Should you buy health insurance from Agent or Broker?

Since your agent represents one Company and can only sell you a product of that Company, he may not tell you that there are better health insurance products available for your needs. He may be:

• Biased: He may push you to buy only his company’s products by positioning his company as better than other health insurance companies.
• Unaware about Health Care: Your agent will not generally have expertise in health care. He will not be the best person to handle your health care claims as he lacks the knowledge to discuss with the health insurance company in case of complicated claims.

Rather than buying health insurance from an Agent, Buy health insurance from a Health Insurance broker who is authorized to sell products from different companies and can compare their pros and cons. A Broker will also be in a better position to handle your claims as he has a better know-how of health care.

To know more see Things your Health Insurance Agent won’t tell you!

What are the information’s your Health Insurance Agent won’t tell you?

When you were buying health insurance policy, your agent kept repeating all your hospitalization charges would be covered. And it is now after your claim was rejected that you discovered the whole concept of exclusions! So here are some things that your health insurance agent may not tell you:

• Since your agent represents one Company and can only sell you a product of that Company, he may not tell you that there are better health insurance products available for your needs.
• Health insurance in India is hospitalization insurance that covers the hospitalization costs incurred in India but there are conditions and exceptions. This is a fact, your Agent may not mention.
• Agent forgets to tell you when you are selecting a product is that your premium amount will change and most likely increase. The two reasons for the increase are- Age and Claims you have made.

To know more see Things your Health Insurance Agent won’t tell you!

Raksha TPA/United India Insurance Company

TPA called Raksha TPA has refused a genuine claim for my mother’s surgery by giving a silly technical reason that the claim needs to be submitted to them within 7 days of discharge from the hospital (our papers reached them on 8th day as per the acknowledgment though they claim to have recd. on 10th day. Their exclusion clause was never highlighted , mentioned in the small( 2”x 3”) pocket guide in a small print. I have communicated with United India Insurance Co.but not much positive response from them so far
Dr.Abhijit Kher
9821043911
info@niramaymothercare.com

What are the condition of Top up and Super top up plan?

General conditions of the policy are as follows-

• You can take a Top up plan or a Super top up for an individual or as a family floater.
• There is a waiting period of 4 years for pre-existing ailments cover with all the companies.
• No expense will be covered till 30 days of buying health insurance policy.
• All expenses should be above the threshold limit for it to be payable.
• You can buy a top up policy even if you don’t have a health insurance policy covering the first level expenses.
• Pre and post hospitalization charges will be payable if the claim amount is above the threshold limit for Top up policies.

To know more see Top- Up your Health Insurance Policy!

What is a Super top-up Health Insurance Plan in India?

Super top up is also like a top up policy the only difference is that for a top up policy, the expenses for a single treatment should be over the threshold while in a Super top up, the total amount of expenses in a year needs to go above the threshold level for the policy to be effective.

For example: For Mr. Sharma, a top up of Rs. 10 lakh will be ineffective as the cost of both his bypass and his mother’s knee replacement is under Rs. 3 lakh. But if Mr. Sharma opts for a super top up, since the cost of treatment in the year comes to Rs. 4.5 lakh, the additional Rs. 1.5 lakh will be paid by the company providing the Super top up.

Thus between Top-up and Super top up, Super top up is more beneficial for the customer.

To know more see Top- Up your Health Insurance Policy!

What is a Top-up Health Insurance Plan in India?

Top-up is a policy that provides an additional cover to add to your existing cover in a very economical way. For example Mr. Sharma can take a Star Super surplus top up of Rs. 10 lakh for just Rs. 5700 for his entire family on a floater basis. This amount is almost equal to his premium for his original cover of Rs. 3 Lacs while now, he is getting a cover that is triple the amount. This situation holds good for most of the age brackets.

But the thing to note here is an amount called as ‘threshold level’ also known as ‘compulsory deductible’ amount. This amount is the level above which the top up can be utilized for paying the expenses. For example, for a 10 lakh top up amount, the compulsory deductible amount is Rs. 3 lakh, the top up amount will only pay for expenses that go above Rs. 3 lakh. Once the expenses exceed Rs. 3 Lacs, the total expenses upto an additional Rs. 10 Lacs will be paid. What this means is that, the Company providing the Top up cover will not require proof of your having a basic cover of Rs. 3 Lacs. It is simply that, their cover will pay from the Rs. 3 Lacs and first rupee irrespective of the first Rs. 3 Lacs is covered under insurance or not.

To know more see Top- Up your Health Insurance Policy!

How Top up health Insurance Plan can help you?

Top-up is a policy that provides an additional cover to add to your existing cover in a very economical way. If the cost of hospitalisation exceeds the ground policy cover, top-up health insurance takes care of the extra amount.

Suppose, a person has a medical policy of Rs 3 lakh from employer or has bought it himself, he has the option of buying a top-up of Rs 7 lakh. Now he has a total health insurance cover of Rs 10 lakh.

But it is from two different companies. In an emergency, if this person is hospitalized and the total expenses incurred are Rs 5 lakh the ground policy insurer will pay Rs 3 lakh and the remaining liability of Rs 2 lakh will be borne by the top-up insurer.

To understand top up plan better see Top- Up your Health Insurance Policy!

What are the things to do after a rejection of Health insurance Claim in India?

Many times there are cases that insured a person who files claim does not provide proper documents. In these cases the claims are rejected. So here is what to do after Health Insurance Claim Rejection:

• Know the reason from TPA
• Check the claim form
• Contact the TPA
• Check the documents submitted
• Gather medical proof
• File an appeal
• Approach Ombudsman

To read each in detail see Is your Claim rejected? Follow these steps!

How to avoid Health Insurance Claim Rejection?

Claim rejection happen because of the mistake made by the policy holder. So here are certain things policy holder should know in order to avoid Claim Rejection and ensure a Smooth Health Insurance Claim Settlement:

• Read the fine print very carefully at the beginning so that you are aware of what is covered and what is not.
• Take copies of all the documents that you submit along with the claim form to the TPA for future reference.
• Submit the claim request within 30 days of the hospitalization if you are including the post hospitalization expenses; send it within 90 days of hospitalization.
• Check all the details provided in the claim form for accuracy.
• Send all the necessary medical records to the TPA.
• Gather sufficient medical opinion in support of the treatment and send it to the TPA.

To know more see Is your Claim rejected? Follow these steps!

What are the reasons for you Health Insurance Claim being rejected in India?

A health insurance claim is a bill for health care services that your health care provider turns in to the insurance company for payment. So here are some reasons why your claim will not be paid:

• Ailment not being covered in the health insurance policy (Exclusion)
• Improper claim form filled
• Procedure deemed medically unnecessary
• Claim not filed in time

To know more see Is your Claim rejected? Follow these steps!