Mediclaim cover may come in parts

Do you have a mediclaim? Get prepared to shell out a portion of the hospital bill in cash in case expenditure under certain heads crosses maximum allowable limits. This may happen even if the total bill is well below the sum assured. Kolkata-based National Insurance Company (NIC) has introduced sub-limits under different heads like room rents, surgeons, medical practitioner, and items like anaesthesia, blood, oxygen, OT charges and pacemakers. Sub-limits, basically mean an individual cannot spend more than the stipulated amount under any specific head. If spent, the individual will have to shell out excess from his/her pocket. What more? Your premium bill may be higher by anything from 5-100% as NIC has also raised premiums for almost all age brackets. The older you are, the higher you will have to shell out. The insurer has raised premiums for persons older than 25. It has, in fact, also hiked the minimum cover or sum assured from Rs 15,000 per person to Rs 50,000. A quick look at the premium hike shows that for individuals between 26 and 35 years the rise is 5%. For the 36-45 range, the rise is 30%. Individuals between 46 and 55 years will have to pay 55% more, while those between 56 and 65 years will now be required to shell out 80% extra. Citizens older than 66 years will see their premiums double. Earlier, NIC had just one flat premium rate for a new-born up to the age of 35. This has now been broken up into two categories. One includes children below one year to 25 years where premiums have in fact declined by about 20%. The other is 26-35. In the revised mediclaim policy, NIC has introduced sub-limits under three broad heads. These are room rents and the limit is 1% of sum assured to a maximum of Rs 5,000 per day. For intensive care units, the sub-limit is 2% of sum assured per day and the maximum is Rs 10,000. Overall limit under this head is 25% of sum assured per illness. The other head includes, surgeons, anaesthetist, medical practitioner, consultants, and specialists’ fee. The maximum limit is 25% of sum assured per illness. Cost of pacemaker, anaesthesia, blood, oxygen, OT charges, surgical appliances, medicines, drugs, diagnostic material & X-ray, dialysis, chemotherapy, radiotherapy, artificial limbs and cost of stent and implant will have to be necessarily 50% of the sum assured. The only relief that an individual may get is when they opt out of the cashless system where NIC may directly pay the hospitals. “We are not charging the 6% service charge on premiums if a consumer opts out of the TPA system,” said a senior NIC official. Nevertheless, a 10% discount on covering the entire family remains so does the cumulative bonus. This bonus increases the sum assured by 5% every year in case there are no claims. The maximum can be 10 years. NIC, however, will provide for free health check-up every four year provided the preceding years were claim free. The maximum limit, however, is 1% of the sum assured.

source :Economic Times