Simplest Guide for Health Insurance in India

Ombudsman is generally appointed by the organization to act as an impartial judge who listens to both the sides and gives recommendations to settle the dispute. After listening to both the sides, if the matter is settled, Ombudsman makes recommendations that are fair to the case. He has to make those recommendations within one month and send the copies to the person who lodged the complaint and to the insurance company.

• If the complainant agrees,

The person who had complained has to send his reply saying whether or not he has accepted the settlement within 15 days of the recommendations. If the Ombudsman has recommended that the person complaining gets an award then the insurance company is binded to pay it. The payment has to be made within 3 months of the receipt of the recommendation.

• If the complainant disagrees,

If the recommendations of ombudsman do not satisfy the complainant, then he can send a reply rejecting the recommendation to both the ombudsman and the insurance company. He can then approach other forums like consumer forum or courts of law.

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

a) Ambulance charges: Ambulance charges will be paid in case the person has to be shifted from residence to hospital in Emergency/ ICU or from one hospital/Nursing Home to another Hospital/ Nursing Home by registered ambulance only for better facilities.

It means that Ambulance charges will only be paid in case of emergency or when patient is shifted to other hospitals for better facilities.

b) Domiciliary treatment: Medical treatment exceeding three days for such illness/disease/injury which in the normal course would require care and treatment at hospital/nursing as in- patient home but actually taken whilst confined at home in India under any of the following circumstances namely:

i)  The patient is in such a condition that he/she cannot be removed to the hospital / Nursing Home.

ii)  The patient cannot be removed to Hospital/ Nursing home due to lack of accommodation in any Hospital in that city/ town/village.

It means that when the patient is not in a condition to be moved or when there is no availability of  beds  in hospitals, the medical care taken at home is payable.

But you will not be paid for Pre and Post hospital Treatment and if you need treatment for diseases like Asthma, Bronchitis, Diabetes Mellitus, Cough, Colds, Arthritis, Gout, Rheumatism. Etc.

c) Diagnostic Tests: Generally Insurance Companies only pay for Diagnostic tests if the individual is found to be positive with disease specified and if the disease is covered in the policy. This expense is taken under the pre- hospitalization expenses.

All diagnostic tests done during valid hospitalizations are covered in the policy

Most policies however pay for such tests upto a percentage of Sum Insured after a given number of claim-free years of cover.

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

In India, renewing one’s health insurance policy on time is as important as paying the premiums, filling up the claim forms and all the other details required to keep the health insurance policy going. To make sure you don’t suffer, here are a few things you will need to know before the renewal of your policy.

• If you want to change your agent / broker etc
• If you want to change your company
• Add or subtract a family member
• If you want top up plans and benefits

To read them all see Things to know before Renewal of policy

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. Professional acting studios in los angeles California.

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

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!

To cancel the policy is your decision, and you may do so at any time after buying the policy. However, when you decide to cancel your health insurance policy, the company may incur cancellation charges – which differ from company to company. For instance, if you cancel the policy within 3 months of buying it, the company may deduct 25% of your premium amount and pay you the remaining 75%. If you cancel the policy within 6 months, the company may deduct 50% of the premium amount and pay you the remaining 50% and so on. You will find these in the policy terms and conditions in the policy document of the various health insurance companies.

To read more see Health Insurance made Simple

The ICICI Lombard Health Advantage Plan- the fixed premium of Rs. 15,000 and Rs. 20,000 looks at covering your entire tax exemption limit. This point makes it the selling point but comparing the price of other policies within the same age group shows that even with Outpatient benefit, you are not getting your money’s worth.

For example Premium for an individual policy for a 45 year old in Apollo DKV’s Easy health for Rs. 2 lakh cover is Rs. 6000; compare that to the 15,000 premium you pay for Health Advantage plan. Even taking the Outpatient expenditure i.e. Rs. 6000 for a 45 year old, you pay Rs. 3000 extra to the insurance company!

ICICI’s Health Advantage is a good investment for someone who wants to invest in health insurance mainly for tax benefit purpose. It isn’t such a good option for a buyer who really wants it mainly for health insurance.

To read more details about this policy see Health Advantage- Consider it for Tax Benefits

Shopping for affordable health insurance can be a daunting task. Some companies and agents take advantage of the general lack of knowledge most people have regarding health insurance. This answer will explain how you should properly shop for health insurance. A lot of consumers don’t realize it, but health insurance exists to protect you financially in case of a major event.

Some of the things you should know are Pre- existing Diseases, Exclusions, Hospitalization, Waiting Period, Pre and Post hospitalization Expenses, Day Care Treatment, Cashless Service. To read in detail see Must Knows about Health Insurance

No, all the health insurance companies do not have standard definition for pre-existing diseases. Different health insurance policies have different definitions for pre-existing diseases. According to some policies, a pre-existing disease is that which shows in a person’s past medical history. While other policies have a narrower definition that includes those diseases as pre-existing for which the insured person had sought consultation or was treated or was aware of the ailment during the last 4 years from the time he signs the proposal form.

To read more such myths read the article Myths around Pre-existing Illness

It’s just a myth as pre-existing diseases are paid, but after a period of maximum four years of buying the health insurance policy, even if a person is undergoing active treatment for such a disease. And even this is possible only if one continues with the health insurance policy with the same company for that period. Again, this differs from company to company and policy to policy, as, in some health policies pre-existing diseases are covered after a waiting period of two years (a senior citizen policy for those above the age of 45). Generally, pre-existing diseases are covered after a waiting period of two to four years. To read more such myths check Myths around Pre-existing Illness