Health-related issues are growing at a rapid pace, taking more lives each year. As per the report of National Commission on Macroeconomics and Health, Ministry of Health & Family Welfare around 38 million deaths occurred due to non-communicable ailments. Around 16 million deaths occurred before the age of 70 and 60% of deaths are in India. Roughly 5.8 million Indians die because of diabetes, cancer, stroke, heart and lung diseases each year. One of the main reasons is the lack of proper healthcare. That’s the reason you should consider buying health insurance!
But the harsh reality is...
Around 3.2 crore people in India become bankrupt by spending exceptionally on healthcare out of their pocket every year. The poorest ones rely on sales of their heirlooms or borrowing money from others to meet the financial hardship. And sadly, 56% of Indians still don’t have health cover!
Health insurance ensures the much-needed financial assistance in case of emergency strikes. It bears the incurred expenses while hospitalised, including the pre and post hospitalisation expenses. However, buying the right policy is what actually matter and you should be careful about certain insurance jargons such as Waiting Period and Exclusions to make to most of it.
Mr Mehta recently bought health insurance from Star Health and Allied Insurance Company. He was a diabetic and considering his condition and frequent medical visits, he bought this plan. While buying you he used Star Health Insurance Premium Calculator to know the offered premiums and other plan benefits and now happy with his decision. But when he raised a claim after one year for hospitalisation due to kidney failure, his claim was rejected. Feeling cheated, he informed the insurance company and then only knew the actual reason for this. His health condition is classified under the pre-existing illness category, which is covered only after a specific waiting period. After this situation, he delved into the concept of Waiting Period for pre-existing illness.
The concept of the waiting period in health insurance is simple. It is a particular period within which, no claim would be entertained, except the accidental one. By applying this, the insurer tries to prevent one from misusing the policy coverage or reduces the chances of fraudulent activity. Underneath are the various types of the waiting period to be applied in a health insurance policy:
Usually, there are three main types of waiting period:
Mostly, health insurers come with an initial waiting period for 30 to 90 days, depending on the plan, within which, no claim is accepted. This is to restrain the policyholders to make a claim immediately after taking the policy if he/she is diagnosed with a serious illness. However, one can claim in case of an accidental hospitalisation.
Under the pre-existing illness category, a waiting period of 2 to 4 years is applied within which, the policy can’t be claimed. During this period, if any emergency arises out of a pre-existing health condition, the claim for the same would not be entertained and the insured will have to bear the expenses on own. Thus, a pre-existing condition is not covered by the plan until a specific waiting period is served.
Usually, not every health insurers cover maternity as an in-built cover. One can buy this as an add-on. However, it comes with a waiting period as well. The period may range from 9 months to 48 months, depending on the type of policy you’ve bought. This requires the insurer to plan the finances much-ahead of planning a family. Otherwise, the policy will be of no use, if you can’t claim it in the hour of need. Moreover, you can’t take this policy once you conceive.
There are certain specific illnesses that are also not covered immediately after you buy the policy. these include Hernia, ENT disorders, osteoporosis or as listed in the policy. Usually, the waiting period in such cases is 2 or 3years.
Now let’s consider policy exclusions!
Exclusions are the most important part of a health insurance policy. However, people tend to ignore this part so often. And eventually, end up facing disappointment while claiming. The insurers straightaway reject the claim for something that is in the list of EXCLUSION!
Here’s why you should be aware of the things that are in the insurer’s exclusions list. Here we go:
Health issues that are prevailing before buying the health insurance are considered as pre-existing illnesses and these are not covered at the initial phase of a health insurance policy. You will have to serve a special lock-in period ranging from 2 to 4 years in order to cover such a condition.
Most insurance companies don’t accept the claim for non-allopathic treatment or alternative therapies. As determining the exact coverage of such therapies are difficult to decide, insurers usually don’t consider this under their coverage list. These mainly include Ayurveda, Unani, Naturopathy etc. However, those who include comes with a condition such as the treatment has to be taken at a government or recognised institution.
Lifestyle-related illness is usually excluded unless the insured has paid an additional premium to cover such a condition. For instance lung disease due to excessive smoking or cirrhosis as a result of consumption of alcohol etc. are excluded.
Cosmetic surgeries are in vogue these days, especially among the upper middle class. It changes the actual appearance and makes you look different. But comes with a cost and the expenses are not covered by a health insurance policy. However, procedures recommended by a physician like plastic surgery to treat an accidental injury may be covered. Additionally, dental treatment expenses are also not covered.
Some health insurers don’t offer coverage for pregnancy or childbirth-related expenses. The cost of treating infertility or abortion etc. are also excluded by health insurance.
The routine laboratory test for diagnosis is expensive and these are not covered by health insurance. But if the tests indicate a certain illness or injury that requires the patient to be hospitalised, will be covered. Similarly, the laboratory expenses incurred during hospitalisation are covered.
Dental and eye procedures are not covered, which don’t need hospitalisation. However, if the policy comes with a day-care provision, which includes dental treatment, only that case it is covered. You can take this as an add-on by paying an additional premium.
Intentional injuries such as suicide or attempt to suicide to harm yourself are excluded. If the persona is injured deliberately, the policy will not cover the same.
Injuries due to war or warlike situation, civil commotion, use of a nuclear weapon, treatment expenses while treating diseases like HIV/AIDS or congenital disease etc. are permanently excluded by all health insurers. However, very few insurers have started covering HIV, but the number is very less. Hence, make sure you have checked the list of exclusions first before zeroing down on a plan and take up the one that comes with minimal exclusions.
So, before the situation turns upside down for you, consider knowing your policy well. Understand the coverage well, the clauses and terms and conditions, especially the exclusions and waiting period that play an important role!
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