Nonetheless, many policyholders consider that insurers are certain to settle their claims in full. That isn’t the case though. Insurers only settle claims based on the terms and conditions set forth within the insurance policy document. Furthermore, they adhere to a pre-fixed rate beneficial by the General Insurance Council (GIC) in India when settling such claims.
Listed below are some ways in which can make it easier to get the utmost claim out of your health policy.
Comprehensive health policy: Most medical insurance policies include a deductible, commonly often called super top-up plans. In such plans, there may be a threshold limit (deductible) on payments. Before your health policy fully covers your medical costs, you need to reach that threshold limit.
Depending in your plan, your annual deductible could be a few hundreds and even lakhs of rupees. In other words, a brilliant top-up plan typically works on a cost-sharing basis. It means the plan doesn’t bear your entire cost; only an element of it is roofed based in your deductible.
Nonetheless, a comprehensive health policy covers every kind of medical costs with none deductibles. It covers a wide selection of medical expenses, including the fee of hospitalization, etc., without the policyholders having to pay for these from their pockets.
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Multi-year health policy: While you buy a multi-year health policy, the premium stays the identical throughout your entire policy period. This fashion, you might be shielded from any subsequent premium adjustments made by an insurer in the course of the time the policy is in force. Typically, policyholders should pay multi-year premiums for up to a few years in a single go. And so, an increase in the fee of insurance won’t affect you for 3 years.
Prawal Kalita, managing director, Marsh India, said healthcare costs are on the rise. One distinct advantage that a multi-year contract offers is the premium lock-in that one gets when choosing such a policy. “Nonetheless, it is advisable to weigh the financial and practical gains of multi-year policies when selecting them,” said Kalita.
Terms and conditions: Insurance documents offer an in-depth explanation on the terms and conditions of the policy that may run into multiple pages, no matter whether it’s bought online or offline. Most policyholders avoid going through the documents because they’re too wordy, and this could prove to be costly in the course of the claim process.
Room rent clause: Certain expenses are unavoidable in the event you are hospitalized and these include the fees paid to surgeons, consultant doctors, medical bills and charges for the operation theatre, etc. Most of those are taken care of fully by your health policy, The exception is the fees paid for the ward or room where you might be admitted. Insurance policies set a limit on the fees that may be paid for this. If the insured person occupies a room that has the next rent than what’s mentioned within the insurance policy, it could lead to deductions from the claim amount.
Ankit Agarwal, CEO and co-founder of InsuranceDekho, said most insurers generally allow basic or single standard private rooms under medical insurance policy coverage. “You need to at all times go for a room with rent that meets the limit set by the insurer. Else, it’s also possible to go for a policy with out a room rent sub-limit or decide to go for a further cover at an additional cost. It is important to confirm the room rent limit in a medical insurance policy,” said Agarwal.
Co-payment clause: This refers to a clause within the policy wherein insurers comply with pay a pre-fixed percentage of the claim amount since most medical insurance policies don’t cover certain expenses.
Agarwal said, “you need to select a medical insurance policy that doesn’t have a co-payment clause. Besides, medical insurance policies mostly don’t cover costs related to maternity, dental, and optical checkups or treatment. It also doesn’t cover treatment arising out of consumption of intoxicants, voluntary organ donation, etc. In some cases, it is nice to go for add-on covers . For instance, you possibly can add a maternity cover to your policy to fulfill maternity-related expenses.”
Claim settlement process: No insurance policy can serve its purpose until and unless it provides proper claim settlement to the insured. Indraneel Chatterjee, co-founder of Renewbuy, said, “There may be a serious query across the claim settlement done by traditional branch-led model even today. It is best to go for a cashless facility regarding health claim settlement.”
“Typically, insurers have a tie-up with network hospitals. For this reason affiliation, they manage to provide discount package rates for frequent treatments to policyholders in the event that they file cashless claims. Insurers and network hospitals offer discounts onlyon cashless treatment because this helps them manage the claims costs for several planned surgeries,“ said Abhishek Bondia, principal officer and managing director, SecureNow.in.
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