Health Insurance Policy Wordings can be difficult to understand for people who are not comfortable with insurance terms and jargons. So many terms and conditions that are written in ‘not- so- user friendly’ manner, can lead to confusion and frustration. No wonder most of those who own a Health Insurance Policy have not read the wordings and depend on their agent or broker to explain their doubts. But for an issue like health Insurance, you cannot depend on others to safeguard your health.
Here are some of the 7 most common things that you must know about health insurance:
A common term appearing repeatedly in the health insurance exclusions. Pre-existing simply means diseases that you are already affected by. But the interpretation isn’t this simple. Pre-existing diseases include any ailments that the person showed symptoms of and was diagnosed and received treatment for. You are required to fill in your exact medical history and reveal if there are any pre-existing diseases.
Pre-existing Diseases are not covered from the start in your policy. These generally are covered after 4 years of buying the policy.
No. 2 Exclusions:
It is another word that is commonly used in health insurance. Exclusions as the name suggests include a number of conditions which are not covered in the policy. Some of the important health insurance exclusions are Pre-existing diseases being not covered from the start, waiting period and list of the diseases that will be only covered after one year of the policy. There is also a list of diseases which are not covered like mental illness and STDs.
While reading a policy, you should not only read what is covered but also what is not covered. This way you will know what to expect from your Insurance Company.
No. 3 Hospitalization:
Health Insurance in India only covers hospitalization expenses. It is one of the most important term in the policy. Hospitalization doesn’t just mean being admitted to the hospital. Valid hospitalization means being admitted for at least for 24 hours in a hospital that covers number of conditions like being registered, having medical practitioner available with minimum number of beds present. Only when these conditions are present is the hospitalization payable.
No. 4 Waiting Period:
Unlike what people think, all diseases aren’t covered from the moment you buy the policy. You have to wait for 30 days to get any disease covered. Further, pre-existing diseases require 4 years and some diseases like cataract have a waiting period of one year.
No. 5 Pre and Post hospitalization Expenses:
Most people aren’t aware of these very useful features of the policy. When you are hospitalized and get the reimbursement for the claim, you are also entitled to get reimbursement of 30 days of medical expenses before hospitalization and 60 days after hospitalization. You have to keep all the record of all the medical receipts,and all the diagnostic reports safely with you. Only when the Insurance Company examines all these documents will you get expenses reimbursed.
No.6 Day Care Treatment:
Due to the advancement of technology, some diseases that took days to treat are being treated in few hours. These treatments are covered even if they require less than 24 hours of hospitalization. These diseases include- chemotherapy, eye surgery, tonsillectomy etc.
No. 7 Cashless Service:
It is an important service that needs mention. Cashless Service is a service where all the medical bills are paid directly by the Insurance Company when there is a notification of hospitalization in a network hospital. You just have to call the toll free number present on the Health Card and then they will co-ordinate with the hospital and you will not have to pay a single rupee for the treatment. But first the Insurance Company will examine your claim and only then will they provide Cashless Service.
With all these health insurance terms clarified, you will have no trouble understanding the wordings or health insurance process as it happens.