Simplest Guide for Health Insurance in India

Dear friends, never take a policy from star health. That is my experience. I have submitted claim No: 7320
in May 19,2010 and when ever i inquire about the status, they will say, we will call back and after that no response. I called them around 10 times and never got a response from them. Now i really got desperate and i feel that i will never get a refund from them. So i am planning to give a complaint against star health , trivandum, plammoodu office in consumer court. so never get in trap with star insurance hearing the sweet words of agents. a very very bad company.

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!

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!

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!

In Cashless Service, when you get hospitalized with a network hospital, you do not have to settle the bill with the hospital. The Insurance Company represented by the TPA, co-ordinates with the hospital and settles the bill.

Some pointers about the Service

• Cashless service is only available in network hospitals.
• All the medical documents including the lab reports, claim forms, discharge summary and final bill has to be submitted to the hospital before being discharged.
• To ensure that your request is not rejected, send a completely filled pre-authorization form and send it within the required time frame.
• Cashless facility is subject to the conditions and terms in the policy.

To know more see Cashless Hospitalization

Do you think that being in late teens and early twenties is a very early age to think about health insurance? Then answer this- When you can vote, race your bike or car, break rules, stay out late and finally decide what to do with your life, then having Mediclaim at a young age becomes a need too. Here is why you should buy Health insurance:

1.       Use the advantage!

When you want to buy a health insurance policy later in life you find numerous limitations and conditions to face! You will have to undergo a waiting period for pre-existing diseases and the premium will be high. On the other hand, when you buy a policy now, you will have no pre-existing disease, hence mostly all the diseases will be covered.

2.       Your Investment for the future

You may feel that buying the policy at this age will only mean losing that premium money, but actually the cost of the premium is negligible compared to amount that you may have to pay in terms of a hospital bill. Even if you don’t claim for a period of ten years, your investment in health insurance will be a profitable one. Imagine paying Rs. 1200 for 10 years which means Rs. 12000 at the end of the 10 years. On the other hand even a simple hospitalization will come to Rs. 20,000. So in all ways, you will profit.

To know more see Eligible to Vote? Time to Buy Health insurance!

A pre-existing disease refers to any illness, injury, or medical condition that existed prior to the date of the commencement of the policy. This can include Diabetes, Hypertension or even Cancer.

Treatments for pre-existing diseases are covered and are payable by the insurance company, but only after the policy has been effective for a certain amount of time. Waiting periods for pre existing diseases typically range from two to four years, depending upon the insurance company and the type of pre-existing disease.

For senior citizens though, there are plans that cover pre existing conditions after a waiting period between one to two years as well.

To know more see Waiting period in a Health Insurance Policy

 “Waiting period” is a part of your policy and determines from when you benefit from the policy, so it is pertinent that you have a complete understanding of the waiting periods in the health insurance policy you buy….

The initial waiting period

This refers to the 30 day waiting period – from the date of the commencement of the policy until the first 30 days – within which you will not be covered for treatment of any disease or ailment, except treatment for accidental external injuries that require 24 hours hospitalization.

To know more see Waiting period in a Health Insurance Policy

Firstly, there is a two-to-four year waiting period before which for pre existing diseases can be covered under the health insurance policy. Secondly there is a 30 day waiting period from the date of issue of the policy, within which you will not be reimbursed the hospitalization expenses, unless, the treatment refers to accidental injuries. Thirdly, certain specific diseases are not covered for certain periods of time, varying from policy to policy, for instance, hypertension may not be covered for two years from the date of policy, while joint replacement may not be covered before four years from the date of issue of the policy.

To know more see Basics of a Health Insurance Policy

Policy holders have to be aware of their rights and be proactive in their measures if they want to benefit from the Institute of Ombudsman which is created especially for their grievance.

Here are the things that you as a consumer should do,

1. Read the Policy wordings, Conditions

The golden rule in insurance is to know what exactly you are getting. So read the policy wordings carefully and ask an insurance agent or a broker to explain it to you before you buy the policy. Even as you attempt to contest your claim, have a thorough understanding of the policy wordings before you approach the Ombudsman.

2. Communicate with the Insurance Company for any grievance before approaching the Ombudsman

You may never need to approach the Ombudsman if you have an effective communication of your grievance with the Insurance Company. So write a detailed letter attaching the proper documents to the Insurance company, the company will be likely to settle the claim if it a valid one. Only if the Insurance Company fails to reply to your complaint or rejects it without satisfactory reasons must you approach the ombudsman.

3. Understand when to approach the Ombudsman

You cannot approach the ombudsman without first communicating with the Insurance Company. You need to read the policy wordings and understand when you can approach the ombudsman. When you follow the proper procedure you have better chances of getting a satisfactory response from both the company as well as the ombudsman.

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