In India, almost all working people have
mediclaim policies be it group mediclaim insurance or private mediclaim
insurance. However, do all they know the basic of this mediclaim insurance
policy?
Read these answers to most frequently asked
questions about mediclaim insurance and decide it for you!
1) Change of hospitals:
Change in hospitals while under treatment is
permitted only under some circumstances and those are 1) in case of better
treatments 2) approved by TPA on the merits of the case and as per policy terms
and conditions.
So why not check the network of the hospitals
provided by your mediclaim company for the best before hospitalization?
2) Benefits of sticking to one Insurer Company:
a) If you are suffering from any
pre-existing disease at the time of commencement of the mediclaim policy then
complications of that disease will be covered only after 3 or 4 years of the
commencement date.
b) If you stick to your mediclaim policy for
more than one year or so, company may offer you bonus or give discount in
premium.
c) After two years of mediclaim insurance
commencement, you may get free health check-ups for every second year. Or you
may get health services and product of market value up to 10% of your last paid
premium.
3) NRI and Health insurance in India:
Yes, NRI can take mediclaim policy in India,
only after submitting residence proof and other required documents. Cost of the
treatment will be set against Indian parameter and premium has to be paid
according to Indian actuaries. The applicant needs to come to India for the
treatment, as he will not be compensated for it in his foreign country.
4) Documentation- before and After:
a) Whenever you go to buy any mediclaim insurance
policy then agent or company will tell you about the things they are covering
to the lengths but none of them will tell you about the exclusions and there
lies the hitch. So before buying any mediclaim insurance, check about its
exclusions thoroughly.
b) After insuring yourself please always keep your
all documents up to date. If you have, any pre-existing disease then its all
history as it is (do not misplace a single prescription also)
c)
In case of planned surgery, intimate it to your mediclaim company in advance
and take preauthorization of it from the mediclaim company. So at the time of
actual surgery, you need not submit any document.
5) Accidental insurance:
If you are opting accidental insurance as
rider to your mediclaim insurance policy then it will cover a very less amount
in the case of accident or hospitalization due to accident.
So it is wise to opt for independent
accidental insurance but do check all the exclusion before opting for it.
6) If it is working couple then are they double
insured?
Yes they are! If you have group mediclaim insurance of Rs.2
lakhs and your spouse has it of 2 lakhs too then you both will be insured for
Rs.4 lakhs. So if either of you met with an accident or hospitalized due
to some sickness, and the expenses are about 2.5 lakhs, then you can claim 2
lakhs from your company and remaining 50000 from your spouse’s.
7) Cashless hospitalization:
You may be disallowed of cashless
hospitalization if
a) Information about the treatment you
submitted is insufficient to confirm the coverage
b) TPA is not in timely receipt of the request
for the pre-authorization. In such case, you need to bear the expenses first
and then send claim for reimbursement.
c) If hospital in which you are required to
take treatment is not on the panel of the company
8) Domiciliary hospitalization:
Is the case where treatment is required for
more than 3 days but patient cannot be taken to hospital and confined to home.
It will be permitted only under 2 circumstances: 1) patient is unable to move
to hospital.2) Hospital is unable to accommodate the patient.
Cover for such treatment is depending upon
mediclaim Company’s policy and you need to check it before opting for the
mediclaim insurance.
9) Mediclaim Vs Critical insurance
Mediclaim is to cover the hospitalization
expenses. Mediclaim covers even the hospitalization due to critical illness.
But critical illness insurance is to cover the reduction or decrease in your
earning capacity due to critical illness insurance. That’s why you will be paid
the full sum assured in critical illness insurance regardless of the hospital
bills.
10) Can I change the TPA?
TPA helps to settle the claims arising from
mediclaim polices. They are also in charge for providing the cash less
facility. TPA is appointed by the insurance company. If you are not satisfied by
the services of your TPA, then you can’t change the TPA without changing your
mediclaim insurance company.
Mediclaim is one of
the risk management tools. If you are not covered with mediclaim, your wealth
may erode just like that if there is a hospitalization. By taking a mediclaim
policy you are actually protecting your wealth.
The author is Ramalingam K, CFP CM is the Chief Financial
Planner at holisticinvestment.in, a leading Financial
Planning and Wealth Management company.