HEALTH CARE- HELTH INSURANCE-CHOOSING THE BEST PLAN

HEALTH CARE- HEALTH INSURANCE PLANS- CHOOSING THE SUITABLE PLAN

We know that  Health Insurance is one of the best option  of our Health Care today. Now there are so many insurance companies offering health care services under various plans to suit the  requirements of all classes of people. However while proceeding to take Health Insurance plan or  Medical  insurance plan, we have to keep certain things in view while choosing a suitable plan to suit our needs and preferences.

Almost all  Health Insurance Policies would normally cover expenses reasonably and necessarily incurred under the following heads in respect of the insured person or  member of the family, limiting  to overall ceiling of sum assured/ insured for all claims covered under the policy.

These are the charges generally required to be  covered in our Health Insurance policy and therefore we have to verify and to get clarified about the admissibility of the undermentioned charges/clauses in the policy.
 
HOSPITAL CHARGES:
 
1.Accommodation / Room and Boarding charges.
2.Nursing expenses.
3.Surgery charges: Fees of surgeon, anesthetist, physician, consultants and specialists.
4.Charges for Anesthesia, Blood, Oxygen, Operation Theater charges, Surgical appliances, Medicines, Diagnostic materials, X-ray, Dialysis, Chemotherapy, Radio therapy, Cost of  Pace maker, Artificial limbs, Cost of Organs and similar expenses.

SUM INSURED:
The  Insurance sum offered may be on an individual basis or on floater basis for the family as a whole.

CLAIM FREE YEAR BONUS:
Health Insurance policies usually offer No claim Bonus, wherein for every claim free year, the Sum Insured is increased by a certain percentage at the time of renewal, subject to a maximum percentage (generally 50%). In case of a claim,  this bonus will be reduced by 10% at the next renewal.

COST OF HEALTH CHECK UP:
Health policies may also contain a provision for reimbursement of cost of health check up. We have to go through the policy and if necessary we have to seek clarification from the insurance advisors/company.
In order to become eligible to make a claim under the policy, minimum stay in the Hospital  is necessary for a certain number of hours. Usually it will be 24 hours, but this  limit will not apply for treatment of accidental injuries and for certain specified treatments.Admissibility of these clauses and conditions shall have to be verified. 

BEFORE AND AFTER HOSPITALIZATION EXPENSES:
Prior to hospitalization and post hospitalization from the date of discharge, expenses incurred  for certain period for Tests and treatment can also be considered as part of the claim provided the expenses are related to the disease / sickness,  for which hospitalized.  It has to be ensured for such specific provision/clause available in the policy.

CASHLESS FACILITY:

All Insurance companies have tie-up arrangements with a network of hospitals in the country. If policyholder takes treatment in any of the net work hospitals,  the insured person need not pay for hospital bills and he can avail cashless treatment facility. The Insurance Company  arranges payment to the Hospital for the treatment expenses. Expenses beyond sub limits prescribed by the policy or items not covered under the policy have to be borne  by the insured person only.
 
The insured person can also take treatment in a non-listed hospital, but  he has to pay the bills first and later claim reimbursement from Insurance Co. In such cases cashless treatment facility can not be availed.

ADDITIONAL PROVISIONS: 

Insurance companies also offer certain other benefits, such as “Add-ons” or riders clauses. Further some stand alone policies that are designed to give benefits like “Hospital Cash”, “Critical Illness Benefits”, “Surgical Expense Benefits” etc will be available. These policies can either be taken separately or in addition to the hospitalization policy.

NON COVERED ITEMS:
The following are generally excluded under health policies:
1.All pre-existing diseases for certain period,usually for four years.
2.Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease will not be eligible, excepting  accidental injury claims.
3. During first year of cover – Cataract, Benign prostatic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, Piles, Sinusitis and related disorders are not covered.
4. Cost of Spectacles, Contact lenses, Hearing aids, Dental treatment /Surgery unless requiring hospitalization.
5.Convalescence, General debility, Congenital external defects, V.D., Intentional self-injury, Use of intoxicating Drugs / Alcohol, AIDS, Expenses for Diagnosis, X-ray or Lab tests not consistent with the disease requiring hospitalization .
6.Treatment relating to Pregnancy or Child birth including Cesarean section
7.Naturopathy treatment.
8.The actual exclusions may vary from product to product and company to company. In group policies, it may be possible to waive / delete the exclusions on payment of extra premium.
9.No short period policies and Health insurance policies are not issued for less than one year period.

Now number of banks/insurance companies are offering Health Insurance services,we can expect various plans and also with the addition of  riders/Add-on conditions, a suitable plan to meet our needs and preferences can be chosen.  Further with the availability of comparative details of different policies and of different insurance companies are available online, we can choose a suitable or tailor made policy by taking little pain.