

For instance, for Optima Restore policy from HDFC Ergo Health, the pre-existing waiting period is 36 months.

There is another type of waiting period for specific diseases or specified procedure and this, too, varies from one insurer to another. Insurers usually have a common list of specific diseases or a list of medical treatments for which this waiting period will apply.

For instance, ManipalCigna’s ProHealth policy has a disease/procedure-specific waiting period of 24 months (two years), after which the expenses for the same will be covered. The list of specific diseases/procedures includes cataract, knee replacement surgery (other than caused by accident), and varicose veins or ulcers.

But keep in mind that if these diseases exist at the time of taking the policy or it is subsequently found that they are pre-existing, the pre-existing diseases waiting period will apply.

Insurers usually have a waiting period of 90 days (from the date of commencement of policy) in case of critical illness or lifestyle-related diseases, including cancer, hypertension and cardiac conditions.

Health policies that offer maternity covers also have waiting period (for mothers and new-borns). Any treatment arising from pregnancy to childbirth including Caesarean sections will be covered under a policy only after the expiry of the waiting period. For instance, ProHealth policy from ManipalCigna covers maternity expenses only after expiry of 48 months. Similarly, Digit Insurance’s health policy, too, has a two-year waiting period for maternity cover.

Lastly, most insurers have personal waiting period which may be applied (from the date of policy commencement) to individuals depending on the declarations made by him/her at the time of taking the policy and the existing medical conditions. Factors including medical history, pre-existing medical conditions, medical test results and current health status will be taken into account by the insurer for applying this waiting period.

In Max Bupa’s ReAssure policy, for instance, personal waiting period is applicable for a maximum of 24 months, while in ProHealth policy (ManipalCigna), it is applicable for a period of 48 months. Personal waiting period will be specified in your policy document and will be applied only after you give your consent. If you decline, your application will be cancelled and premium, if any paid, will be refunded.

But most of the time, personal waiting periods are not applied by the insurers.

Points to note

There are a few points to keep in mind about the waiting period clause in health insurance.

One, you can reduce your waiting period. If you feel the pre-existing or disease-specific waiting period is too long, some insurers let you reduce the same.

But you might have to cough up additional premium.

For instance, in the case of ICICI Lombard’s Complete Health insurance policy, you can reduce the pre-existing waiting period if you opt for sum insured (SI) over ₹2 lakh.

The waiting period comes down to 24 months from 48 months. Similarly, in ProHealth policy (ManipalCigna), you can reduce your waiting period if you opt for a higher variant of the policy.

The pre-existing waiting period is reduced to 24 months in ‘Plus’ and ‘Accumulate’ variant while it is 36 months for the ‘Protect’ variant and 48 months in other variants.

Two, if you renew your health policy without any break in premium payment, the policy continues to cover you.

But if you renew your policy after a break, you may have to undergo another waiting period similar to what a new policy entails.

At the time of porting, too, if you continue the policy without any break, your waiting period will be as per the new policy or as per your health status at the time of porting.

However, if you enhance your SI (at the time of porting as well as in an existing policy), the waiting period shall apply afresh to the extent of increased SI.

[ad_2]

CLICK HERE TO APPLY

Leave a comment , , , , , ,