What does a health insurance plan cover.
A plan cover includes all the ailments and conditions that the policy offers to pay for. While some plans offer cover only for accidental injuries, surgeries. There are other plans that offer cover for critical illness, ambulance charges, prescription medicine charges and other medical expenses. It is important to find out if the plan offers the right cover for you.
Are pre-existing conditions covered?
Most of the insurance policies do not cover pre-existing conditions like Diabetes and Blood pressure. So, it is important for you to declare all the health problems you face, so that you can select the correct policy for yourself.
The Waiting Period Clause
If you are aware of the waiting period clause, then you would be in a better position to make a decision. The insurer will not accept any claim arising out of pre-existing illnesses or specific illnesses during this period. And it can range anywhere between 24 months to 48 months depending on the insurer and the plan that you have chosen. Moreover, you will be able to claim the benefits only when this period is over. This waiting period shall apply to pre-existing illnesses like thyroid, blood pressure, diabetes, etc. that one may have before buying the policy.
Additionally, it is applicable to certain specific treatments and illnesses like arthritis, varicose veins, cataract, etc. So, you can compare and choose a plan that comes with a minimum waiting period to be able to claim the benefits in case of a health emergency.
Cashless Hospitalization Benefits
Health Insurance companies usually have a tie-up with network hospitals where the insured members can avail cashless treatment in case of a medical emergency. So, you do not need to arrange for funds and then file for its reimbursement. It will be helpful if you check with your insurer for the list of empanelled hospitals and know what all network hospitals are there in your vicinity.
Pre and Post Hospitalization Coverage
Most health plans cover the medical expenses that may incur during the hospitalization. Buy a plan that covers expenses incurred before and after the hospitalization as well to save expenses incurred on ambulance charges, medical tests, medicines, doctor fees, etc. Usually, most of the policies have pre-hospitalization of 90 days and post hospitalization of 180 days.
Co-Payment Clause
Lot of people find this term confusing and tend to ignore it at the time of purchase. It is the percentage of the amount that you would need to pay at the time of claim and the rest amount will be, paid by the insurer. So, before you sign your Mediclaim policy check if there is any co-payment clause applicable that might impact your claim amount. If possible, buy a plan that does not have sub-limits. However, if you have any pre-existing medical issues or have crossed a certain age limit most insurers would have a co-payment clause.
Day care procedures
Nowadays, certain medical treatments are completed within a day. Thus, it is important to ensure if such treatments are covered under your health insurance plan. These are small medical procedures like cataracts, tonsillectomy, etc.
Alternative treatments
These are non-allopathic treatments like Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH). Many health plans allow these non-allopathic treatments’ coverage up to a specified limit. AYUSH treatments have gained importance during the COVID-19 pandemic, and most people prefer these over standard allopathic medicines.
Room rent limit on the health insurance plan.
A hospital’s room rent may sound like a trivial charge, but it can be exorbitant depending upon the type of hospital. The room rent limit in health insurance specifies the maximum room rent coverage allowed under the policy. If the policyholder chooses a hospital room with a higher rent, he will have to proportionately share the load of the entire hospital bill.
Now a days all the health insurance companies have become extremely strict regarding the policies they issue. if at all you have any critical illness and you go for a regular policy the claim will 100% get rejected if at all you have not specified the illness during the inception of the policy. So, it is especially important for you to declare all the diseases the medicines you take for the same to the insurance company.
