With rising costs of quality medical care in India, having a health insurance policy to deal with healthcare expenses has become necessary. Hospitalization or other medical expenses can damage and derail your financial plans and burn a hole in your pocket. It becomes even more difficult when the sole breadwinner of a family is hospitalized or when sudden medical emergencies like COVID-19 strike. However, all of this can be avoided by just opting for the right health insurance policy that covers medical tests costs, hospitalization expenses, and even doctors’ consultation fees.
Yet, there is one important point to keep in mind before buying a health insurance policy which is Health Insurance Claim Rejections.
Yes! Many people buy health insurance policies without even knowing about the exclusions and later suffer when a claim is rejected. As per recent data by the General Insurance Council (GIC), of the total 7,76,809 claims reported in the third quarter of FY21, around 6,55,739 claims were paid while others were rejected or remained pending. According to the data, exclusions are one of the main reasons for claim rejections, apart from a lack of proper documentation.
Exclusions can give you a bad experience if you don’t know about them beforehand. These can be specific expenses or medical conditions that are not covered under your health insurance plan. Hence, it becomes imperative to know about the exclusions of a health policy before buying it.
7 Things To Look Out In A Health Insurance Policy
Let’s look at some of the most common exclusions in health insurance policies.
1. Pre-existing illnesses
If you are suffering from any disease like kidney stones, cataracts, arthritis, etc, then these are classified as pre-existing diseases when you buy a health insurance policy. This means that these pre-existing health conditions are not covered in your healthcare policy for a certain period, which is known as the waiting period. There is usually a waiting period of two to four years, depending on the insurer or the type of disease.
You can always choose an insurer with a shorter waiting period to get coverage against pre-existing illnesses at the earliest.
2. Standard waiting period
Except for accidents and pre-existing illnesses, there is a general waiting period during which specified coverage is unavailable. For example, there will be a waiting period of 1-2 months after you buy a policy, and only after that, you will be able to file a claim against the insurance policy. An initial waiting period is also called a cooling-off period. Treatment for diseases or illnesses occurring during this period is not covered. However, medical care required in case of an accident gets covered in this period, without any conditions.
3. Maternity and related expenses
Expenses related to pregnancy, childbirth, child vaccinations, and other related conditions are typically not covered under a health insurance policy unless categorically specified. Moreover, if the health plan of your choice allows maternity coverage, it could still have a waiting period ranging from 9 months to 48 months.
4. Cosmetic treatments
Cosmetic surgeries or treatments that are not medically necessary are usually excluded from being covered in a health insurance policy, except in circumstances where they become important for treating an accidental injury. Apart from that, dental treatments are also excluded from health insurance plan coverage, although some plans cover dental treatments up to a certain limit. Similarly, circumcision and gender-change treatments are also excluded from coverage.
5. Specific exclusions
Certain hospital costs like room rent, ambulance costs, doctor fees, etc., can be excluded from your healthcare policy unless specified. Expenses of consumables like cotton, bandages, syringes, face masks, PPE kits, etc. are also usually not covered. Some policies do not have limits on room rent, and some also cover ambulance expenses. At the same time, it is also possible that some of these expenses are partially covered by the insurance company, depending upon your policy.
6. Cases of self-harm
Injuries or illnesses suffered due to self-harm or attempted suicide is not covered under health insurance policies. Injuries arising out of participation in hazardous activities, adventure sports, criminal acts, or injuries suffered due to alcohol or drug abuse are also excluded from coverage.
7. Getting the right health insurance
While you must take note of the above-mentioned common exclusions, do remember that these exclusions are not standard in all policies. You should review and compare different policies to ensure that your specific risk factors are not excluded from the policy you choose if that is possible. Moreover, regardless of these exclusions, it is vital to have health insurance.
If you are confused about choosing the right health insurance policy, you can explore Finserv MARKETS, an online marketplace that offers insurance plans from some of the best insurers in the country. You can compare plans from different insurers and choose what best suits your needs. Some of the plans available at Finserv MARKETS also cover emergency ambulance charges and room charges without any limit. To cover for consumables, these plans also offer daily hospital cash, which can be utilized to pay for such expenses. The Bajaj Allianz Health Guard Plan, available on Finserv MARKETS also provides coverage related to maternity, subject to certain conditions.
The first step in securing your healthcare needs is identifying the right health insurance policy. If you are looking for one, you can start the process right away from Finserv MARKETS.
Disclaimer: This is a sponsored article powered by Finserv MARKETS. The information provided in this article in the form of text, tips, suggestions, and products, which comprises general advice for consumers. 1mg does not endorse any brands and is not responsible for their efficacy.
General Insurance Council Dashboard. https://onlinemis.gicouncil.in/dashboard