When it comes to taking health insurance policy, the veracity of the policy benefits can be judged by the claims experience that one encounters. More often than not, the terms and conditions associated with a health insurance policy almost make it seem as if these policies are meant to provide insurance for a narrow coverage, with several exclusions. However, if you probe the agent whom you interact with in detail at the time of purchasing the policy, chances are you will get a better understanding of the insurance policy you buy and what exactly it provides you with at the time of a claim.
Cover
Do not go blindly by the premium you pay and the insurance cover that you get. Dig deeper to get into the details of what treatments and illnesses are actually covered under your policy. For instance, figure out if the policy covers OPD expenses or the minimum hospitalisation needed for policy benefits to accrue. Likewise, there are polices that only cover critical illness or have features like hospital cash benefit.
Waiting period
Pre-existing diseases are usually excluded for the first four years. There are time-based exclusions too, which exclude the treatment of age-related ailments in the first two years. Similarly, health policies usually do not entertain claim for the first 60-90 days.
Exclusions
The list varies across policies and it is best if you read the exclusion list before you actually take it. For instance, some cover maternity expenses, dental treatment, routine tests, cataract surgery, whereas some might exclude them altogether or at least won’t cover during the waiting period.
Sub limits
Policies come with or without sub limits. A policy with a sub limit clause does not cover certain expenses like room rent, doctor’s fee, etc, beyond a certain limit irrespective of the actual expenses. These limits vary on the basis of the variant of the policy. Ask the insurance agent about the sub limits to avoid any surprises.
Specific needs
Some policies these days cover natural medication under AYUSH treatment clause. Check if your policy covers for it, if you plan to be treated by natural medication.
Claims
Check how and when the cashless feature kicks in and how your claims will be treated in case of reimbursement— by when you will get the money.
nk@outlookindia.com
