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
