health insurance policies

1. Understand Your Health Insurance Cover Understand Your Health Insurance Cover Medical emergencies, unpleasant as they are, can surface anytime. Hence, it’s important that you hold sufficient health insurance cover. Just as crucial is the need to understand the provisions of your health insurance product, failing which you may be exposed to rude shocks at the point of claim. Most people presume premiums are the sole costs of a healthcare insurance. The associated costs, which are disregarded, must be comprehended in their entirety. The following should get you started: 1. Voluntary Deductible: The insurance deductible is the amount of money you will pay as your share in an insurance claim. It is your portion of the financial responsibility and forms part of your insurance contract. You pay your voluntary deductible and the insurance company agrees to pay the rest (up to the policy limits and conditions in the wording). 2. Copayment: A co-payment is a cost-sharing requirement under a health insurance policy that provides that the policyholder will bear a specified percentage of the admissible costs and share the risk. The policyholder agrees to pay a certain percentage of the total claim; in doing so, insurer charges a lesser premium. Importantly, the sum insured remains the same and is not reduced. Understanding important terms in your health insurance cover: 1. Pre-Existing Illness Illnesses that existed prior to the date of purchase of the policy are known as pre-existing illnesses. By and large, providers refuse to cover illnesses that existed 4 years or less before the first policy. However, some insurers cover this with a waiting period or charge an additional premium or put terms and conditions for such coverage. 2. Waiting Period

2. There is waiting period for all health insurance policies. The usual waiting period is 30 to 90 days for most health plans. There will be no cover during the waiting period. 3. Minimum hospitalization stay A minimum hospitalization period of 24 hours (may vary based on the policy) is necessary to claim the benefits. 4. Cashless Facility Cashless hospitalization, if offered by the policy, will not require you to pay at the time of admission to a network hospital which has a tie-up with the provider. An Insurer or a Third Party Administrator on behalf of an insurer will be responsible for settling the bills. If admitted to a non-network hospital, the insured must settle the bills and claim a reimbursement from the insurer. 5. Exclusions Reading your policy document thoroughly and coming to grips with what’s not covered will go a long way towards being prepared for exclusions under the policy. There are some exclusions that are standard across policies such as dental treatment, venereal disease, AIDS, congenital diseases, intentional self-injury and so on. 6. Grace Period The additional period offered for the payment of premium post the due date is known as the grace period. General insurance companies offer a 15-day grace period but you would do well to check how many days your policy allows. 7. Grievance Redressal Any grievance related to your health policy should first be taken up with the insurer. The complaint should be acknowledged by the insurer within 3 working days. In case you are unhappy with the resolution of your grievance, you can register a complaint with the Integrated Grievance Management System portal of IRDAI. You may also choose to lodge a complaint with IRDAI over a telephone (Toll-free number 155255) or by sending an e-mail to complaints@irda.gov.in. The IRDAI will get in touch with the insurance provider and mandate a resolution within 15 days. continue reading