I would like to list out some of the important points while choosing a health insurance product irrespective of your age, occupation, gender etc….
Health insurance in India primarily focuses on Mediclaim insurance (hospitalization -medical insurance) which will be applicable to the concept of INDEMNITY (the claim is payable only if there is a loss (or) damage to the insured person). If there is a claim, then your financial loss towards the same is paid out.
Health insurance also covers CRITICAL ILLNESS, HOSPITAL CASH, Personal accident cover also (they are paid out as cash benefit in case of being diagnosed and it is a rider option to the basic health insurance).
Always remember that “HEALTH INSURANCE is more of a PREVENTIVE SOLUTION than a REACTIVE ONE”, what I mean is that coverage is provided for UNKNOWN disease, not for KNOWN disease (as waiting periods are applicable for pre-existing conditions and waiting period will be applicable which will vary depending on the plan).
Let us understand the waiting period in detail.
- Initial waiting period: This waiting period is applicable in all health insurance products and company will consider the claim only if hospitalization request is raised after 30 days (kindly note any accident caused due to accident covered from Day 1 of issuance of the policy)
- Specific waiting period: For some of the common disease occurred due to life style disorder and general conditions which do have waiting period when someone chooses HEALTH insurance for the 1st time. Kindly note waiting period is usually 24 months for the below conditions but in some superior plans, it might have only for 12 months . 2 Year general waiting period for 17 Conditions like cataract, Stones in biliary and urinary systems, Lumps / cysts, Surgery on tonsils, Arthritis, Rheumatism, Spondylosis, Fissure / Fistula / Haemorrhoids, Hernia / Hydrocele, Sinusitis, Knee/Hip Joint replacement, Varicose veins, Benign Prostatic Hypertrophy, Hysterectomy for any benign disorder.
- Pre-existing illness waiting period: This is the important condition where if a person is already diagnosed with any illness (for example: B.P., Diabetes, cholesterol (or) any surgery happened recently), then it will be covered only after a waiting period. Pool of money collected from policyholder’s premium is for the unknown disease not for the KNOWN disease. Each plan has a waiting period ranging from 2 years to 4 years (depending on the plan chosen, sub- option chosen etc…). General rule is Higher the Base sum insured, lower the waiting period.
- Permanent exclusions: In India, there are some illnesses which will not be a part of any health insurance contract. Some of the examples are :
Hazardous Activities, Artificial life maintenance, Circumcision, Conflict & Disaster, External Congenital Anomaly, Convalescence & Rehabilitation, Cosmetic or Plastic Surgery, Dental/oral treatment, Eyesight & Optical Services, Experimental or Unproven Treatment, Hormone Replacement Therapy, Hospitalization not justified, Inconsistent, Irrelevant or Incidental Diagnostic procedures, Obesity and Weight Control Programs, Sexually transmitted Infections & diseases, Sleep disorders, Substance-related and Addictive Disorders, Unlawful Activity.
If you would have noticed, you can understand that MAJORITY of the diseases listed under Permanent Exclusion is specific to LIFESTYLE DISORDER rather than need-based medical assistance.
Understanding these terms and conditions completely will help POLICYHOLDERS of health insurance to make an informed decision and understand the product and services better before finalizing the one.
Health insurance is mandatory, not optional post the COVID-19 world, hence it is important that each individual should ensure adequate coverage along with a comprehensive plan for their family members. In India, salaried persons only consider their employer coverage but in this dynamic world, no person is married to a single employer, during the break in employment, if any illness happens then the individual’s financial liability will also increase.
Do plan for Health insurance and ensures that your financial well being is taken care of at all times as Health insurance provides cover till LIFETIME.
Finally, let me reiterate that the Services of a financial advisor is critical to plan while choosing health insurance.
A professional financial advisor will help you to plan the right plan, understand the terms and conditions better and also help you to assist during claim either through cashless (or) through reimbursement.
