The relevance of fine prints in Determining your health insurance cover
Medical treatment is beyond the reach of common man today with costs escalating every now and then.Cost of hospital room rent,doctor's fees,medicines and related health services can work out to be a huge sum in an emergency.A much needed financial relief in the form of health insurance is of utmost importance at such times.
In view of the above the fine prints in health insurance schemes are of immense relevance in determining which one or which type, is to be opted for, based on your specific needs.
To begin with one has to reckon that health insurance cannot be availed by people aged below five and above seventy-five. Also we should not wait till we fall sick,it would be a judicious decision to make an investment in health insurance either in a personal scheme or a group scheme sponsored by your employer.
Another aspect of health insurance which needs to be borne in mind is that they do not cover certain ailments at all times and a few ailments are not covered in the first year of cover.
There are four major insurance companies in India,which are regulated by General Insurance Corporation and the schemes and covers are the same with the possible variation only in the quality of service.
Insurance company liability of all claims during the period of insurance shall not exceed the Sum Insured per person mentioned in the Schedule,hence one has to be sure that the Sum Insured is likely to be sufficient enough or at least close to his needs.
The definitions of "Hospital/Nursing Home" needs to be kept in mind,so that you do not run into any problem on this count,e.g.,whether they are registered? or whether they comply with the minimum criteria of at least 15(10 in class 'c' towns) in patient beds,fully equipped operation theatre, fully qualified nursing staff and doctors required for their class of city.
Based on your family history and your proneness to specific diseases you have to opt for policies which stipulate a minimum of 24 hours hospitalisation for expenses to be admissible with relaxation in case of Dialysis,Chemotherapy, Radiotherapy,Eye Surgery,Dental Surgery,Lithotripsy(kidney stone removal),Tonsillectomy.
To avail Domicilliary Hospital Benefit(DHB) you have to ensure that Medical treatment is for a period exceeding three days for such illness which normally would require Nursing Home/Hospitalisation but actually taken at home in the event of:-i)the patient's condition being such that he/ she cannot be removed or ii)the patient cannot be removed for lack of accomodation in Hospital/Nursing Home.
One has to keep in mind that DHB does not cover i) expenses for pre and post hospital treatment,ii)expenses incurred for Asthma,Bronchitis,Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all types of Dysentries incliding Gastrroenteritis,Diabetes,Mellitus and Insipidus,Epilepsy, Hypertension,Influenza,Cough and Cold,all Psychiatric or Psychosomatic disorders,Pyrexia of unknown origin for less than 10 days,Tonsillitis and Upper Respiratory Tract Infection Including Laryngitis and Pharingitis,Arthritis, Gout and Rheumatism.
The fine print in "Any one illness" is important.It says that occurance of the same illness after a lapse of 105 days will be considered as fresh illness.
In Pre Hospitalisation, expenses incurred up to 30 days prior to hospitalisation will be considered.
In Post Hospitalisation, expenses incurred upto 60 days prior to hospitalisation will be considered.
There are some exclusions which one should be wary of,like
1) All dieseases which are pre-existing.
2) Any disease contracted during the first 30 days from the commencement date.
3) Expenses on treatment of Cataract,Benign Prostatic Hypertrophy,Hysterrectomy for Menorrhea or Fibromyoma,Hernia, Hydrocele,Congenital Internal diseases,Fistula on anus,Piles, Sinustis. 4) Injury/Diesease caused by War/Invasion/Act of Foreign Enemy.
5) Circumcision unless necessary for treatment.
6) Cost of spectacles and contact lenses,hearing aids.
7) Convalescence,general debility,Rest cure,sterility,veneral diesease,intentional self-injury.
8) All expenses associated with Human T-Cell Lymphotropic Virus Type III (HTLB) or Lymphadenopathy Associated Virus(LAV) or AIDS
9) Dental treatment or surgery unless requiring hospitalisation.
10) Injury or diesease caused by nuclear weapons/materials.
In conclusion one should be certain to send notice for Claim within 7days from date of Death,Injury,Hospitalisation and also all supporting documents relating to the Claim must be filed within 30days from date of discharge from the Hospital.
by Rana Bhattacharya
