Executive Summary – A health cover reimburses financial expenses incurred due to diseases or accidents. There are some terms & clauses that you should carefully understand before buying a health cover. They are:
2. Sub-limits – Insurance policies cover the room rent but up to a limit. Many times, the limit is not just on the room rent but on all other expenses incurred. So if you go for a room that’s higher than the limit in your policy, there can be a huge deduction in your claim amount. Again, IRDA wants no such sub limits to be applied by insurance companies. We have seen that the top players have already introduced products that comply with this requirement. So it’s better to buy a policy without any sub-limits to avoid unpleasant surprises.
3. Cashless Hospitalisation – Many insurance companies provide the facility of cashless hospitalisation. But you cannot claim this if treatment details are unclear or the hospital does not allow cashless facility. Ensure that you know the regulations of the insurance provider and the hospital policies.
4. Premium Loading – Some insurance policies are very cheap when we buy. This is a marketing ploy. Once we make a claim, the renewal premium becomes high because of the clause of loading premium. Of course, today there is portability and lot of choice for the customer. But one has to check if this condition is applicable and how and to what extent it is applicable. If you are older, the portability won’t be very easy nor will all insurance companies be ready to provide you medical insurance. Keep in mind that the IRDA regulation prohibits insurers to apply claim loading at individual policy level.
6. Accidental Insurance – Many health covers offer accident insurance for a slightly higher premium. You should check the accident cover and clauses attached to this feature. Many times, the cover is not sufficient if there is a hospitalisation due to accident. In most cases, this does not include protection for partial disability, permanent disability and temporary total disability. If required, you should take a different policy for accidents.
7. Domiciliary Hospitalisation – Sometimes the patient is unable to go to the healthcare facility and the healthcare facilities are brought home and the patient is given treatment for many days continuously. It is important to confirm with the insurance provider if this will be considered as hospitalisation for claim purposes.
It is important to have a health cover policy for yourself and your family. But before you buy one, read all conditions thoroughly and get all your questions/ doubts answered so that the claim process becomes easier.
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