With so many options available to you, it is wise to shop around and compare all the health insurance policy options available to you before committing to a particular company. Instead of focussing on the premium costs alone, one has to ask certain basic questions keeping in mind one's future medical needs.
Checklist for insurance policy shoppers
One of the first questions you must ask is if the company favours cashless settlements or will the medical payments have to be made by you and reimbursed by the insurers later. If it is the former, you have to ensure that in your time of need, the insurance company is informed of your medical requirements so they can weigh in with a list of approved hospitals where you can seek treatment. If it is the latter, you can be better prepared to keep a lump sum of money aside for critical times as the payments will have to be made by you to begin with. A wise move would be to check whether the hospitals near your residence, which might be used in case of emergencies, are a part of your insurance company's hospital network.
Illnesses not covered
You should ask the insurers for a list of ailments and procedures not covered by the policy. For example, as of now dental and cosmetic surgeries are not covered by most health insurance providers.
Costs not covered
Some policies do not cover diagnostic or medication costs. Out patient treatments are not paid for by insurance companies either. Hospitalization for a minimum of one day is mandatory for the insurance to kick in. It is best to check all the details of the expenses that will be reimbursed. It will help you plan better to save for future expenses.
Timing for reimbursements
Some policies do not reimburse medical costs incurred within the first year of the policy being issued. For example, some insurance companies do not cover cataract operations within the first year of issuing a policy. You need to be aware if your policy falls into this category.
Sometimes, there are sub-limits for various expenses within a policy. You should be aware of how much the insurance company will pay for a particular expenditure. The policy might have the right amount for the treatment but the sub-limit ceiling might prevent the company from paying out for a particular medical cost.
Given today's socio-political climate, it might be better to ask if injuries sustained due to riots or terrorist attacks are covered under the policy you choose.
Cooling Off period
The first 30 days after you buy your health insurance policy is called the Cooling Off period. Any hospitalization due to illness during these 30 days is not covered by most policies. The cover starts from the 31st day. However, hospitalization due to an accident is covered from the first day of the policy being issued. Please make sure you ask your insurance provider for further details on their Cooling Off period.
Checklist for new policy holders
So you have just bought a new health insurance policy. Your first task is done. Now you have to protect yourself by making sure you read the fine print to understand all the technical specifications of the agreement. Here are some things to watch out for:
Undisclosed health conditions
Many insurers ask you questions about your present health before issuing health policies. If you suffer from a medical condition and do not disclose this to the insurer, your policy might not cover any expenses you incur for treating said condition.
Upper limits for reimbursement
Insurance companies usually have an amount limit on their policies. If your medical expenses exceed that amount, you will have to fund the rest out of pocket. So even after buying insurance, it is essential that you set aside a part of your savings for health related issues.
Medical insurance is usually made available only up to a certain age limit (for most insurance companies this is 65 years). So if you are above this age limit, you will not be given a fresh policy and on the same lines the existing policy will not be renewed after a certain age. Ironically, this is the age when individuals need financial assistance the most, although the government has encouraged the insurers to take out special policies for senior citizens, it is yet to be implemented.
Following these guidelines will give you a good idea of how to best protect yourself from unforeseen illnesses and medical emergencies. In case your monetary claim is rejected or delayed inordinately by the insurance company, you can approach the Grievance Redressal Cell of the Insurance Regulatory and Development Authority (IRDA). This cell has been specifically set up to look into complaints from policy holders.