Purchasing
health insurance is a huge financial decision. It is, therefore, important to
understand the fine print of the document before signing on the dotted line.
Read the terms and conditions carefully as it has a lot to say with respect to
the benefits and coverage you are eligible to receive.
Following
is a guide explaining nine common terms associated with health insurance
policy.
1.
Room rent
This refers to how much money the insurer will approve for occupancy of
the hospital room. This cost is included in ‘reasonable charges’. It means that
if any overhead is exorbitantly charged, the insurer does not pay for it. For
this reason, insurers do not cover the entire amount for hospital room charges.
Generally, 1-2% of the sum assured is paid towards room rent. If the actual
room charges exceed this amount, the policyholder will have to shell out the
excess amount.
2.
Copay
Insured individuals sometimes opt for a plan wherein they have to make a
certain payment each time they access a medical service. Copayment, also known
as copay, is a fixed percentile of the
total cost, which the policyholder has to pay. For example, if your plan has a copay of 20%, you will have to shell out 20%
with every claim you make. Generally, copayment rates are higher for senior
citizens and those suffering from pre-existing diseases.
3.
Pre-existing diseases
Pre-existing diseases are those diseases which the policyholder is being
treated for prior to the enrollment of the healthcare plan. Many insurance
companies reject claims with respect to pre-existing diseases. This is because;
such individuals are more likely to undergo treatments for the same, thereby
increasing the insurer’s liability to pay the hospital bills.
4.
AYUSH
AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy. Many individuals these
days are opting for such alternative treatment options. It is believed that
these non-medical treatments are highly effective and powerful. The Government
of India has exclusively set up the Department of AYUSH to ensure development
and propagation of AYUSH systems in India.
5.
Day care treatments
Expenses are generally reimbursed when the insured is hospitalized for a
period greater than 24 hours. However, due to advancement in technology, some
procedures may merely take a few hours, which would otherwise have required
hospitalization of 24 hours or more. These treatments are known as day care
treatments. The scope of day care treatments varies
from insurer to insurer. Generally, day care treatments include cataract
operation, chemotherapy, dialysis, radiation, besides others.
6.
No Claim Bonus
Those individuals who do not make any claims during the entire policy
term are awarded a certain discount on premium by the insurance company. This
discount is known as No Claim Bonus (NCB). Plan holders may avail of NCB on the
next renewal of their policy.
7.
Restore and recharge
Health insurance plans these days come in many variants and numerous
benefits. Insurance companies are now offering the benefit of restore and
recharge to their customers. Under the restore
benefit, if the sum assured gets depleted towards the treatment of a particular
illness, insurers restore the sum insured. It is important to note that this
benefit is applicable only for future claims made towards an unrelated illness.
The recharge benefit is similar to that of restore benefit but with
different conditions. According to the recharge/refill condition, the insurer
reinstates the sum insured for the year once the NCB and the sum assured are
exhausted by the policyholder for that particular year.
8.
Top-up and super top-up
Top-up healthcare plans offer an additional coverage over the existing
threshold limit or maximum limit known as a top
up. Such plans are highly beneficial when the threshold of the existing plan is
used up and there is an additional
medical cost to deal with. It is important to note that top up benefit may be
used if the claim amount is above the threshold for a single hospitalization.
There may be times when the threshold limit gets exhausted during
multiple instances of hospitalization. During such times, a super top-up
benefit comes to the rescue. Such a benefit takes into consideration the total bills and not just a single instance.
9.
Critical illness benefit
Those suffering from life-threatening conditions may avail of critical
illness insurance, also known as dread disease policy. Holders of this policy
are eligible to receive a lump sum amount from the insurance provider. This
benefit, known as critical illness benefit, is provided only if the insured is
diagnosed with an illness mentioned in the predetermined list of the policy
document.
It
is imperative to have adequate knowledge about healthcare plans before
purchasing one. Read through the policy-related jargons thoroughly and avail of
a plan that offers the best benefits based on your health requirements. Compare
lenders in the market and opt for the best health
insurance that is
cost-effective and highly beneficial at the same time.
No comments:
Post a Comment