Health Insurance has become one
of the most important requirement in today’s time. It protects you from the
rising costs of medical treatments. Average cost of treatments like Cancer,
Heart Disease, Kidney Failure, Major organ transplants and other important
surgeries goes up anywhere from Rupees One Lakh to Rupees Twenty Lakhs. Additional
costs of pre hospitalization and post hospitalization expenses add more problems.
It is therefore most important to
get a health insurance policy for you and your family. As soon as one thinks of
buying a health insurance policy, the next question that comes to your mind is
how health insurance works. In this article, we will try to understand the
process of getting a health insurance policy for you and your family.
·
As soon as you decide to buy a health insurance
policy from a particular company depending on the insurance amount, the
exclusions, the premium amount, the claim settlement ratio and additional benefits
if any, you submit your proposal to the insurer.
·
The insurer then asses you and your family
members’ risk based on age, height, weight, profession and past medical history,
if any.
·
Depending upon all the factors the company may
ask for medical test for one or all of the family members. Upon assessing these
reports, the underwriting team takes the decision of policy issuance.
·
The insurer issues the policy directly if no
medical tests are required.
·
The initial waiting periods starts upon policy
issuance.
·
If any claim arises after the initial waiting
period of first 30 days, which is applicable to all new health insurance
policies, the company will process the same based on the terms and conditions
applied to the policy.
·
Note that, the maximum amount payable by an
insurance company for any policy is only up to the limit of Sum Assured of that
particular policy.
·
There should be at least 24 hours
hospitalization for any claim to pass. However, this condition is not
applicable to day care procedures.
·
The insured person needs to inform the insurance
company in case of hospitalization and register the claim; such intimation
should be within Twenty-Four hours from the hospitalization.
·
If the insured person takes treatment at a
network hospital, the insurance company provides cashless settlement of the claim
that is the insured person is not required to pay the hospital bills for all
the approved bills; however, the insured person needs to pay all the non-approved
expenses to the hospital.
·
The insured person, if hospitalized in a hospital
other than network hospital then all the bills have to be paid by the insured
person and later submit for reimbursement of the same.
·
The insured person requires submitting all the
documents in original for claim settlement such as Hospital Main Bill with
breakup of all the items, all the Pathology and Radiology reports, all bills of
reports, all the payment receipts, etc.
·
The insurance company settles the claim as per
the terms and conditions of the policy in a hassle free manner.
·
The insurance company gives a “No Claim Bonus”
benefit by adding a particular percentage of amount of Sum Assured to the
policy if there is no claim in a previous policy year.
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