Exclusions in a Health Insurance Policy

What does a health insurance policy not cover i.e exclude?

The moment of truth in an insurance policy is at the time when a claim arises. One of the most common reasons for a health insurance claim not being paid by an insurance company is when they say that the particular disease is not covered by the policy and is an "exclusion". It leaves a bitter taste in the mouth of the policyholder and can sometimes put the policyholder in great financial difficulty. Thus, it is very important to know in detail about the exclusions in a health insurance policy before purchasing it. In our opinion, it is a far more important variable than price. A policy might be 10% cheaper than a competitor's policy but might have many more exclusion clauses-in such a case, the policy with the lesser number of exclusion clauses would be the better choice for the policyholder.

In this article, we deal with some of the common exclusion clauses in Health insurance policies. Of late, we are seeing some innovation in this area with the new companies not excluding certain ailments which had traditionally been within the exclusions area

Maternity: In most cases, maternity and maternity related expenses are not covered in an individual or family floater health insurance policy. Maternity is typically covered in a group policy. In certain cases, we are seeing maternity being covered after 5 years into the policy.

Diseases or illness contracted within the first 30 days of the policy. The insurance company does this to safeguard itself against customers buying a policy immediately after a disease has been detected

Cataract, Prostrate, Hernia, Piles, fistula, gout, rheumatism, kidney stones, tonsils and sinus related disorders, congenital disorders, drug addictions, non allopathic/alternate treatments, self inflicted injuries, hysterectomy, fertility related treatments, etc are normally not covered under a health insurance policy. Dental treatment and cosmetic surgery is also typically excluded. Contact lenses cost is also not covered. HIV/AIDS is excluded, which has been a subject of great debate and criticism in the last few weeks. Some insurance companies do not cover treatment incurred outside the country, so you should check once before buying the policy

Pre existing diseases are not covered in Health insurance policies. Preexisting means a disease that you have had prior to joining a health insurance policy. The policyholder may or may not have been aware of the pre-existing disease. Further complications which arise due to the preexisting disease are also not covered. For example, renal problems which arise due to a person having diabetes at the start of the policy would not be covered. This can sometimes lead to a lot of confusion and heartburn. Someone gets admitted for a kidney related treatment, and the insurance company turns down the claim saying the kidney problem has arisen because the patient had diabetes, and rejects the claim. It can get a little grey here as medical science cannot sometimes clearly pinpoint the root cause of a particular disease outbreak. In most cases, preexisting diseases are covered after 3 or 4 consecutive policy years. This is the single biggest reason why one should buy a health insurance policy at a young age, and continue with the same insurer. Because if you shift to a new insurer, you lose your previous credit and a disease that was being covered by the old insurer might be treated as a pre-existing disease by the new insurer. We have noticed that insurance companies start facing more claims from the health insurance customers from their 4th or 5th policy year, as pre existing begins to get covered and the profitability of the portfolio goes down

War related health insurance claims are mostly excluded from the policy coverage

Abortion related health expenses are not covered in Health insurance policies

Pl do note that with competition heating up, some of the exclusions mentioned above will begin to get covered by a company or two so that it can be used as a selling point. Thus, the lists mentioned above are subject to change. The moot point here is that 10 minutes spent to read the exclusions list of the policy you are considering to buy could save you a lot of headache buyer. Be an informed buyer- there will be no else to blame but yourself.

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Importance of Health Insurance Portability

Choice is always good. In a globalized world, the consumer has a plethora of choices in everything, from airlines to automobiles. This is why nowadays even airlines make an announcement after the passengers land: "We know you have a choice. Thanks for flying with us!"

It's rather simple. You have a choice - if you don't like the product or service, switch! The same goes for health insurance policies as well. In India, people have woken up to the promise of health insurance, which has led to a proliferation of health insurance providers across the board. Because of this wide variety available, the policyholder doesn't need to stick to an insurance provider if they feel dissatisfied with the services.

What is health insurance portability?

Health insurance portability is the manner through which a health insurance policyholder can transfer his/her existing policies from the current provider to a new one. Portability offers a way for customers to opt for better service and product. That way, an insurance provider cannot take them for granted.

Reasons for porting

When and why should you port a Best Health insurance In India to a different provider? Here are some pointers to help you decide:

o Quality of Service

If you feel that the standards of service offered by a policyholder is not at par with what they promised while logging you in, maybe it's time to move on. Often, an insurance provider will promise the moon while getting a customer on board in the eagerness of cracking a deal, but gradually, reality strikes and the customer realizes that it was all hogwash. There's no point continuing a bitter relationship, right?

o Increased Benefits

There might be a point when you realize the cover offered to you by your current Best Health insurance In India provider is not sufficient, and after talking to them it seems clear that that's the best they can do. Under the circumstances, it may be wise to switch to a provider that can offer the additional cover/ benefits.

o Expensive

There is really no point in paying more for a service/ benefit that is available for a much lesser price with a competing provider. If you feel the competition offers a better product at lesser cost, it is time to make that switch.

o Specialization

Best Health insurance In India policies are offered by general insurance companies as well specialized health insurance providers. If it is felt that with the current provider, the attention is more on non-health policies, switching to a specialized health insurance company may suit your needs better.

o Relocation

When you relocate to a new city, you need to have the same services and cover as before. But your existing insurance provider may not have as better access or as many network hospitals in the city. It might then make sense to port to a provider who has those services in your city.

o Claim Settlement

This is important. Some companies take ages to clear a claim. Before you land up in such a situation, it's important to know whether your insurance provider has any such reputation. If that is the case, port out.

o Transparency

Often there are hidden clauses and conditions in the contract which the policyholder is not aware of. Such hidden clauses rear their ugly head during emergencies, and you do not know where to go. Time to move to a provider with more transparency in their dealings.

Now that we have a fair idea when to opt for portability, it is also important to know the benefits. What does a policyholder gain out of it? Well, here it goes:

Benefits of portability

Customization

While porting to a new provider, it becomes easier to customize the features to one's specific needs and requirements. You can add nominees, even go for additional cover or benefits.

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Health insurance policies

Important Points to Ponder Before Buying a Health Insurance Plan

A health insurance plan is an essential part of financial planning in this era of skyrocketing medical costs. Medical inflation has been aggravating at its full spree which makes it all the more important to buy a Health Insurance plan which could sponsor the hospitalization and medical treatment bills or expenses.

It is important to evaluate and look for the following parameters to get a best health plan for you and your family.

1. Check for the Waiting Period Clause

You must be feeling care free after taking insurance, but your Health insurance plan comes with a waiting period clause for specific conditions. There is an initial period clause which says that any hospitalization claim will not be admissible in first 30 days of the policy commencement apart from accidental hospitalization. The pre-existing diseases or conditions are also not covered immediately after you purchase a policy. There is a waiting period ranging from 2 years to 4 years as per the plan conditions in the industry. Also, there are certain surgeries and treatments like hernia, cataract, joint replacement, etc. which can be treated after a specific waiting period of 1 or 2 years.

So, it is important to check the waiting period clause before you finalize the Health insurance plan.

2. Check for Sublimits

There are certain capping or sublimits in your health plan which says that the specific kind of expenses are paid by the insurance company upto a specific limit and beyond that the insured or customer has to bear them at his own. For example: Room rent charges are capped on per day basis for different health plans. Some health plans also come with mandatory co-pay where the portion of the admissible claim is to be borne by the insured and the remaining is paid by the insurance company.

Check for the sublimits in your health plan to avoid any last minute surprises at the time of claim.

3. Check for Network Hospitals

The insurance companies offering health plans have certain empaneled network hospitals with whom they have a tie up. Any hospitalization or treatment taken in the mentioned or specified network hospital list is done on the cashless basis subject to policy conditions.

Check for the list of network hospitals of insurance company and ensure you have network hospitals of the insurer near your place of residence in case of any emergency hospitalization. Also, a treatment in non-network hospital may not offer cashless treatment and some insurers have a co-pay clause if you take a treatment in non-network hospital.

4. Check for the Claim Process

Different insurance companies have different claim procedures. Some settle or administer claims through Third Party Administrators (TPA's) and some have their own in house claim settlement unit to foster quick and hassle free claim processing. Also, check the claim settlement ratio of the insurer you intend to buy a Health insurance plan from to have a clear picture on the number of claims settled by the insurer.

It is important to have handy information on claims procedure to have a smooth and hassle free treatment in the times of hospitalization.

5. Compare & Buy Online

It is important to take a right buying decision which can be done by comparing the available health insurance plans online. You can compare the price, key features, policy benefits, value added benefits, eligibility, exclusions, etc. of multiple health insurance plans to make a right informed choice of your own without any interference of the agents. Buying online health insurance plan is a hassle free process which required least documentation and quick policy processing. There are certain online portals which will enable you to make an easy comparison and will assist you in choosing the right Health insurance plan.

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Progressive Health Insurance Reviews - Best Way to Select Your Plan?

What insurance policies are you insured with? Are you covered properly or are still in the dilemma of selecting a good insurance policy? Selecting a good policy is very vital, especially if you wish to enjoy the maximum advantages. Compare health insurance plans and make your choice instantly.

Selecting a health insurance policy is a tricky task rather than being a very difficult task. Tricky because the internet is swarmed by millions of online sites, each demanding to offer you the best, most advantageous, money-saving healthcare plans. So, amongst this confusion of selecting the best health plans, the procedure to select the policies becomes all the way more difficult. Simply selecting the plans from their health insurance reviews is no longer the safe idea. You need genuine insurance plans offered to you by genuine insurance companies. Hence, selecting the progressive Health Insurance Reviews policies based on the company reviews is surely not the best way.

Another approach you may possibly wish to follow for selecting a suitable policy is by comparing the quotes of the various health and life insurance companies.

Select progressive health insurance policies from companies that provide you a comparative chart of their plans along with plans offered by other firms.

Check the premium amount you need to pay for each of these policies.

Compare the amount and the possible returns you may receive once you select the plan.

Read the listed benefits, the healthcare medical facilities offered, list of health diseases included within the policy, etc.

Before you make your decision, you should read the hidden clauses and conditions included to these plans. Marketers today are smart and very much aware about the facts that lure the readers. Hence, they prefer mentioning only the positive aspects of the Health Insurance Reviews rather than informing the readers with the real facts of the policies.

Take your time and consult your friends for their reviews.

And also ask your doubts if any, to the customer service executives for full assurance.

Selecting a healthcare policy is hence a difficult task. Don't make the decision hard and fast. If you really wish to secure your health from all types of possible factors, make sure you select the best Health Insurance Reviews. After all, it is your hard-earned money you are investing for a healthier future. So, compare insurance plans offered to you by various companies and reap the benefits of your policy when needed.

Article Source: http://EzineArticles.com/6126028

Options for suitable Health Insurance Plan, Now!

Importance of medical insurance & its feature