It's not final edited because on laptop u can only see things in dark.
Will edit tomorrow asthetic
Will be making thread on most common reason for health insurance rejection/ partial rejection
Buying a health insurance has become a hectic task , because there is too many sub clause and sub limits added and as much as we are vulnerable while availing the health emergency , these company leach on those moments and save their money .
so before buying health insurance like any other thing you buy ,
make a list what do you need in your health insurance
questions like
is 5 lakh cover sufficient ?
do you think hospital you would admit having 5-6k per day budget good ?
are you ok with double wing sharing ? or you need single private room ?
but bigger question is we will buy policy based on features but there is always some conditions hidden .
now question is who need health insurance ? anyone who doesnt have corpus in multiple crores should take health insurance
there are two types of health insurance
1 individual
2 family\flotter - cheaper but let say u take 10 lakh insurance for 5 member but if one uses 8 lakh then 4 can only use remaining 2 lakhs
take individual plan for person with more risk ( like elders like one with alcohol or smoking ) as adding them in flooter would increase premium for everyone , flotter for childrens and less risk individual
now lets talk about devil in the show
1 room rent fasade - lets say you took 5 lakh policy , it has 1% policy for room rent cap so 5000 and you took 10k room and thinking u only have to pay 5k extra of room but in some policy company would only give 50% of the surgery amount too as room rent was also 50 % reimbursed
even for other post surgery expenses
so ideally take higher value policy or dont take policy with such clause
2 CO PAY - avoid this at all cost
3 sub limit - some insurance have sub limit on type of surgery like heart attack etc has 2 lakh sub limit , avoid these policy too
4 zonal vs pan india policy - sometimes policy premium depends on area , ideally take insurance on pincode you live dont take at rular address to save money . sometimes due to this you might have to do 20 % co pay .
not a deal breaker but ask your policy agent .
5 top up and super top up - these are stand alone policy you can take from same company or other . take same company for cashless experience
top up --- say u have 5 lakh insurance and 5 lakh top up
surgey 8 lakh so 5 lakh from base 3 from top up
but same year u got another 2 lakh bill u can't claim from top up as top up only will activate after 5 lakh base in same year
but in super top up - u can claim that 2 lakh standalone in next surgey same year
take super top up
6 pre and post hospitalization - ideally every company is providing this 60 day pre op and 180 day post op . some have 30 and 60 respectively so check according to your need . more for old people , less for young guns
7 day care coverage - some surgey dont need 24 hour admit , and to claim any health claim u have to be admitted 24 hour minimum so take day care coverage if you live in city as medicine is getting smarter
8 extended coverage - ayush treatment should be there , if you want to go that way , cosmetic is very much optionallllll
9 - waiting period - 30 day is minimum waiting period for any claim this is standard waiting
critical illness - has 90 day waiting period
maternity claims - 9 to 36 months (depends on policy )
10 pre existing disease -3 or 4 year depending on company but there are few diseases which would be there in policy paper has 2-3 year waiting period even though u dont have that disease
11 no claim bonus - ideally they increase the base cover in next 3-4 year for no claim bonus . say 5 lakh insurnce can go upto 7.5 with 3 year no claim bonus ( must have )
12 ambulance charges - check if this is covered or not
13 cashless hospital - check for hospital link up for cashless in city its not a prob , for tier 3 town etc you must know your hospital
14 free health checkup - a big stress reliever as having free check up from company linked checkup would be , your health condition would be updated yerly so no chance of denial for pre existing diseases
15 restoration of sum assured - lets say u took 5 lakh policy but it has restoration benifit once a year , then u can claim 10 lakh in total . but there can be clause u cant use restoration for same disease etc
16 - exclusions --- there is list of exclusion like reg fees ,some diseases which will never be covered no matter what etc so keep eye on it
17 - you should anyday choose cashless +reimbursement policy as in case of accident , no one will care for your only cashless network hospital , reimbursement is best for any planned surgery as cashless claims are being used as scam to loot money from insurance from hospital . i know many clinic doing this fake admit and earns 10k daily being fake admit patient
most important thing dont lie about your health problem like drinking & smoking
these were some of the question you should check . ideally if you would choose all you might not get any policy ticking all boxes so you have to prioritise which one most important to you
Will edit tomorrow asthetic
Will be making thread on most common reason for health insurance rejection/ partial rejection
Buying a health insurance has become a hectic task , because there is too many sub clause and sub limits added and as much as we are vulnerable while availing the health emergency , these company leach on those moments and save their money .
so before buying health insurance like any other thing you buy ,
make a list what do you need in your health insurance
questions like
is 5 lakh cover sufficient ?
do you think hospital you would admit having 5-6k per day budget good ?
are you ok with double wing sharing ? or you need single private room ?
but bigger question is we will buy policy based on features but there is always some conditions hidden .
now question is who need health insurance ? anyone who doesnt have corpus in multiple crores should take health insurance
there are two types of health insurance
1 individual
2 family\flotter - cheaper but let say u take 10 lakh insurance for 5 member but if one uses 8 lakh then 4 can only use remaining 2 lakhs
take individual plan for person with more risk ( like elders like one with alcohol or smoking ) as adding them in flooter would increase premium for everyone , flotter for childrens and less risk individual
now lets talk about devil in the show
1 room rent fasade - lets say you took 5 lakh policy , it has 1% policy for room rent cap so 5000 and you took 10k room and thinking u only have to pay 5k extra of room but in some policy company would only give 50% of the surgery amount too as room rent was also 50 % reimbursed
even for other post surgery expenses
so ideally take higher value policy or dont take policy with such clause
2 CO PAY - avoid this at all cost
3 sub limit - some insurance have sub limit on type of surgery like heart attack etc has 2 lakh sub limit , avoid these policy too
4 zonal vs pan india policy - sometimes policy premium depends on area , ideally take insurance on pincode you live dont take at rular address to save money . sometimes due to this you might have to do 20 % co pay .
not a deal breaker but ask your policy agent .
5 top up and super top up - these are stand alone policy you can take from same company or other . take same company for cashless experience
top up --- say u have 5 lakh insurance and 5 lakh top up
surgey 8 lakh so 5 lakh from base 3 from top up
but same year u got another 2 lakh bill u can't claim from top up as top up only will activate after 5 lakh base in same year
but in super top up - u can claim that 2 lakh standalone in next surgey same year
take super top up
6 pre and post hospitalization - ideally every company is providing this 60 day pre op and 180 day post op . some have 30 and 60 respectively so check according to your need . more for old people , less for young guns
7 day care coverage - some surgey dont need 24 hour admit , and to claim any health claim u have to be admitted 24 hour minimum so take day care coverage if you live in city as medicine is getting smarter
8 extended coverage - ayush treatment should be there , if you want to go that way , cosmetic is very much optionallllll
9 - waiting period - 30 day is minimum waiting period for any claim this is standard waiting
critical illness - has 90 day waiting period
maternity claims - 9 to 36 months (depends on policy )
10 pre existing disease -3 or 4 year depending on company but there are few diseases which would be there in policy paper has 2-3 year waiting period even though u dont have that disease
11 no claim bonus - ideally they increase the base cover in next 3-4 year for no claim bonus . say 5 lakh insurnce can go upto 7.5 with 3 year no claim bonus ( must have )
12 ambulance charges - check if this is covered or not
13 cashless hospital - check for hospital link up for cashless in city its not a prob , for tier 3 town etc you must know your hospital
14 free health checkup - a big stress reliever as having free check up from company linked checkup would be , your health condition would be updated yerly so no chance of denial for pre existing diseases
15 restoration of sum assured - lets say u took 5 lakh policy but it has restoration benifit once a year , then u can claim 10 lakh in total . but there can be clause u cant use restoration for same disease etc
16 - exclusions --- there is list of exclusion like reg fees ,some diseases which will never be covered no matter what etc so keep eye on it
17 - you should anyday choose cashless +reimbursement policy as in case of accident , no one will care for your only cashless network hospital , reimbursement is best for any planned surgery as cashless claims are being used as scam to loot money from insurance from hospital . i know many clinic doing this fake admit and earns 10k daily being fake admit patient
most important thing dont lie about your health problem like drinking & smoking
these were some of the question you should check . ideally if you would choose all you might not get any policy ticking all boxes so you have to prioritise which one most important to you
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