Lesser-known features of health insurance
Known Features Of Health Insurance Even though many people are now aware of how to check a policy’s features.
Benefits and also make a comparison before buying a policy, there are still a few lesser-known facts.
Having a health insurance policy is the first step of financial planning, as suggested by experts before an individual starts to save.
COVID-19 pandemic, buying health insurance online has also seen a rise, especially due to the focus on health care costs.
Even though many people are now aware of how to check a policy’s features, benefits.
Make a comparison before buying a policy, there are still a few lesser-known facts that one needs to know.
Health insurance policies cover pre-existing ailments after 36 or 48 months of buying the policy.
However, it will only be applicable if the policyholder discloses them at the time of applying.
If the policyholder hides any important medical information & existing ailments while buying the policy.
The claim settlement could get delayed not disclosing them could also lead to claim rejection in the future.
Various elements depending on the cover include sub-limits.
The room rent has a sub-limit which is determine by the sum insure in the health insurance policy and is link to the claim during hospitalization.
If the sum insure is Rs 5 lakh, the room rent is cape at 1 per cent per day which is Rs 5,000.
If during hospitalization the room rent is higher, the medical expenses in the hospital bill of the policyholder could get proportionately reduced.
He/she might have to end up paying from their own pocket even with a cashless medical insurance plan.
Known Features Of Health Insurance of a health insurance policy is pay cheque, net banking the premium qualifies for tax benefit.
If the health cover is buy by paying cash, you will not get tax benefits on it.
If payments are made towards preventive health check-up up to Rs 5,000 tax benefit is allow even if it in cash.
Insurance companies conduct medical tests of the buyer before issuing a health insurance policy, but mostly for those who are above age 45.
Insurers could also ask for a medical examination even for those who are below 45, in case of a larger sum insured.
Experts say one should always disclose all their medical & family history in the application form while opting for a policy.
Free health check-ups
Most health insurers provide this offer once every 3-4 years but policyholders are usually not aware of it.
It will only be applicable if there is no claim made on the policy.
Experts say one could use it to get a full-body check-up.
The amount, however, is generally capped at 1 per cent of the sum insured of the policyholder.
Under section 80D on the premium paid for preventive health check-up there is a tax benefit up to Rs 5,000 within the overall limit of Rs 25,000 or Rs 50,000 depending on the age.
PPN rates are lower than cash rates for listed illnesses
There are some listed illnesses in health insurance plans offered by Government -backed insurance companies.
For these listed ailments, the Preferred Provider Network (PPN) rates at tied-up hospitals are lower than cash rates.
While many individuals owning a health plan of public companies feel that reimbursement claims are better.
For listed illnesses, cashless claims are better as they are lower. For instance, for placing a stent in the heart.
The PPN rate might be Rs.1.2 lakhs through cashless settlement while the cash rate for reimbursement claims might be Rs.1.5 lakhs.
Clients should be encouraged to choose PPN rates at the time of claims if they are buying a health plan from a Government health insurance provider.
All health plans have lifelong renewal
The (IRDA) has directed health insurance plans to offer lifelong renewal facility.
As such, there is no maximum coverage age and health plans come with lifelong renewals.
The policyholder can, therefore, enjoy coverage for his entire life by renewing the health plan regularly.
Claim-based premium loading is a thing of the past
Many policyholders fear that after making a claim their premium rate in the subsequent year would increase.
This is no longer the case.
While health plans followed this concept earlier, in recent times, the concept is obsolete.
The premium depends on the age bracket and the sum insured opted.
It doesn’t increase based on the claim history of the policyholder.
Room rent sub-limit is applicable even if the total claim is lower than the sum insured
In many health insurance plans there are sub-limits on the admissible room rent.
This sub-limit is an important factor at the time of claim which is often ignore by policyholders.
If the actual rent is higher than the allow sub-limit, the entire inpatient hospitalization cost incurve is affect.
The insurance company doesn’t pay the entire claim in this case.
Day care treatments and free health check-ups provide enhanced coverage
Almost all health insurance plans cover day care treatments and provide free health check-ups.
Day care treatments are those which do not require a continuous hospital stay for 24 hours due to advanced medical technology.
Free health check-ups, on the other hand, cover regular health check-ups after a specified number of years.
Many policyholders are unaware of these coverage benefits and they fail to utilize their health plans fully.
Though health insurance plans provide a wide gamut of coverage benefits, they are not fully understood by many.
You should, therefore, educate your clients on these lesser known health insurance facts.
When your clients understand the true benefits of their health plans, they would invest in the plan easily.
So, understand these facts and help your clients understand them too so that they can enjoy full benefits provided by health plans.