While going for health insurance

Healthcare has suddenly caught the fancy of life insurance companies. Be it lumpsum amount on hospitalisation or ambulance expense reimbursements, the benefits offered under such policies have shot through the roof. Some even claim to cover more than 1,000 illnesses under one policy.

However, before signing the documents for such tempting benefits on the health and hospitalisation side, one should ask a few quintessential questions, lest his claim is denied after he has got a lengthy bill.

Yes, the billboard of the insurance firm would proclaim that no medical tests are required to take the health policy. But, the fact is that there would be conditions laid out on the same. One would either have to declare that he is healthy or he would have to have another policy with the same firm, under which he had undergone a medical examination.

Even though most policies offer the basic benefit of hospitalisation charges reimbursement, there is a minimum period for which the policy holder has to be hospitalised. Usually, insurers ask for a minimum of 24-hour hospitalisation, but a few others put out additional conditions.

One of the life insurance health product insists that the policy holder must be hospitalised for at least two consecutive nights and he must be charged the room rent for at least two days for the claim to be made.

There is also a survival period for the patient, which distributors say is used as an excuse frequently by insurers to deny claims. This basically specifies the minimum period during which the policyholder must be alive for the claims to be payable.

The survival period asked by companies ranges between 30 to 60 days. So, if a survival period of 30 days is specified in the policy and the policyholder dies on the 29th day, none of the medical expenses will be reimbursed.

Few health insurance policies offer post-hospitalisation benefits as well, which is meant for the treatment and care needed after the hospitalisation period, essentially medicines etc. But, companies specify a condition for this too.

For example, a recently launched policy states that the benefits provided for follow-up tests and post-hospitalisation consultation would be given only if the person has been hospitalised for at least five days. The same policy puts another condition to claims for surgery.

If more than one surgery is conducted under one anesthesia than the claim for the severest surgery is paid in full, while only 50% benefit is given for the second surgery. No claim would be paid for any subsequent surgery under the same anesthesia.

The procedure for submission of bills for claims can be another area that one must pay attention to. Most policies ask for original bills and hospital documents for claims purposes.

So, the policy holder might face a problem as he wants to apply for claims to two different health insurance companies. Check, with the insurance firm whether duplicate or attested photocopies of bills are acceptable.

Source: DNA