It is rightly said that necessity is the mother of invention. This also applies to health insurance. Deteriorating lifestyle patterns and rising health care costs in India have paved the way for health insurance. This need is compounded by the fact that, unlike in the West, social security systems in India do not exist. Governments have made every provision to collect taxes from citizens in every possible way, but when it comes to health care and social security, they have done nothing at all.
It is therefore the citizen’s responsibility to protect themselves. But it is not so easy to take out the right health insurance. There are more than two dozen general insurance companies offering different types of health insurance in India. Often people end up buying health insurance policies that are irrelevant to them and that don’t help them in times of need.
That’s why it’s critical that you understand the nuances of health insurance plans and only then make a decision. Here’s a quick list for you.
What do health insurance policies cover?
Health insurance is primarily designed to provide you with coverage against hospitalization and critical illness. Most plans cover this. But there are many plans that do not cover certain types of health problems. For example, you can find several mediclaim plans that do not cover blood pressure and diabetes-related issues.
The coverage ratio may also differ. For example, not every scheme covers the costs after hospitalization. In some cases, the coverage period can be up to 45 days and in some as little as a week.
It is your responsibility to check these matters. Trusting the insurance agent chasing you can cost you dearly later on. Agents are interested in making sales and commission. They may show concern and tend to offer you the best plans, but the reality may be very different. So just take care of these aspects.
The development of the health insurance industry in India has motivated insurance companies to introduce comprehensive plans. A wide range of riders is also at your disposal. So if you buy a standard policy, you can add riders who can cover you against many other risks such as permanent disability benefits, diabetes coverage, etc.
Do they cover pre-existing conditions?
Most mediclaim plans in India do not cover pre-existing conditions unless otherwise specified. Do not assume in this matter. If you are seeking coverage against a pre-existing medical condition, clarify this in the first instance. You can compare health insurance policies online and consult with customer service via the online chat option or by phone.
There are plans that cover pre-existing conditions under certain conditions. In general, there is a predetermined period of time during which pre-existing conditions are covered. The cost of such plans, of course, is higher than the standard.
Can several family members be covered under one insurance policy?
Yes, it is possible. You can easily opt for a family floater plan and have your family members covered under one plan. There are countless benefits of these plans. The premium is slightly higher, but a lot less if you choose different health insurance policies for different family members. The collective costs for different subscriptions are much higher.
Family floater plans, on the other hand, are cost-effective. The most frequently asked question about family plans is what happens if one member consumes the coverage limit and another member gets sick. There are solutions to these conditions.
You can top up the cover limit during the term of the insurance. Of course you have to pay some extra premium to get the extensive coverage.
Can you switch from one health insurance policy to another?
Portability is not just limited to the telecom sector. The Insurance Regulatory and Development Authority of India (IRDAI) has enabled portability in the health insurance industry.
If for any reason you want to change health insurer, you can request the switch. Health insurance until now is offered by general insurance companies and they cannot reject your transferability claim.
They may try to keep you, but in the end it’s your prerogative to make the final decision. If you run into any issues related to your health insurance plan, you can file a complaint with IRDAI’s online consumer complaints system. It is amazingly efficient and you can expect an action within a 15-45 day period.
Nevertheless, the IRDAI has taken tough measures to protect consumer rights and there are every possibility that your complaints in the first phase will be solved by the insurance company itself and in that case you do not have to approach IRDAI.
What about tax exemptions?
In the current fiscal year ending March 2015, you can claim a tax deduction up to the limit of Rs 15,000 for the payment of the health insurance premium under Section 80D of the Income Tax Act. From the next fiscal year, this limit will be set at Rs 25,000 per year.