Arun was a young and passionate 27-year-old IT professional who was basking in the glory of his new job. His world came crashing down when his father suffered a heart attack and he was left hunting for cash to pay the huge hospital bills. He lost a good fortune of his savings since he was not covered by any health policy. Many individuals, like Arun, do not get insured under a good health insurance policy on time and later regret it all their lives.
Most people refrain from buying a policy as they do not feel confident to read between the lines and understand the terms and conditions of different policies. Unfortunately, this is a common story with majority of working professionals in India and around the world. This article discusses some practical tips to help you decide which health insurance policy is most affordable as per your needs.
1. Selecting an insurance company astutely:
In general, you can get health insurance from both general insurance and life insurance companies. But, financial experts suggest that it is wise to select a general insurance company as they would be more focused on health insurance. Also, it has been seen that when you buy health insurance policy from a life insurance company it costs more. So, pick a phone and speak to some licensed insurance agents and then choose your insurance company wisely.
2. Plan in advance for your needs:
You need to think ahead of the time if your family comprises of elderly people or are planning to start a family soon. Once you are sure of your insurance needs, you can think of policies that are specifically meant for parents or cover maternity overheads.
3. Ask questions about different types of health insurance:
There is a myriad variety of health insurance policies available, and thus you need to go through all the options and filter the one that does not meet your needs. If still you feel confused then do not hesitate in asking questions. For instance, some people may get benefitted from cashless policy while some may find a family floater plan more useful. Thus, try to understand each and every policy carefully.
4. Give priority to ‘sum assured’:
‘Sum assured’ in layman’s language means the maximum amount of money that can be reimbursed to the insured person in one policy year. Keeping in mind the escalating medical costs, choose the sum assured vigilantly. Furthermore, do not choose the sum assured so high that it becomes almost impossible to pay the premium for you.
5. Keep a track of the enrolled hospitals:
Every insurance company tie up with some hospitals that are instructed on ways to handle the claims of a patient who is insured. Before selecting a particular health policy, always check the enrolled hospitals under the insurance company as you can have your favoured clinic or doctor. Also, look for the specialty, prominence and distance of the hospital from your home. In case of an emergency, you would obviously visit a hospital that is near to your home.
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As healthcare costs are soaring high these days a rejection of your claim means the entire purpose of buying a medical insurance is defeated. Besides, it could also give you a sense of being cheated. While insurance companies have proper guidelines to accept or reject a claim in most cases of rejection it is found that the insured is not fully aware about the policy terms.
To make sure that you do not have to pass through this pain of rejection, there are a few important things that you need to take care of.
1) Do not hurry into buying a health insurance policy
An insurance agent has all the reasons to hurry you into buying a medical insurance from him. However, you have to ensure that you are not carried away. Before buying a policy, you should enquire from the agent about both the benefits that are available under the policy and also those benefits which are not available (commonly referred as exclusions). It is quite common to see agents opting for a selective disclosure while they explain the policy terms.
2) Be aware about the Exclusions and Pre Existing disease clause
A host of diseases are excluded and not covered under the medical insurance policy. If you are not aware of these and file a claim for hospitalization expenses owing to any of these diseases, your claim stands to be rejected outright.
The other important reason for a claim to be rejected is, filing a claim for hospitalization due to a pre-existing disease. Most health insurance policies have a waiting period of 3-4 years before they would allow reimbursement of healthcare costs related to these diseases
Besides pre-existing disease, a certain types of disease like (fistula, piles, cataract etc) are not covered in the first year after the purchase of a policy.
3) False representation of personal / family information in the Proposal Form
While buying a mediclaim, be sure that all details submitted in the proposal form are not only accurate but also factually correct. The proposal form would ask you several details on your habits and existing health conditions and if these are found to be incorrect at any point in the future, you run the risk of claim rejection. If you are a regular smoker, it is wise to disclose it upfront. Remember there are scientific ways to determine whether you were a regular smoker in the past or not.
4) Suspected malafide intention
A few people attempt to make money by submitting incorrect claims, which are either highly inflated or completely fake. With so many private hospitals on the market, it has been found some insurers collaborate with these private hospitals for making money from insurance claims. If the insurance company suspects such a malafide intention, it has the right to reject a claim.
A smarter way to buy a health insurance policy is through an online portal, which will help you get a more thorough understanding on the important features in a policy.
In a few cases, a health insurance claim may also be wrongfully rejected and people have a right to appeal the rejection.
Medicare health insurance coverage can seem like a maze with no way out. All the ins and outs of deductibles, what is covered and what is not, and all the different parts and descriptions. When picking a healthcare plan, you need to know all your choices and what each one entails before making any final decisions. Medicare Part A is a great plan, especially for those who do not have money to pay into an insurance plan. For most people, this plan is free. Here is some quick information for Medicare Part A.
What Does Medicare Part A Cover?
The biggest concern for anyone thinking of enrolling in this program is the amount of coverage and what kind of services can be obtained. A great way to find out what services specifically you will be eligible for is to talk to your doctor or provider such as myself about your needs and whether or not you would qualify for certain supplies, tests, and visits under Medicare Part A. Often times, doctors will provide detailed letters for Medicare, stating why a service is essential to a patient’s care, which can ensure that your new insurance will cover that service.
Part A covers hospital care, but not necessarily all doctor visits. If your doctor is not on the hospital list, visits to his or her office may not be covered. It does cover acute hospital care, emergency room or urgent care visits, rehabilitation clinics, long-term hospital stays, mental health facilities, and inpatient admission for a clinical study.
Nursing homes are also covered, including meals, medications, medical supplies, and the care of a nurse. In order to fully qualify for nursing home coverage, however, a doctor must examine and advise the nursing home stay, and there must be a significant medical reason for the stay. Once this is determined, Medicare will cover almost all costs of the nursing home.
Hospice and home health care are also covered by Part A. Your doctor will determine if hospice is the right choice for you and your family. When he does, he will help you set up a hospice plan and management team that will ensure all your needs are met.
What Does Medicare Part A Not Cover?
As far as hospital visits go, private rooms, televisions, phones, and personal hygiene items are not covered. Part A will also not cover nursing home stays where only custodial services are required. These facilities are more commonly called “retirement homes,” and because they are not a medical necessity, Medicare will not cover them. Patients must need daily attention by a skilled medical professional in order to qualify for nursing home coverage.
How is Coverage Determined?
Coverage is determined expressly by your doctor and by the insurance provider. The insurance provider uses the recommendations of your doctor in order to determine if you qualify for any service or visit. What is covered may also be restricted based on state laws and by the insurance company that services your Medicare program.
Though local companies rarely go against Medicare’s own guidelines, on occasion, a company will determine that something Medicare normally covers is not a medical necessity and will not be covered.