#healthinsurance
My previous post on the importance of health insurance garnered a lot of responses and queries. It was the helicopter view. Now let's try to look at it from a fine lens.
🟣Purpose of health insurance?
To pay up for the unexpected large scale payments for advanced diseases which require HOSPITALIZATION - Kidney Issues, Cancer, Cardiovascular diseases, Chronic, Implants, Major Accidents, Neurosurgery etc.
Basically the treatment which will cost you more than ₹2L
It is not meant to pay for the day-to-day treatable diseases fever, cough, jaundice, stomachache etc.
⏳Waiting Period?
Health Insurance is a business and to be profitable:
a) certain diseases and planned surgeries(cataract, joint replacement, deliveries, prostate/ENT surgeries etc) have a blanket cool off period for 2 years.
The above ailments once diagnosed can be carried without any intervention for 2/3 years hence.
b) If you happen to have any disease prior to purchasing insurance then you have got to declare it's nature and severity. Now based on your submission , Insurance Co. can either
- Accept it with or without a specific waiting period ( Ex , Claims for Heart disease not covered for first 4 years)
- Accept it with loading i.e. increase your premium (High BMI, Overweight - From ₹22k to ₹30k)
- Accept but Permanently exclude THAT disease (no claims for Liver Cirrhosis diseases & its complications [chronic alcoholic who marked himself as non-alcoholic in proposal] )
- Reject the proposal ( eg. High order kidney disease)
🏥 Network Hospitals
A Hospital registered with an insurance company are called Network Hospital. They have a predefined discounted rate structure. (You'll pay more in direct cash for the same procedure)
Claim is settled in the form of :
i) Reimbursement - if treatment in a non-network hospital than you pay first and take claims based on your bills, usually a lengthy & cumbersome process.
Can be managed for claims upto ₹2-5L for which a person can bring forward money. Not for large amounts (Cancer treatment ₹20L) , or frequent hospital procedure (Kidney dialysis)
ii) Cashless Facility - at network Hospital, Require a Pre-Authorization from your insurance co.
Generally, Pre-Auth comes in for the amount of 50-75% of estimate amount.
The team that handles Pre-Auth has a TAT of 2-6 hrs to either accept, reject or raise a query. Chances of acceptance are high.
Cashless is a facility and not an obligation.
Recently a friend of mine posted how his nephew requires, ₹25L for Liver Transplant. Now if it's not cashless then you need to first pay off bills worth that amount, and then file a claim.
Most families won't be having that kind of liquidity handy and they'll drown in debt.
Or
Weekly chemo/radiotherapy costs ₹40-70K and for a salaried person it's near impossible to arrange
[ Side note - Think how useless stock dividend/bank interest as second source of income are. It's a minnow game ]
🩻💊Pre & Post Hospitalization Expenses
Generally its 30 days before hospitalization, and 60 days post Hospitalization Expenses.
For Gall Bladder Removal Surgery,
Pre expense would cover investigation (ultrasound, CT, Blood Work, Doctor visit, Medicine)
Post Hospitalization will cover medicine, follow-up treatment, physiotherapy, etc
Bottom Line -
a. No company is good or bad. Just depends on how good you are with paper work (an agent is very handy here)
b. Insurance is a convenience for your time at distress that too for a very nominal fee. Hence, it is important to play the game by "their rules".
c. Keep a large personal health cover. Don't fret over "wasted premiums". Think of it that insurance co. is praying to God on your behalf to keep up your good health 🙏
d. Keep an emergency credit card when things go bad you can access emergency cash flow on your own.