When you or a loved one is ill and in hospital the last thing you want to worry about is the means to pay the hospital bill. Hospital expenses reimbursement policy (called mediclaim or Health insurance policy in common parlance) enables you to pay for hospitalization expenses when you or your loved one are unfortunate enough to get admitted to a hospital.
You should take health insurance when you and your family members are healthy because you are unlikely to get the Insurance if a serious illness or disease has already set in. Answer the proposal form fully and completely without hiding any facts as it is better to get the health insurance policy at a higher premium or even not to get it at all instead of paying premium and then not getting the money when the claim arises.
Check the age up to which the policy is renewable, any sub-limits for room rents, any requirements to pay part of the eligible hospitalization expenses yourself (called co-payment), formula for increase in premium if you make a claim, formula for no claim bonus and the coverage of pre-existing disease. Or you can just fill up the form alongside and get competing offers from the leading health insurance companies. Don't forget to ask them about the parameters pointed out above.
Another policy that you may definitely need is a serious illness disability policy (also called Critical Illness Policy). When a serious illness such as a stroke or kidney failure hits you the mediclaim policy only pays for the hospitalization expenses. It obviously does not cover you for the loss of income arising from the loss of job or business due to the serious illness. This is what a critical illness policy covers. You can buy standalone critical illness policies from non-life Insurance companies or take a critical illness rider along with your life insurance policy.
Critcal Illness Plan Exclusions
There are a few exclusions applicable in case of a critical illness health insurance plan. Find out more about these exclusion, read onn.Apnainsurance.com Research Bureau
03 Dec 2007
Some of the exclusions applicable to the critical illness health insurance plan are:
- Any illnesses and procedures within 90 days to 120 days from start date of policy will not be covered. This clause is not applicable for policy renewal (without a break)
- Death within 30 days following the diagnosis of a critical illness
- Any pre-existing illness
- Lack of doctor's medical certificate confirming the diagnosis of illness/injury or medical/surgical procedure undergone
- Any congenital illness or condition
- Any medical procedure or treatment that is not medically necessary or not performed by a doctor; treatment by family member and self-medication or any treatment that is not scientifically recognized
- Treatment relating to birth defects and external congenital illnesses
- Birth control procedures and hormone replacement therapy
- Any treatment/surgery for change of sex or any cosmetic surgery or treatment
- Presence of HIV/AIDS infection
- Naval or military operations of the armed
forces or air force and participation in operations requiring the use of
arms
- Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption etc.
Some exclusions to the personal accident rider on the critical illness plan for insurance are:
- Compensation/claim under more than one of the categories specified in the policy with respect to disablement
- Claims arising out of sickness/illness
- Death, injury or disablement of insured:
o From intentional self-injury, suicide, or attempted suicide
o Whilst under the influence of intoxicating liquor or drugs
o Directly or indirectly caused by venereal disease or AIDS
o Any condition associated with childbirth or pregnancy or as a consequence of the same
o Engagement in dangerous activities
o Traveling in any aircraft other than as a fare paying passenger on a scheduled flight
o Mental disorder or psychosomatic dysfunction
o Permanent total disablement prior to commencement of the policy.
See also:
Miscellaneous Health Insurance FAQs
Health Insurance FAQs about Coverage
Health Insurance FAQs about Claims
Health Insurance FAQs about Premiums
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