Hello Nik,
Below mentioned are some of the important points you must keep in mind before taking a Health Insurance.
- Individual Policies & Family Floater: Health Insurance policies come in two basic variants. Individual plans and Family Floaters. As the name suggests, an Individual plan means a separate insurance for each person with defined cover. On the other hand, in a Family Floater, the coverage limit can be utilized by any of member of the family. If you take a Health Insurance policy on Family Floater basis, then any member can utilize this entire limit.
- Sum Insured: Sum insured is the maximum amount that an insurance company will pay out in the event of a claim. Health Insurance policy works on the principle of indemnity, which means compensation for any damage, loss or injury. While taking a Health Insurance, one should consider an optimal Sum Insured that is equivalent of treatment of a serious health condition.
- Pre-Existing Conditions: These are medical conditions that are present before someone requests a Health Insurance policy. It may prevent you from getting Health Insurance coverage or make it more likely that you will pay a costly premium when coverage is obtained. However, insurers do provide coverage to those with a Pre-Existing condition, although there may be certain restrictions.
Network Hospitals, Third Party Administrator (TPA) and Cashless Claims: Insurers tie up with network of hospitals and nursing homes called “Network Hospital” across the country. Hospitals typically enter into agreements with insurers or TPA’s to request pre – authorization & extend cashless facility. In a Cashless Claim, the insured can make a claim without paying any cash up front, which is possible only at insurer’s Network Hospitals. We have our own inhouse health claim services to cater these cashless facilities. Hospitals which do not have a prior agreement for cashless hospitalization with your insurer are non-network hospitals.However one can still avail treatment in these hospitals and claim for a reimbursement of the incurred expenses.
- Exclusions / Waiting Periods: There are certain medical conditions that are not covered (some temporarily and others permanently) under a standard Health Insurance policy. All Health Insurance companies incorporate a number of Exclusions in their Health Insurance offerings to prevent customers from taking undue advantage of a service that is essential. It is advisable to read through the list of exclusions before taking a Health Insurance policy.
Thanks
Akanksha
