You have heard about the importance of getting your health insured given the rise in accidents, diseases and various critical conditions. But you don’t know the basics of health insurance and dread the complexities associated with the claims processes, documentation and reimbursement.
Here are 10 pointers on the basic terms and processes associated with health insurance
As the term suggests, health insurance or non-life insuranceis about taking a medical cover against illnesses, diseases, medical conditions, accidents and unforeseen health disasters in general.
Hospitalization discharge card/summary
You need to approach an insurance company to buy the health insurance policy, pay a certain sum of money every year as premium to keep your policy active. God forbid, should you meet with a health disaster, the policy will cover the treatment and hospitalization subject to the terms and conditions of the policy.
Who should be taking health insurance
Just about everybody should take health insurance regardless of age, gender and physical condition. For the simple reason that medical disasters do not make exceptions and can afflict anyone at any time.
Without health insurance, treating an illness or accident from your own pocket can prove very expensive.
Hospitalization is necessary
Health insurance covers the expenses so long as there is hospitalization. In other words, the patient must undergo treatment in the hospital for at least for 24 hours. A sickness / injury that does not result in hospitalization is not covered by the health plan.
Charges covered by the policy
All expenses related to the sickness / injury – ward room charges, surgeon’s fees, consultant doctor’s fees, operation theatre charges are covered. Usually there is a time frame, with all pre and post-hospitalization expenses over the time frame covered by the policy.
As far as disease coverage is concerned, excepting certain diseases or pre-existing conditions specified under the policy’s terms and conditions,In case of critical illness insurance all diseases and illnesses,including critical illnesses, are covered.
Critical illness is a health condition of a grievous nature. It can have a devastating effect on the individual’s lifestyle and can incur considerable medical cost, in addition to loss of income from inability to work.
What are pre-existing diseases?
Pre-existing diseases as you may have guessed are diseases that a person may have suffered from, or sought treatment for, or even a disease which he may have contracted regardless of whether he was aware of it, before taking the policy. There is usually a waiting period of two to four years before the individual can file for health cover on pre-existing diseases.
Documentation required to file a claim
First, a reimbursement form, readily available on the company’s website, must be filled. The form should be supported by documents like original hospital receipts and bills, prescriptions, doctor's note for tests and investigations, details of operation performed and surgeon's bill, receipt, to list the most important.
While the turnaround for claim reimbursement various across insurers, it usually takes 15-21 days once the forms and documents have been submitted. The insurance company takes this period to verify the claim, ascertain eligibility and tie up related processes. The claim is accordingly approved and the reimbursement cheque is sent to the customer.
As you have seen, taking health insurance isn’t that complicated at all. If you are still not confident of the process, do not hesitate to approach an agent who will guide you on the best way to avail of a health insurance policy.