Tag: medical cover

Pick the right health insurance plan

Personal Finance

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The Covid-19 pandemic has made people realise that we must be prepared to deal with medical emergencies. While having a good health insurance policy may seem simple, there are a few intricacies involved in finding a good plan. Here are some key factors that one should look at when buying a good comprehensive health cover for yourself and your family.

 

Check sub-limits

Sub-limit is a cap put by an insurer on medical treatment, doctor consultation fee, ambulance charges, and hospital room rent. Sub-limit means that if you incur charges on say medical treatment beyond these caps, the policyholder will have to bear the expense. However, many health insurance policies come with no sub limit. Choose one such plan, despite a little higher premium.

Co-payment clause

Co-payment clause means that you are agreeing to pay a certain percentage of the claimed amount. Suppose your policy has a co-payment of five per cent, it means you are agreeing to pay five per cent of the total claimed amount while the remaining 95 per cent will be paid by the insurer. It is always better to go for a policy with a no co-payment clause.

Waiting period

Before you buy a health policy, you must also look at the waiting period. Say, someone buys a health policy without checking the specific waiting period related to specific diseases. Within a month, that person is diagnosed with uterine fibroids but, she can’t claim for hospitalisation as her policy has a two years waiting period for the disease.Normally, there are two widely prevalent waiting periods across all the policies. One, a normal waiting period of one month when you buy a new health insurance policy. For the Covid-19 coverage the waiting period is 15 days. Two, pre-existing illness waiting period which varies across insurers and policies(two to four years).

Network hospitals

In order to avail cashless treatment during any emergency, one must check the insurance provider’s hospital network. At a network hospital, your insurer and the hospital together will take care of the expenses related to the treatment. You will enter the picture only when the hospitalisation expense will shoot up beyond your sum insured limit.

Claim settlement ratio

To ensure that there is minimal probability of your claim getting rejected, one should look at the claim settlement ratio of the insurer. This ratio shows how many claims have been settled/rejected by the company. You can also check the time taken to settle claims.

OPD cover

One must know that a regular health insurance policy does not cover you for OPD expenses like doctor’s consultation fees, different tests and X-rays, though these expenses can cost a considerable amount. So, it is important to buy a health cover that provides coverage for OPD expenses. An OPD cover assists the insured to claim expenses incurred other than on hospitalisation. Under OPD cover of your policy, you can claim expenses without a waiting period and make multiple claims within the same year until the limit is completely exhausted.

The writer is Head, Health Insurance, policybazaar.com

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How to make a claim on your health insurance policy

Personal Finance

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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.

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How you can maximise your health insurance

Personal Finance

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Given the consistent increase in hosptial expenses, the medical insurance you have today may become insufficient after a few years. To ensure that you have sufficient cover even a few years down the line, you can choose to enhance your existing sum insured (SI) in a cost-effective manner. In addition to the restoration or NCB benefits offered by the insurer, there are two options. One, you can upgrade your existing policy with a higher SI. Two, you can buy a super top-up plan. Here is what you should know about SI enhancement.

 

Enhancement of sum insured

If you already hold a health insurance policy, you can enhance your SI at the time of renewal. Accordingly, your premium outgo will also increase and widen the scope of coverage. But if you find the premium outgo to be high for the increase in SI, then you can consider a super top-up cover.

A super top-up plan is similar to a regular health cover where the policyholder gets covered for hospitalisation and other medical expenses. It is different only in terms of coverage initiation. That is, a super top-up will cover you once hospitalisation expenses exceed a certain limit known as ‘deductible’. Let’s understand this with an example. Assume you have a total cover for ₹3 lakh in your base health policy and you choose to purchase a ₹5 lakh super top-up product which has ₹3 lakh as deductible. Now, during a policy year, you make a first claim for ₹1 lakh. This gets covered in your base policy. Your second claim is for ₹2.5 lakh. Now, ₹2 lakh gets covered by your base plan and the balance ₹50,000 comes from your super top-up plan. The super top-up plan comes into use as you have crossed the remaining deductible limit of ₹2 lakh.

Key points

Though sum insured enhancement or super top-up plan is cost effective and widens the coverage and benefits, there are certain points to keep in mind. First, all the waiting periods – initial, pre-existing disease and disease specific waiting period will continue to apply on the increase SI.

Second, other conditions, including co-pay and deductible, if any, will also apply on the additional sum insured.

On the positive side, as super top-up plans are similar to a health plan, they comes with benefits such as cumulative bonus, restoration of SI, and wellness programme.

Sum insured as reward

Most health insurance policies in the market offer built-in options to increase or restore your SI every year without any additional premium. Under this feature (known as restoration feature), the insurer fully reinstates the original SI once the entire health cover is used up during the policy year. Some insurers reinstate original SI even after partial exhaustion of (original) SI.

No-claim bonus or NCB is another feature through which the insurer increases your SI without any increase in your premium . However, the increase in SI comes with a limit, say, 10 or 20 per cent increase in base SI every year, usually up to 100 per cent of SI, if there is no claim filed by the policyholder.

You can even opt for the NCB rider over and above the in-built NCB in the policy for additional costs.

Your choice

Though insurers reward you with an increase in SI, it has its own limitations in terms of reinstatement of SI and having a claim-free year mandatory for NCB. The pace of increase may be slower as well. Therefore, between additional increase and a super top-up plan, you can choose what works for you, based on the additional premium you have to pay and the coverage and other benefits.

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Tips for buying a good health cover

Personal Finance

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The Covid-19 pandemic has taught people the importance of insurance . If one falls sick and is in need of hospitalisation, not having an adequate health insurance plan can impact your finances . Also, the financial setback that comes with pre-hospitalisation costs, OPD expenses, medicines, diagnostic tests, etc. can be avoided if one has a comprehensive health insurance plan. Here’s a checklist on choosing a health insurance cover:

Extent of coverage

One should choose a policy that covers not just hospitalisation, but also related medical costs, together with outpatient treatments and check-ups. Besides, check for policies that boost sum insured for every claim-free year. Also, there are policies that increase the sum insured every year even if there is a claim. These features will help you be in tune with rise in future medical treatment and hospitalisation costs.

Be sure to check exclusions, specific waiting periods, conditions for pre-existing diseases as well as other things such as number of daycare procedures included or specific benefits like maternity, depending on one’s life stage.

Disease-wise sub-limits

Different plans will have specific limits on the benefits that can be claimed. These can vary from a limit on sum insured for specific diseases or limits on amounts payable towards certain medical expenses. This is termed as sub-limit. So, an insurance plan with a sub-limit will impact one’s out of pocket expenses, as a policy holder will have to bear the expenses. Thus, it is advisable to opt for a plan with no disease-wise sub-limits.

Take note that hospital charges are linked to the type of room or the room rent you have taken. It is important to check the room rent and ICU sub-limits of various health plans before finalising on one. Generally, sub-limits in the plan makes the insurance policy look cheaper.

Restoration benefits

You may claim for an illness and, God forbid, there could be multiple unrelated illnesses or injury that require you to get hospitalised.

Restoration cover restores the sum insured any number of times under the policy (for unrelated illness/injury) to additional 100 per cent in a policy year. This is provided the existing sum insured, including cumulative bonus, is insufficient to settle a claim.

Ease of claim process

Select insurers whose claims processing service is fast and accurate.

A simplified claim filing process can help you to conveniently access digitally and on phone for expeditious cashless and reimbursement claims settlement

Network of hospitals

Check the network of hospitals under the policy that offers cashless facility and the proximity to one’s neighbourhood. In case one travels frequently, check hospital network across the country so that a policyholder can continue to get treated from his/her preferred choice of hospital.

Critical illness cover

With non-communicable diseases, including cancer, cardiovascular diseases, stroke and diabetes on the rise, it is always prudent to choose a health policy that could help cover critical illnesses. However, this comes with a price and the decision needs to be made based on its affordability.

It’s also important to look for additional benefits and riders such as cumulative bonus booster and rewards for healthy lifestyle, among several other factors.

These tips can come in handy while investing in a health insurance plan that is comprehensive and best-suited for one’s family. After all, an economical and comprehensive health insurance plan is much better than inflated medical bills.

The writer is MD & CEO ManipalCigna Health Insurance Company Limited

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