Friday, 5 August 2016

9 Secrets to Choose Right Mediclaim Policy

Health cost are galloping and Health Insurance, the supposed solution, is getting too costly and generally
unreliable. What you've got to do to safeguard yourself and your family? If you have to settle on from the maze of suitable health insurance choices, how does one approach toward it? Following are some basic things to keep in mind while buying health insurance.

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1-> Splitting up of your coverage

It is possible that you or another working member of the family gets insurance coverage as part of an employee insurance plan. However, the employer’s coverage is only as long as you work with them and the terms and amount of coverage may not be enough for your family. In such a situation it helps to choose an additional health insurance cover. Decide which members of your family need to be a part of the health insurance policy. 
You might find splitting of policies more beneficial. When buying for a family, check multiple options. Sometimes it’s beneficial, from a cost perspective, for the oldest member of the family to have a separate policy.

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2-> Act in Good Faith

A health insurance policy is a contract between you, the buyer, and the insurer, issued in good faith. If you fail to make any disclosures required by the insurer at the time of issuance of the policy, your claims could be rejected later. For example, many insurers ask you questions about your present health before issuing a policy. If you suffer from heart disease and do not disclose this to the insurer, your insurer will not cover any expenses you incur for treating your heart ailments later. It may even reject other claims.

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3-> Read Exclusions 

Read the list of exclusions of the health insurance policy - both permanent and those applicable in the initial years. Exclusions define the ailments and the conditions or which health insurance coverage will not be valid. Also, check all the details of the expenses that will be reimbursed,
e.g., diagnostic and medication costs might not be covered under all insurance policies. 

Exclusions also have a bearing upon how your ‘Preexisting Diseases’ are dealt with by the specific policy. Put together, a sound understanding of the list and conditions of exclusions give you a good sense of the suitability of the insurance product for you or your family

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4-> Check Hospital Network

Check how wide the network of hospitals the health insurance companies have managed to create. Ensure that the hospital near your residence, as well as the one where you seek regular or specialist treatment from, is a part of the hospital network. A wide hospital network is important when applying for cash-less hospitalization. 
More importantly, in case of emergencies or urgent visits to hospitals it is better to have a insurer that is supported by a wide network of hospitals instead of trying to find hospitals that accept your insurer, when emergencies strike.

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5-> Understand Cashless Facility 

Check whether the insurer facilitates cashless settlement of claims. You might have a preference for a specific doctor or hospital either because you may have sought treatment in the past or because you have greater trust. This doctor or hospital should ideally be a part of the insurer’s network of hospitals for cashless settlement of expenses. If not, you will have to make a choice between cashless and your preference for doctor or hospital. Some policies have a minimum time before hospitalization, by when the insurer has to be intimated of the admission. Once approved, the cashless hospitalization can go through smoothly

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6-> Know the Caps (Sub Limits)

Due to rising costs of healthcare, many insurers have quietly enforced sub-limits or caps for various kinds of expenses. Check whether there is a maximum amount each plan will pay for a specific expense and if there are any sub-limits on specific expenses. When such caps do exist, it makes
sense to consider buying either top-ups or super top-ups.

How do capping works 
Let us your sum insured in Rs 5 Lakhs then in a network hospital , room rent would not be more than 2% of Sum insured and it also differs in a non-network hospital. 
Do check such kind of Sub-limits before purchasing medical policy
There is also something called as Co-payment which means the fixed percentage of the total bill which you have to pay in case of a claim. This percentage is already defined in the policy document. The co-payment clause may be around 10% or 20% for such policies. For some policies, it can go as high as 40%. You will have to Identify those diseases that come under the co-payment clause before you opt for a health insurance policy

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7-> TPA vs In-House Processing

Most insurance companies employ what are called Third Party Administrators (TPAs) to process your claims while others handle in-house. There are pros and cons for both. There have been complaints about TPAs arbitrarily rejecting claims while health insurers that handle claims in-house may be expensive. 
Whether the insurer is using a TPA or not is not decisive factor but must be kept in mind. Make sure you know the critical conditions in either case, such as when to keep the company and the TPA informed about planned hospitalisation.

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8-> Keep Cash

Always keep some cash aside for medical emergencies as health insurance might not cover 100% of the costs. It may often happen that inspite of having sufficient insurance, you may have to avail of medical services at non-network hospitals or clinics, even when the hospital may be covered, the TPA may end up causing a delay in approval of the cashless admission. There is no other option than to have atleast a minimum amount of cash to take care of expenses which you may later claim from your insurer. 

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9-> Documentation

Ensure that all your medical records and supporting documents,including health insurance cards, are kept safely in an easily accessible place known to all your family members. After all, you or your family should not be running around to take care of paperwork when your immediate priority is to get medical care.
Use the above tips to ask further questions either to your agent or to the insurance company. Additionally, try to build a nest-egg through long-term investments in stocks and mutual funds. You mediclaim could turn out to be inadequate for many reasons. ‘Health is wealth’ and ‘Prevention isbetter than cure’. Now, it is the time to act.

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Disclaimer  :-

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