Demystifying Health Insurance: Your Comprehensive Guide

Discover the ins and outs of health insurance with a focus on critical aspects that are often overlooked or misunderstood. This blog post discusses key questions related to health insurance claims, multiple policies, and the importance of personal insurance over corporate plans.

Key takeaways:

1. Understanding the intricacies of the ICU claim process and the role of room rent caps.
2. The possibility of claiming benefits from multiple health insurance policies for a single hospitalization event.
3. Identifying whether a corporate health insurance plan is sufficient.

Handling ICU Claims

An essential understanding about health insurance is that while your ICU claim is generally covered, a room rent cap can determine the extent of the coverage.

Here's an example to clarify:

• Suppose a policy has a sum insured of 3 lakh rupees, with a room rent cap of 1% per day (i.e., 3000 ₹) for any room, and 2% per day (i.e., 6000 ₹) for the ICU.
• If the actual room rent is 4000 ₹ a day and the ICU rent 10000 ₹ a day, not all expenses will be covered. Only 3000 ₹ and 6000 ₹ will be approved, respectively.

The nuances don't stop there. Expenses relating to tests, procedures, and doctor visit fees will also only be approved in the same 3/4th and 3/5th ratios. As a tip, ensure there are no room rent limits in the policy or that the sum insured is high enough to cover most charges.

Multiple Health Insurance Policies

Good news! It is possible to claim benefits from multiple policies for a single hospitalization event, though the full claim cannot be made simultaneously from all them. Here's an illustrative scenario:

• Chandu has two policies, one from insurer A (10 lakh ₹) and one from insurer B (5 lakh ₹). If his total hospital bill amounts to 12 lakh ₹, he first claims 10 lakh ₹ from insurer A. If approved, that 10 lakh ₹ goes to the hospital.
• Now the remaining balance is 2 lakh ₹. He can now submit a claim for this amount to insurer B.

Corporate Health Insurance Plans – Are They Enough?

There are pros and cons to relying on corporate health insurance. These plans often have no waiting period or exclusions for pre-existing conditions and can sometimes also cover parents. However, they may fall short in the sum insured, have restrictive room rent limits, and risk being lost during a job transition. With personal health insurance, it's possible to better control these factors and secure comprehensive coverage.

Managing the Co-Pay Clause

The 'co-pay' clause represents the percentage of the medical bill you're expected to cover. For instance, if Chandu has a bill of 10 lakh ₹, but the co-pay is 20%, he would have to pay 2 lakh ₹ out of pocket. He can then claim the remaining 2 lakh ₹ from his second insurer.

Bonus Tip: Start Early

Shakespeare hinted at insurance when he said, 'Better three hours too soon than a minute too late.' Opt for an insurance policy when young and healthy to lower premium costs and ensure coverage.

Planning for contingencies is the essence of insurance; it's meant to safeguard against unforeseen health expenses, not to be relied upon once health complications have already arisen.

Conclusion

Corporate plans can be beneficial, but having an individual health plan along with a corporate plan is a safer choice. Remember, insurance is best planned in advance—don't wait until you're thirsty to dig a well!