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.
General Health Insurance Plan Exclusions
The exclusions on a health insurance plan vary from company. Pay attention to is whether pre-existing diseases or treatment for common but expensive treatments, such as cataract or hernia are covered.Apnainsurance.com Research Bureau
03 Dec 2007
The exclusions on a health insurance plan vary marginally company to company - what one should pay special attention to is whether pre-existing diseases or treatment for common but expensive treatments, such as cataract or hernia are covered.
The typical expenses that are not covered by a general health insurance policy are:
- Any disease/injury during first 30 days of commencement of policy (except accidental injury)
- Any treatment relating to any illness/disease already in existence at the time of proposal; certain policies may cover a few pre-existing diseases from the fourth, fifth or sixth year onwards; provided the policy is renewed with no lapse
- Expenses incurred on treatment of following diseases within the first two years from the start date of the policy are not covered, but would be covered from the third or fourth year onwards or later if they are pre-existing covers:
- Arthritis
- Benign prostate hypertrophy
- Cataract
- Dialysis required for chronic renal failure
- Dilatation & curettage
- Fistula in anus
- Gastric and duodenal ulcers
- Gout
- Hernia
- Hydrocele
- Hysterectomy unless because of malignancy
- Joint replacement (unless due to accident)
- Myomectomy
- Piles
- Rheumatism
- Sinusitis and related disorders
- Skin and all internal tumors / cysts / nodules / polyps of any kind, including breast lumps, unless malignant / adenoids and hemorrhoids
- Stone in the urinary and biliary systems
- Surgery on tonsils and sinuses
Permanent exclusions could comprise of the following illnesses:
- Vaccination, inoculation, change of life, cosmetic or aesthetic treatment, plastic surgery unless necessitated due to accident or as a part of any illness
- Treatment of asthma, chronic nephritis and nephritis syndrome, gastro-enteritis, diabetes mellitus and insipidus, epilepsy, hypertension, influenza, cough and cold, all psychiatric or psychosomatic disorders, pyrexia of unknown origin for less than 10 days, tonsillitis and URTI, arthritis, rheumatism (as far as domiciliary hospitalization is concerned)
- Dental treatment or surgery of any kind unless requiring hospitalization
- Cost of spectacles contact lenses and hearing aids
- Convalescence, general debility, "run-down" condition, sterility, venereal disease, intentional self-injury, use of drugs and intoxicants
- Hospital / nursing home charges not forming part of any treatment
- Treatment connected with pregnancy, child birth, voluntary medical termination of pregnancy within first 12 weeks of confinement
- Nuclear perils and war group of perils
- Naturopathy or non-allopathic treatment
- Any internal congenital illness
- Pregnancy and childbirth related diseases
- Expenses arising from HIV or AIDS and related diseases
- Use or misuse of liquor, intoxicating substances or drugs as well as intentional self injury
- War, riots, strike, terrorism acts, nuclear weapon induced treatment.
Miscellaneous Health Insurance FAQs
Health Insurance FAQs about Coverage
Health Insurance FAQs about Claims
Health Insurance FAQs about Premiums
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