Health Insurance - Reading the Fine Print

What you do when you buy a new product, get to know its functions and features, right?

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      Health Insurance is no different. But the merit to a health plan is that it comes with 15 days gracing period to let you go through the fine print. If within 15 days, you get to discover any clause in the plan that doesn't go with your needs; you can return the plan and get your money back.

       

      But the grim reality is, just a look at the lengthy fine print and most of the people end up skipping it or caring not to give it a complete read. But there's a price to pay later, should you choose to ignore the fine print now. It is wiser to go through all the clauses in the fine print, one at a time.

      Start with the Main Course

      The best way to start reading the fine print is to see what the plan covers. Apart from the regular coverage, you should look out if your health plan features the following benefits:

      • Cashless hospitalization
      • Pre and post hospitalization
      • Maternity benefit
      • Pre-existing coverage
      • Domiciliary hospitalization
      • Ambulance charges

      Move on to the Little Details

      Once you are through with the meat of the plan, you can move on to finer details of the coverage. That would include looking out for value-added benefits in the plan such as daily cash benefits, 24x7 medical consultation, free health checkups, medical concierge benefits, restore benefits, etcetera.

      You should also get to know the maximum age up to which the policy can be renewed. Nowadays, some insurance plans feature lifelong renewability.

      Also, look out for the network hospitals specified in the plan. If you discover that the nearest hospital is too far from your home, make sure the plan provides a non-network coverage, wherein instead of cashless hospitalization, the insured can get a treatment course in a non-network hospital and the expenses incurred are reimbursed later.

      Know Your Limits

      Just knowing the sum insured is not enough, you should also be aware of the individual upper caps on specific expenses.

      To get an idea, suppose the sum insured is 3 Lakh, under which the upper cap on room expense is Rs 40,000. Suppose, you had to expend a total of Rs. 2 Lakh of which Rs. 60,000 was spent on your room expense and the rest Rs. 1,40,000 on doctor's fees, medications and treatment. The payout in such a case will be Rs. 1,40,000 plus 40,000 i.e. Rs. 1,80,000. Thus, the insured ends up bearing Rs 20,000 as an out of pocket expense.

      Look Out for Exclusions

      Be well versed of the waiting period. More often than not, there's a waiting period of 4 years for pre-existing diseases, 2 years waiting period for specific illnesses and 1-month default waiting period.

      An alternative treatment is treated as an exclusion in most of the health plans. Too good you decided to resort to nature to get healed; too bad your insurer doesn't cover you for alternative treatment.

      Get to know the pre-existing conditions excluded from the policy. Mostly there is a 4 years waiting period, after which such conditions are included. But there are certain conditions mentioned in the fine print that won't be covered even after the waiting period.

      The usual exclusions on a health insurance plan include expenses incurred on dental and vision care, the influence of alcohol/drugs, cosmetic expenses, etc.

      Be Wary of Expenses and Charges Involved

      • Did you know that your insurer might require you to make a co-payment every time you file a claim? It's like sharing a fixed fraction of the medical costs incurred in the case of an eventuality.
      • When a claim is made, the insured has to incur an extra charge on the renewal premium; this is called a loading charge. Newer health plans are freeing the insured of having to incur the loading charge.

      Most people believe than fine print is all about restrictions but it's not like that. Many times, you might discover the little valuable benefits hidden in the fine print. So read the fine print should not be seen as an obligation, instead of as a good habit that lets you get the most of your health insurance plan.

      At any point, if you do not understand any clause in the fine print, you should get it clarified from your agent or directly from your insurer. Finally, we agree it's not easy meddling with the fine print. But seeing the merits, this one time pain is all worth it!

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30-minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881. Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. As per the Insurance guidelines, you are allowed to cancel the policy with-in 15 days from the date of Issuance of policy. For more details, please read the Plan Brochure carefully or talk to our advisor at the time of purchase.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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