Don’t buy health insurance blindfolded

With the healthcare expenses sky-rocketing, it goes without saying that health insurance is the need of the hour. The medical inflation rate in the country is astonishingly higher than the global average and extensively higher than other developed economies. In such turbulent times, especially when it comes to medical emergencies, health insurance is the only oasis. However, policyholders should learn all about the coverage, benefits and exclusions of their health insurance plans.

It is no secret that a health insurance plan does not cover each and every medical expense. It is pretty understandable that every health insurance comes with a list of inclusions and exclusions. But, it is the exclusions that can present a shocker if one is unaware of them from before. If one is a smart insurance buyer who takes the pain to go through the terms and conditions, and the inclusions and exclusions, one can surely shy away from those spiteful surprises in the future.

Complete health insurance comes packed with features that can assist an insured in managing expenses associated with medical emergencies and also with preventive healthcare. The basic inclusions are as follows –

The expenses incurred in case of hospitalisation of 24 hours or more are covered. These expenses include – room rent of the hospital, rent of ICU, OT charges, doctor and surgeon’s fee, anaesthetist and nurse’s fee, and the cost of medicine, blood, and oxygen.

Medical costs incurred during pre and post-hospitalization are covered.

The costs sustained in taking the insured in an ambulance are covered up to a limit.

All daycare treatments which do not require hospitalisation for 24 hours are covered.

Health insurance policies cover the expenses incurred in harvesting the organ from the donor along with the transplant surgery.

Many health plans also cover non-allopathic treatments like Ayurveda, Siddha, Yunani and Homeopathy.

Treatment at home or domiciliary treatment due to the non-availability of hospital beds or when the insured is in no condition to be shifted to a hospital is also taken care of in many insurance plans.

Almost all health insurance policies permit free precautionary health check-ups once in 1-4 claim-free policy years.

One of the most important popular benefits in a health insurance plan is the restore benefit. This allows an insured to reinstate the entire sum insured in the policy year when it gets partially or completely bushed due to claims. But, this benefit does not work for the same ailment of the same individual and can be used once in a year.

While the above features are commonly found in most health plans, few popular health insurance plans offer few prominent features like maternity coverage bundled with newborn baby coverage wherein the cost of childbirth is also covered; and OPD coverage wherein medical expenses incurred on an outpatient basis are covered.

The health insurance policies are otherwise all-inclusive in their extent of coverage. However, there are a few instances which are not covered under most plans. These are the exclusions and should be paid heed to seriously –

Health insurance plans usually do not cover pre-existing ailments i.e. if the policyholder is already suffering from any disease at the time of buying the policy. The waiting period ranges from 1 year to 4 years across plans.

Medical illnesses within the first 30 to 90 days of buying the policy are not covered.

Specific treatments like joint replacement, hernia, piles, etc. are not covered in the first 2-4 years of the plan.

Self-inflicted injuries, war, riots and related perils, injuries due to nuclear contamination and injuries due to alcohol or drug abuse; and HIV/AIDS are not covered.

Maternity-related expenses like pregnancy, childbirth, vaccination and likewise cannot be covered unless one has opted for a maternity cover.

Cosmetic treatments, dental treatments, unproven and experimental treatments are not covered.

OPD expenses are not covered unless the plan has an inbuilt OPD cover.

In short, it is wise to understand the inclusions and exclusions properly before zeroing in on a health insurance plan as it helps in setting the right expectations for a policyholder.

(The writer is MD & CEO, ManipalCigna Health Insurance)