10 Lesser Known Facts about Your Mediclaim Policy

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.  

All you wanted to know about Mediclaim Policy

Health care costs are sky rocketing day by day. Therefore the need for having a mediclaim policy for you and your dependents has grown. Suppose you have to undergo some medical treatment or need to be hospitalized for certain reason, then a mediclaim policy will be of immense help to you in covering your health care expenses. The reason is Mediclaim offers protection in case of unexpected medical and health care emergencies.

Hospitalization expenses in case of illness, disease or accident will impose a heavy financial burden on individuals and families. This is where the mediclaim policy comes in handy. The mediclaim policy can reimburse the hospitalization expenses or can pay the hospital directly on behalf of you.

A mediclaim policy provides a health cover of certain amount of money. This amount depends on the amount that the insured person was insured for.

The mediclaim policy can be taken for an individual or for an entire family. Some insurance companies allow a discount on the premium if the policy is taken for a family.

Insurance companies have fixed some age limit for medical test. If the individual is below that age, then he or she need not undergo medical test for taking mediclaim policy. If the individual is above that age limit then he needs to go for medical test.

If any pre-existing disease has been found out in the medical test, then those diseases will not be covered under the mediclaim policy for a waiting period of a first few years.

If you have a mediclaim policy from your employer, that may not be sufficient. Employer may cover the employee and not necessarily his entire family members. And moreover these policies are not portable and cannot be individualized if you leave the job. Employer provided policies cannot be transferred to another employer in case you switch your job. Also employer provided policies will give you coverage as long as you are employed. Once you retire you may not be having coverage.

It is really unfortunate that only after your retirement you need health insurance at the most. If you plan to take a fresh policy after retirement, insurance company will not cover the pre-existing diseases at that point in time. Though your employer provides a health insurance policy it is better for you to take a separate health insurance policy at least with a small amount of coverage.

The coverage amount of the health insurance policy need to be decided based on your health consciousness, your family health history, and the class of hospital you choose for treatments.

If you are not health conscious or you don’t do regular exercises or you don’t follow proper diet or you frequently take outside food or don’t go for annual health check-ups then it is advisable to go for more sum insured coverage in your mediclaim policy.

If your family has got any adverse health history like heart disease, high blood pressure, stroke, diabetes, kidney disease, cancer, any form of paralysis, or any hereditary disorder then you need to choose higher coverage amount in your health insurance.

If you will be choosing high class hospitals for your treatment then you need to go for higher sum assured. If you will be choosing medium level or low level hospitals then you can choose the coverage amount accordingly.

Also you need to revise your health insurance coverage amount based on the changes in the above factors and the changes in the medical cost. Also the increase in the age needs to be considered for deciding the coverage amount.

The icing on the cake is you get tax benefit under section 80D for the mediclaim premium paid. For senior citizen the limit under this section is Rs.20000 and for others it is 15000.

Most people don’t think about health insurance very often.  But it comes to mind first when a loved one is sick. Mediclaim policy is one of those things everyone knows he or she should take but usually puts off until a more opportune time. Living without a mediclaim policy is like going out on a rainy day without an umbrella or a raincoat.

If you have not covered adequately yourself and your dependents with mediclaim policy so far, then now is the right time to take action. The fact that you are reading this article shows you have decided to stop procrastinating, delaying and have answered the ancient question, “If not now, when?” with “NOW!”. 

The author is Ramalingam K, an MBA (Finance) and Certified Financial Planner. He is the Founder and Director of Holistic Investment Planners (www.holisticinvestment.in) a firm that offers Financial Planning and Wealth Management. He can be reached at ramalingam@holisticinvestment.in.