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5 Commonly Missed Points while Taking Mediclaim Insurance in India

Author: Prateek Jha
by Prateek Jha
Posted: May 20, 2016

Buying oneself the most suitable health insurance policy is amongst the key decisions to be taken by an individual. It is understood that nobody wants to stake one’s life, then why not health? One should buy a mediclaim policy to ensure that he or she is not going to face financial troubles going forward. In exchange for that, a certain amount of premium is required to be paid to the insurer.

The best mediclaim policy provides the insured with special benefits in addition to those basic points of coverage. However, coverage is not the only thing you should run after; you should also consider affordability one of the major factors that back your decision.

Medical insurance provides you with the assurance that you can avail medical treatment at any of the network hospitals whenever needed. You only need to intimate your insurer about your need for the treatment. If not the insurer, you can inform the Third-party Administrator (TPA) seeking approval for the same. Mentioned below are 5 key things to remember before you buy a medical insurance policy:

1. Pre-existing Disease, if any

Your insurer must know about any pre-existing disease you may have in order to any issues going forward when you will need to get claim reimbursement or treatment at a network hospital. Generally, the diseases covered by medical insurance policies are: Asthma, Diabetes etc. Your insurance policy may not cover any pre-existing disease during 3 to 5 years of policy inception, whereas some insurers offer coverage for such diseases from the first policy year. So do confirm the same before getting it.

2. List of Network Hospitals

Health insurance plans offered by insurers are backed by tie-ups with various multi-specialty hospitals. This is in order to ensure that their customers stay healthy and can avail preliminary treatment whenever needed. Therefore, you need to explore the list of hospitals to figure out whether it includes a hospital in your nearby region, as this ensures that you would be able to avail the benefit of cashless treatment whenever needed. Needless to say, you cannot afford to miss a nearby hospital in a medical emergency just for availing the cashless facility at a network hospital. Thus, do confirm if you can avail treatment at a nearby hospital and get reimbursement for expenses incurred.

3. Reimbursement for Hospitalization Expenses

People are often seen confused about cashless hospitalization facility offered by the insurer. Generally, cashless facility is offered only in the case of hospitalization for at least 24 hours or more. This facility excludes day-care procedures or hospitalization for a period of less than 24 hours. People often overlook the policy terms, which results in confusion at the point of hospitalization. Thus, make sure you confirm whether your policy covers day-care procedures or hospitalization for less than a day.

4. Age for Policy Renewal

Health insurance or mediclaim has a certain period during which it remains in force. Once this period is over, you have to pay the premium for policy renewal. The coverage and benefits of a policy change with the increasing age of an individual. Also, the premium and benefits of a policy do not remain the same for a person of 20 years of age and another person of 65 years of age. Some insurance policies have a cap of the maximum age of 60 years while many others may cover you until you get 70. Therefore, you need to confirm if your current policy will cover you at the age of 65 or 70.

5. Explore the list of Diseases Excluded

Despite the list of inclusions, you need to explore the list of exclusions too. Generally, mediclaim insurance plans exclude cosmetic and dental procedures as well as any medical emergency arising from any of these procedures at your own cost. If you want to include these procedures in the coverage list, then you can ask your insurer about the same. If coverage can be offered for these procedures, you would have to make an additional payment of the premium.

The Verdict

In addition to the aforementioned, you need to figure out the value of your insurer as well as the number of claims settled by the company. A high claim settlement ratio means that your insurer settles most of the claims it receives.

About the Author

Prateek is a seasoned independent writer. His explanatory and creative writing style helps understand the subject matter easily and offers tips, tricks and expert suggestions for Star Health Insurance polices..

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Author: Prateek Jha

Prateek Jha

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Member since: Jan 23, 2016
Total live articles: 26

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