Health Insurance Scenario in India
In India, with entry of many Insurance companies, after opening up of the insurance sector in 2001, we as customers are having a wide choice /range of over 300 products available from 3 different groups of companies comprising of;
- General Insurance Companies
- Health Insurance Companies
- Life Insurance Companies
All of them are trying to cater to different needs of the customers and that too with different pricing/benefits.
What It Covers?
Generally the Health Insurance Policy covers the curative treatment in hospital. In addition to this expenses covered 30 days prior to hospitalization on diagnosis and 60 days after Hospitalization are also covered. If a person is admitted into a hospital and even after various tests (over 1 day hospitalization ) nothing is found /diagnosed then according to the policy nothing is payable as nothing is cured. This should be an eye opener for many as we find most people think that by having the policy they can get admitted into any hospital for as many days for check ups at the expense of Insurance Company.
Wider Product Range Is Now Available
Recently some companies have introduced policies which can cover
- Out patient services-consulting doctor /consultant/medicines, but these are few and are as expensive as if you pay out of your pocket as per your wish
- Dental treatment
- Diabetes policy
- Many others. In total now the customer has choice of over 300 products so one should asses the need in consultation with experienced insurance intermediary, say an Insurance Brokerage Firm, which is handling products of all Insurance Companies.
Conditions of Health Insurance Policy to Be Read Carefully
All the normal, most common heath Insurance policies issued are having certain conditions and you should keep these in mind. Some of these are;
- 30 days cooling off Period, which means no illness claim is covered during first 3o days of the policy. However accident claims are covered even during first 30 days.
- Certain diseases are not covered during first year,
- Certain diseases are not covered during first 2 years
- Certain diseases are not covered during the tenure of the policy. Like maternity
What is Hospitalization?
Hospitalization means stay of 24 hours or more but day surgeries are covered and a separate list is attached to the policy. This number may be as large as 147.
Service providers who come into action when claim is to be lodged
Every company has list of empanelled hospitals and cashless hospitalization is covered.
Some companies use Third Party Administrators and some are managing claim settlement in house.
Sum assured available
The sum assured can be chosen depending upon your choice and it can vary from Rs 1 lakh to Rs 25 Lakhs
Concept of Coverage for Individual vs. Family Floater
As a family you can choose sum assured for every family member say Rs. 1 lakh and can have discount if the family size is more than 2.In this case every family member can lodge claim to maximum limit of Rs 1 Lakh.If the family comprises of 3 family members then each member can claim only Rs 1 Lakh.
Alternatively you can go for Family Floater which means that all 3 family members can be covered for agreed amount say Rs 3 Lakhs .In this case any or all family members can lodge as many claims but total claim payable during the year for the whole family will not exceed Rs 3 Lakhs.
Family Floater will generally cost 40 % cheaper than normal policy as explained above .This is the reason that this product is becoming popular.
S.K. Sethi, Vice President of Insurance Foundation of India answers 10 most frequently asked questions about Health Insurance.