Simplest Guide for Health Insurance in India

You need to lodge a written complaint addressed to the Insurance Ombudsman of your jurisdiction. You can find the insurance ombudsman of your jurisdiction through the document provided at the time of buying the policy or by referring to the IRDA website. You can approach ombudsman in cases like:

• If you think the insurance company has not fully paid a valid claim.
• If there is a disagreement about the payment of premium between the insurance company and you.
• If there is disagreement between the interpretation of the policy wordings.
• If there is delay in the payment of the claim.
• If the insurance company does not provide any insurance document after acceptance of the proposal and even after you have paid the premium.

To know more see The Role of Ombudsman in Health Insurance in India

These are medical expenses relevant to the disease that results in hospitalization incurred during a period up to the number of days specified in this policy, prior to hospitalization for treatments of disease, illness or injury sustained as part of a claim admissible under the policy.

What it means: It means that you can claim all medical expenses that you undertook for the treatment before you were hospitalized, if the hospitalization is payable. Generally, all expenses incurred 30 days before the hospitalization can be claimed by providing proper receipts and reports required.

To know more see Understanding Hospitalization vis-à-vis insurance

Cosmetic surgery does not affect the life of an individual. It’s main role and benefit lies only in external looks and beauty, which are not life threatening. Hence, cosmetic surgeries of any kind, including botox, liposuction, et al are not payable by the health insurance company. And it is of note, that circumcision is now considered cosmetic surgery under most health care plans and is not covered. Circumcision, plastic surgery will be payable only if it forms a part of the treatment of an illness.

To know more see Your Mediclaim policy excludes these expenses

A good agent is the one, who is customer centric and you ensures that you remain happy after you have bought your health policy from him. And you need a good agent so that you remain hassle free once you have bought your health insurance policy. So here are some tips for you to help you find a good agent:

• Information: It is not enough to read the policy and explain it to the customers, there is lot more that is needed to be a good broker. The person should go in depth of the exclusions and the policy details and must understand the rationale behind the provisions. He must have enough information to answer all your questions.
• Genuine: A good agent is a genuine person, who can inform you everything about the policy you are to buy and does not hide any such thing that can create problems for you when the time comes to claim. A genuine agent must tell you about the waiting period for specific diseases, he must tell you about the exclusions as well as the fine prints, so that you remain completely aware of the policy that you are taking.
• Proactive: A good insurance agent will be the one who would ensure that he reminds you of your policy renewal date, in case you are out of town and cannot make it in time for the payment of the premium on the renewal date and suffer the termination of policy.

To know more see Good Health Insurance agent

Before deciding to buy a policy we need to think of who were are buying the health insurance from. People buy health insurance policy from a person, who deals with motor, household and fire policy, or even life policy and not specifically health. In fact buying health insurance directly from the company is preferred over to buying from someone who understands nothing or has only half of health insurance understanding! Here are the benefits of buying health insurance from health expert:

• They handle your Claims Disputes:

A right broker will tell you why your claim has been rejected and whether it is rejected for valid points. If it is unfairly rejected, he will help you in filing your claims again and if needed he will assist you in approaching the ombudsman (a third party platform that resolves claims issues).

There will be times when a claim is rejected by an insurance company that has a good chance of being passed if more reports and evidence is provided. A broker with a good health insurance and health knowledge will be able to discern whether there is scope for reapplying for the claim settlement and what the Insurance Company expects.

• They design policies:

A health expert can help design corporate health insurance policies. His special expertise will help him understand the facts behind the claims and the reasons why there is rise in claims for some diseases and a dip in others. The health and health insurance knowledge clubbed together can help him design a policy that is based on the needs of the company.

To know more reasons see Health Insurance from Health experts

If you find your existing Broker falling short on many of these criteria then you need to make a switch too. Remember when buying health insurance policy; be sure that the person you are buying the health insurance from is a good one, because regretting later is no good.

Experience: A Broker/ Agent who has just started out won’t be able to give you the best service that is needed as he is not that familiar with the field yet. It is advisable to go to a person who has a considerable amount of experience with many contacts in the field that would help process your claim better.

Organization or individual: Your broker or the agent you buy health insurance from needn’t necessarily be individuals you may also buy your health insurance policy from organizations who act as brokers. The advantages of going for an organization are many namely- they are experts in the field, they have structured way of working hence the records and renewals will be done separately, they will have separate departments that will handle the claims and due to their size they are in a position to talk and when needed, fight with the insurance companies. On the other hand you may just miss the personalized attention that individual agents or brokers give.

Service: When you receive a call by an agent/ broker to sell a policy, ask the person to give you contact details of at least two clients of his. Talk to those customers and ask them about the kind of experience they had; ask them, if they found him to be knowledgeable, accessible and efficient in taking care of the renewals and policies. If they have had a claim, ask them if the agent/broker was helpful and co-operative during the process. Once you are satisfied with their response, you may choose the person as your health insurance Agent/Broker.

To read more see Change Broker/Agent

Following are the time when you know that you have to change your Broker:

• No accessibility: When you never seem to get access to your agent or your Broker. His contact numbers are non functional or he is not entertaining your calls.
• No health insurance knowledge: When you ask him simple questions regarding the policy, the broker/ agent is unable to give you adequate information.
• No maintenance of records: When you find that your broker has no computer records of your transactions and renewals or if he does not remind you of your renewals.
• Ineffective: When your Broker is unable to help you at the time when you need him most like when Suresh needed him most. There will be some who do not have those skills that are required to provide the service that customers need.

To read more see Change Broker/Agent

Children who have insurance have a better chance of being healthy. Having health insurance will allow your kids to get the medical and dental care, without having to worry about how you are going to pay for it. Here are some ways to cover your kids:

If you are covered in a Group Insurance Policy: If your company has covered you in the health insurance policy, then contact your human resource department to know whether they provide coverage to children under maternity benefit. If they do, you should check whether the child is covered from day one or after 90 days.

• For day one coverage: Notify the insurance company within 7 days of the birth to get coverage from day one of his birth. After 7 days, the child will get coverage from the day of the notification.
• For 90 day coverage: You will have to contact them within 7 days of completion of the 90 days of birth, otherwise you will be covered from the day notified.

If you have a Floater Policy: You can add the name of your child as a dependent in the floater policy you already have, in some companies children of more than 3 months can be added and others have a minimum entry age as 5 years. You have to add their name at the time of the renewal i.e. the day you renew your policy by notifying the company.

To buy an Individual Policy: You can buy an individual policy for your kid after he turns five. Here is alone gets a sum assured to himself.

To know more see Don’t forget to cover your Kids!

No matter how we try, we can’t always be there to protect and shield our children. There are times when they will get hurt or when they will be unwell. But there is one thing that we can be sure of, that is, providing our children quality health care when they need it. So here are some reasons to buy health insurance for kids:

• In the time of emergency you will not have to think of how you can afford the care your child needs as it most likely covered. Also in case of emergencies when arranging finance at admission is an issue, you can directly be admitted in a network hospital by showing the health insurance card.
• When your child is covered at the younger age, there are almost no restrictions, generally he will not have pre-existing diseases hence he will get full coverage from the start.
• When there is no claim from policyholders for a year, may insurance policies award them with discounts and bonuses, which means reduction in the premium or more cover.

To know more see Don’t forget to cover your Kids!

Yes. Section 80D of the income tax act 1961, ensures that there is a tax benefit available to everyone who has bought a health insurance policy. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment towards premium of his/her health insurance policy for self and dependants. For senior citizens, this deduction is Rs. 20,000.

To read more see Health Insurance made Simple