I had an ear surgery in Apollo Gleneagles super specialty hospitals last year. That surgery was done with the cashless facility under health insurance. Total cost was 88000 INR, of which I paid only 8000 INR remaining was paid by the Insurance company.
Next day I was getting a discharge from the hospital. As it was under cashless facility I had to wait for a long time to clear the bill. That time one ambulance rushed to the hospital with an accident patient. After sometimes I was talking to an old man, the father of the patient. Then come to know that his son met an accident. His son becomes critically injured. Apollo is the nearest hospital so they admitted him to this hospital. But the hospital had a condition to start treatment . They have to deposit 70000 INR in advance. The old man was crying and talking to others for a loan. Trying to sell land.
This is frequently happening in India. Medical emergency leading a lot of out of pocket expenditure. This is breaking a lot of Indian and bringing them below the poverty level. So I decided to write on Health insurance awareness.
Some freaky facts:
- In a developed country, Health Insurance is mandatory for every individual citizen.
- India only 15 % of people have a health insurance, 14% from rural and 18% from urban.
- Every year in India at least 6 million people bringing down the poverty level of out of pocket expenditure due to a medical emergency.
- In India, few people buy health insurance but lack of knowledge and not understanding of terms and condition properly of the insurance policy may become reasons for the rejection of the claim. More than 20% of claims are rejected due to improper documentation and not following the terms and condition properly.
Type of Health insurance:
Individual health insurance plan:
Individual health insurance is for an individual person. The premium of individual health insurance is usually less but coverage are high.
Family floater health insurance plan:
This type of policy is for an entire family. If a family have an older member, that family should not include that older person in the plan. Because it will increase the cost of the premium. That older person will come under the Senior citizen health insurance plan.
Senior citizen health insurance plan:
This type of policy is designed for a senior citizen. It excludes some facility as older people become more frequently ill and premium becomes less.
Critical illness health insurance plan:
Critical illness health insurance is purchased for about 25 critical illness like cancer, heart attack, etc. To get this insured money the only diagnosis is sufficient. If the insurer will have any of the critical illness as per policy, the insurance company will pay entire coverage amount.
Group health insurance plan:
This is mainly for the employer for their employees. Here premiums are less with more coverage.
If the insurer met an accident, the insurer gets a lump sum amount. This helps the insurer to rum the expenditure of his / her treatment and other expenditure.
Mediclaim is a normal health insurance which gives its insurer cashless treatment facility in-case of hospitalization. It bears the cost of medicine, doctors’ bill, daycare treatment, etc.
Suppose you want to have a health insurance for coverage of 5 lakh. Then you can have health insurance of 3 lakh and then 2 lakh you can have a top-up plan. It will reduce the cost of the premium. If you directly purchase a health insurance of 5 lakh coverage, you have to pay more premium. In the case of a top-up plan, you will be paid the top -up coverage amount only when your expenditure will cross the base amount.
Some important fact to be considered before you purchase a health insurance:
Coverage and premium:
Compare coverage and premium in policy bazar. Decide wisely whether you will buy an individual policy or family policy. Your proper evaluation will help to have less premium for the same coverage.
Disclose all existing medical condition:
Sometimes we do not declare existing medical condition which becomes the reason for the rejection of the claim. To be truthful about your existing medical condition. Because of declaring your medical condition your premium may increase but it benefits you during the settlement of the coverage.
Bed charges will be given 1% of your total coverage amount. So select the health insurance or hospital bed accordingly.
Make sure that your preferable hospital is empaneled under the network of the insurance company. If the hospital is empaneled, it will help to easy approval of your claim.
Co-payment and other charges:
Your health insurance may cashless but this does not mean that they will pay the complete bill, some consumable items coverage are excluded. Hence go through for which consumable items coverage is not available.
Read terms & condition:
Read terms and condition carefully. Like how to intimate them and within how many time they have to be intimated in-case of hospitalization. Pre-hospitation and post-hospitalization period coverage. Within how many days reimbursement claim to be submitted. So remember all this important information.
Policy settlement ratio:
Do some research in Policy bazar on the settlement ratio, company background, then only buy those policies even though its premium become more. Settlement policy of 2017 of some leading health insurance company provided below:
As on date health insurance is a mandatory requirement for every individual. It will save you and your family during a medical emergency from a financial disaster. Read each and every terms and condition, claim procedure carefully and follow the procedure holistically to avoid rejection.