Use multiple plans efficiently

It’s not uncommon for an individual to be covered by two, or even three, health insurance policies. One reason for this is the rise in the cost of health-care services in the past decade. Ten years ago, a Rs. 2 lakh health insurance cover was considered fairly sufficient for an entire family. Today, it will barely be enough to pay for a five-day stay in a hospital. Also, medical insurance cover from employers is not sufficient. In both circumstances, one has to buy another policy.

            But while a larger insurance cover is a good thing, multiple health insurance policies can lead to confusion when making claim. Should a person claim only from one insurer? Does he need to inform his insurer about the additional covers? Will the hospital allow two cashless claims for the same illness? Will he get the no-claim bonus if the second policy is not invoked? It’s all quite confusing for the policy holder, who might be under strain due to the illness.

            The first things to know is that it pays to inform all insurers whenever there is a hospitalization. This does not mean that one can separately claim the expenses from each of them. “You cannot profit from a medical  insurance plan”, says Joydeep Roy, chief executive of L&T General Insurance Company. It’s only that by informing all the insurers, the policyholder is able to optimally utilize the cover available to him. The claim has to be paid by the insurers in the same proportion as their health cover. Say, a policy holder has two policies – one for Rs. 2 lakh and the other for Rs. 1 lakh. If he makes a claim of Rs. 1.5 lakh, the first policy will pay 2/3^rd of the amount (Rs. 1 lakh) while the second policy will pay the remaining 1/3^rd (Rs. 50,000).

            This sharing is subject to the terms of the policies. “There is a contribution clause in most policies. The expenses are shared by the insurers proportionately,” says Sanjay Datta, head of customer service (health and motor insurance) at ICICI Lombard General Insurance.

            You may want to know why the person would claim from the second policy. After all, isn’t his Rs. 2 lakh cover his expenses. Perhaps not, because unlike in the past, most health plans now have limits on the expenses under different heads, For instance, there is usually a cap of 1% of the sum assured on the room rent per day. So, a Rs. 2 lakh policy will only reimburse up to Rs. 2,000 a day. This means that an insurance plan may not fully cover your medical expenses(see table*) . It is also a good reason why one should study the policy features in detail, especially the fine print on benefits, before buying one.

            Financial planners advise that whenever the need for hospitalisation arises, one should inform the third party administrators (TPAs) of all the health policies held by the person. For instance, if you have three policies (one from your employer, one from your spouse’s employer an done bought on your own), you will need to mention that you have additional cover at the time of making a claim. Claim forms require the policyholder to state if he is covered under any other medical policy or group insurance scheme. “ The policyholder can choose to claim from only one insurer. If he has another policy but the claim has been made only with us, we will process  and settle the claim as per norms. Later, we can pursue with the other insurer for their share of the claim,” says Subrahmanyam B., vice president & head, health vertical, Bharti AXA General Insurance.

            However, if one of the policies has been bought recently and still in the waiting period, then the policyholder can claim only from one policy which is already in effect.

            Insurance companies require you to submit original bills and documents at the time of making claim. Since you will be claiming from more than one insurer, request the hospital to provide you with

certified duplicate copies of the treatment summary, bills and discharge slips. That’s easier said than done because hospitals are fussy about these things. If your hospital is not helpful, submit the originals to the primary insurer and attested photocopies to the others. Like we said, if all insurers are in the loop, you will not face any problem.

*Why a Rs 1 – Lakh health plan won’t fully cover a bill of

Rs. 65,000

Expense Head	Expenses Incurred	Limit as % of sum assured	Claim allowed
ICU charges (Rs. 8,000 x 1 day)	Rs. 8,000	2% per day	Rs. 2,000
Room rent (Rs. 3,000 x 5 days)	Rs. 15,000	1% per day	Rs. 5,000
Doctor/surgeon/ Anaesthesist fee	Rs. 20,000	25% per illness	Rs. 20,000
Surgery, implants, medicines, treatment and diagnostics	Rs. 20,000	50% per illness	Rs. 20,000
Ambulance	Rs. 2,000	Rs. 1,000	Rs. 1,000
Total	Rs. 65,000		Rs. 48,000

• In the above example, while some of the expenses were fully covered, the limits on certain heads such as ICU charges, room rent and ambulance service reduced the amount of reimbursement.
•  If the policyholder has another health insurance plan, he may be able to get the full claim.
•  In the case of multiple plans, insurers will bear the cost proportionately to the cover they offer.
•  Multiple health plans enlarge your cover but also makes the claim process cumbersome. You can avoid this by getting additional cover from the same insurance company.

Source: Times of India

Have you used your cashless card yet?

The concept of health insurance in India is seeing a continual improvement in the past few years. One such result is cashless medical insurance which allows the policyholder to be hospitalized without the harassment of immediate payment, especially during emergencies. You just intimate your Third Party Administrator (TPA) of your situation and avail the medical treatment. TPA verifies your policy details, on behalf of the insurer, and gives clearance for the cashless services to be processed. In case of a planned visit, you should first inform the TPA and then avail treatment under the network of hospitals. Thus the most important research here is the number of tie-ups your cashless insurance carrier has with hospitals across the country.

Needless to say, the more hospitals your medical insurance provider has in its network, the easier it will be for you to avail its benefits.

Though Insurance companies hype cashless settlement policies as customer-friendly and convenient, for many who have bought these policies, the experience has not lived up to the promise. Many-a-times the insured has to either pay the hospital himself and get it reimbursed later, or run from pillar to post for the 'pre-paid'

facility, in which case the entire essence of a cashless facility vaporizes. Reasons behind it are many, the primary ones being the ignorance of the user and the hospitals overcharging patients under cashless claims.

It is thus worthwhile to keep the following in mind, when availing cashless -

• For planned hospitalisation, send the pre-authorisation form to the TPA, at least a week before the surgery.
• In case of accidents, make sure the doctor fills in fields like time of accident and evidence of alcohol abuse. A partially filled or illegible form sent to the medical team means it will be sent back to the hospital for clarification and cause more delay.
• If you are accompanying the patient then mention your cell phone number on the pre-authorisation request to ensure that the TPA can get in touch with you immediately.
• Carry your cashless settlement card at all times. This is of significant help in case of an emergency.
• Find out which of the network hospitals is close to your house or place of work.
• Be clear about which expenses and surgeries are covered by your policy.
• Don't forget to renew your policy every year.

Can the Insurers walk out of contracts mid-term?

According to the regulations, a policy can be cancelled only if there is a case of fraud, misrepresentation or non-disclosure of material fact from the insured.

But, few corporate have faced the problem of cancellation in their group health in the mid-term because of high claims, which according to IRDA isn’t allowed.

There were a series of complaints from group health insurance customers which lead to this move by IRDA. A circular has been issued to all the companies stating that insurance policies cannot be cancelled mid-term.

Both the insurance industry and the insurance policy holders have their own stand on the decision. According to the people in industry, after giving enough notice to make alternative changes, including cancellation clause has been a regular practice internationally and historically. Plus, in the cases where cover has been provided on the basis of reinsurance, it is important to have a cancellation clause because the reinsurance companies have the similar clause.

But again, there are different views as well. If we think from the side of the policy holder, he takes the policy trusting that his claims will be settled. Just to increase the top line, insurance companies should not overlook the risk involved with the client. A proper underwriting should be done before the policy is issued to the client.

So, what is your take on the issue? Do you think IRDA did the right thing?

Source: Times of India

Good news for those who believe in non-allopathic treatment :)

As we are aware, most of the health insurance policies only cover allopathic treatment but other form of treatments like ayurveda, homeopathy, etc were not covered. And we all know that, now days people are moving to these so called ‘less harmful’ form of treatment esp when it comes to chronic ailments like spondilytis, arthritis and epilepsy but again even these treatments are not very ‘cheap’.

So for the relief of those, few insurance companies have included such alternative forms of treatment under their cover, especially ayurveda. Though it has been limited to individual or govt. scheme or corporate policy from company to company but yes the first step has already been taken. And ofcourse, there are limits on the amount which can be claimed.

Naturopathy treatments are excluded in all policies, while few cover unani and homeopathic. This is because other forms of treatments have no standard treatment protocols and highly varied costs thus making it difficult to actuarially compute the cost to be covered. Even under ayurveda, select procedures are covered to ensure people do not misuse a policy for a basic rejuvenation procedure.

It is important to note that there is no standalone cover available for covering alternative treatments. You will have to buy a standard health insurance cover from these select insurers and others who start offering the non-allopathic coverage.

Before you head for alternative treatment and make a claim, see whether the treatment is listed in the insurance policy document. Insurers are particular about the specific treatments covered.

Source: Economic times

Waiting period for Health Insurance

Did your claim got rejected because your disease was not covered in the first 2 years of the policy??

Are you suffering from some Pre Existing Disease and want to cover the same??

There are many diseases like Appendicitis, Hernia, Cataract, etc for which an individual can delay the treatment. Many people apply for a policy after discovering they are suffering from one of these diseases. So to avoid such intentional claims, the Waiting Period clause is there in All Health Insurance policies in India.

So, when you sign up for a new health insurance policy, it doesn’t get implemented with immediate effect. The policy comes into effect after a ‘waiting period’, which depends on the kind of insurance and factors such as

·         The nature of disease

·         Your medical history

·         The Insurance company

·         The Insurance Policy Chosen

In other words, the insurer is liable to entertain any claim amount filed only after this waiting period. If an individual undergoes an accident or undergoes hospitalization during the waiting period, the customer may not be covered for a loss.

 

As mentioned before, the concept of waiting period exists across different kinds of insurance policies, and the quantum of waiting period may differ depending upon the insurer and the nature of the insurance policy. However, following are the broad indicators of waiting period.

1)      There is an initial waiting period of 30 days during which no claims is entertained (except maybe an accident case where it has to be proved the accident happened after issuance of policy)

2)      There is an initial waiting period of 1-2 years for diseases like Appendicitis, Hernia, Cataract, Gall Bladder or Kidney Stone, Piles, Tonsillitis, etc

3)      Pre -existing diseases are normally not covered till 4 years of the policy. Previously pre existing was not covered at all. However, now IRDA has made in mandatory for Insurers to cover pre existing after 4 claim free years. In fact, some insurers are also covering pre existing after 1 year like the Varishtha Policy of National Insurance

4)      Diabetes and Hypertension can be covered in many policies from Day 1 on payment of extra premium. Else Diabetes will fall under the Pre Existing Clause

5)      Maternity can be covered in companies like Apollo DKV and Max Bupa after a certain waiting period too

A pre-existing disease refers to any medical condition of an individual prior to the commencement of the policy. Now the policy may be effective for any other ailments in the first few years of the policy. Buy any claim filed for illness related to the pre-existing disease will not be covered in the first 1-4 years of the policy as stated in the policy document. This feature is most common in insurance policies designed for senior citizens. Also, the insurers may insist that you stick with the same insurer if you want the cover to continue without further waiting periods in future.

However, when a corporate takes a Group Policy for all its employees, they can customize the policy to remove the “waiting Period” clause and even “pre existing” disease or “maternity” can be covered from the first Day of the Policy.

For more details, feel free to mail to our Health Insurance Help Desk at health@healthandinsurance.in or call at (+91) 98 30 01 23 88

Healthy lifestyle

It may be easy to forget the importance of living a healthy life when we’re going through the daily grind. It may be even easier to get caught up in what’s convenient instead of what’s good for us. However, the benefits you can enjoy with a healthy lifestyle are worth making healthy living a priority!

Here are three healthy living tips that can be used along with your adequate health insurance, to better your health, increase your happiness, and enjoy life to its fullest:

1.  Rest and rejuvenate. The biggest healthy living tip that many people overlook is the need for sleep.

Life can get hectic. When we don't have enough time to get things done, most of us opt to stay up late to make up for the lack of time. Or perhaps our busy minds prevent us from getting a restful sleep in the first place. However, getting less sleep is actually counterproductive to doing anything efficiently, effectively, or well!

·    Getting enough sleep enables you to work and pursue your passions vigorously. It rejuvenates your body, mind, and attitude. You should have an ergonomically correct mattress and pillow to ensure you get the best sleep possible.

2.  Eat nutritious food. Another healthy living tip is to eat a healthy, balanced diet. Many people believe that they don’t need to eat nutritious food or watch their diet because they don’t need to lose weight. This couldn’t be further from the truth! You should put only the best foods in your mouth no matter how much you weigh, what size you wear, or how fit you look.

·    What you eat affects your entire body, including your brain. By eating nutritious foods YOU CAN think clearer, feel happier, enjoy more energy and avoid illness and pay less medical insurance premium!!. Strive to eat more raw vegetables and fruits instead of processed or packaged foods.

3.  Affirm the positive. Having a positive mindset is the key to living a fulfilling life. Many people don’t realize the importance of living and thinking positively. As a result, they inevitably find themselves allowing negative things to rule their mind and body.

·    Your attitude is one of the most important contributors to both your happiness and health.

Like every other healthy living strategy mentioned, being positive all the time (or even most of the time) may take some effort. However, an easy way to incorporate positive thoughts into your everyday life is to use affirmations.

Many people use affirmations to help them think more positively as they go about their daily life. Positive affirmations are simply statements you can use to replace the negative thoughts running through your head.

·    A good affirmation encourages you to live the healthiest lifestyle possible and be the best that you can be.

Positive affirmations often remind you about how important it is to take care of yourself. An example could be, "I can neutralize bad habits with good food, exercise, and healthy living."

This is a simple way to be reminded of how important your body is, and how important your mental health is and hence how to keep it healthy. This is more relevant in country like India. Health insurance in India is yet to reach the mass.

Hence self help is the best way to protect your health.  

You have a whole toolbox and support system at your disposal to help make your life happier and healthier. All you have to do is take action!

Insurance Brokers ---- for you!

Not everyone is aware of the concept of brokerage in Insurance. Well, people are not even aware of benefits of insurance, that’s why only 3% of Indians are insured. Irony is that 2% are insured either by govt. or by employer. If we want to define Insurance in one line, it will be ‘Insurance is all about transferring your risks’. Wow! In an economy where health expenditure can easily make a whole in your pockets, if given a chance why will not anyone go for health insurance or mediclaim? Sometimes…in fact most of the times, we think….this is not the right time….we are healthy enough….but think again…are you really healthy enough and there is no probability that you will fall sick? We feel that adversity will never knock on your door before arriving.

Trust us…BEST TIME to buy a health insurance policy IS NOW! Most of the policies have waiting period of 3/4 years for pre-existing diseases and for certain other diseases; there is a waiting period involved. Think about your parents, your dependent children….giving them a healthy future is the perfect gift.

So, where brokers come in picture? Brokers are an IRDA (Insurance Regulatory Development Authority) accredited firm who deal with all the insurance companies. The basic difference between an insurance agent and a broker is: broker will represent a client to the insurance company as compared to an agent who represents an insurance company to the client. Brokers under the strict guidelines of IRDA should have sound technical employees to deal with the clients. Brokers take full responsibility for your policy documentation, renewal and claim settlement.

HEALTH INSURANCE IS OUR BIRTH RIGHT and we all should avail it. Taking few minutes out of our busy schedules to invest for a healthy future is not at all a bad bargain.