5 Things You Might Not Know About Health Insurance Policy

But, there are many technical aspects of health insurance which confuse many policyholders. The insurance terms with their fine details might be difficult for the insured to understand. Though there has been a growing alertness about health insurance among the common public in recent times, these technical hitches might still pose a threat in the way of buying health insurance for many.

5 Things Everyone Should Know About a Health Insurance Policy

Rejection of a cashless claim doesn’t mean that your claim is denied 

Cashless claim is a facility offered by every health insurance policy provider, whereby the insurer directly pays the medical bills to the hospital to settle a claim. This makes the entire process easy and hassle-free for the insured. However, at times your cashless claim might not be approved by your insurance company because of any reason. But that doesn’t mean that your claim will not be settled by the insurer.  In fact, if a cashless claim is rejected your insurer might settle your claim via the reimbursement method.  So, in this case you will have to pay the medical bills on your own initially and later can make a reimbursement claim for the same. Further, you must note that every insurer has a claim redressal team where you can raise your grievance if your issue is not resolved by the insurer. You can also approach the court of law for a claim settlement complaint.

Hospitalization Charges (for pre and post hospitalization) are reimbursement only

In almost all health insurances, the facility of cashless hospitalization is not offered in case of pre and post hospitalization. For all other things like treatment charges, hospitalization during treatment and other costs you can avail cashless facility. However, for pre and post-hospitalization costs, you cannot have a cashless facility. So, you can have your entire claim settled via cashless claim but the charges of pre-post hospitalization are done on a reimbursement basis. So, you need to keep your bills incurred on such costs safely and apply for a reimbursement claim to get it settled with the insurance provider. Also, even if small you should file for such claims and get them settled easily.

PPN rates is a feature of many health plans 

Preferred Provider Network (PPN) is a feature in which particular hospitals tie up with an insurance company. These hospitals have specific charges called PPN rates specified for different treatments. So, if an insured gets treatment in a PPN hospital, the rate of the specific treatment might be different from that of the normal hospital charges. Here you may note that the treatments that fall under PPN rates mostly offer low costs and thus your bills are low and so is the claim amount. Under such a health plan feature, you can retain a greater portion of the sum insured to make other claims.

Co-pay clause is zone-wise 

In India, insurers segregate the different cities of the country as per different zones and tiers. For instance, the zone 1 or tier 1 cities are the main metro cities of the country like Mumbai, Delhi NCR, Chennai, Bangalore and Kolkata. Similarly, cities like Pune, Indore, Lucknow, Patna etc. are in tier 2 or zone 2. Other cities of the country fall in zone/tier 3. So, people buying health policy from tier 2/ 3 cities and availing the treatment in a hospital in tier 1 city might not get the full settlement of the claim. Also, the treatment offered in different cities differ as per the advanced technology used and the cost charged. Metro cities are, of course, more costly as compared to other cities and so the premium charged in such cities are high as compared to cities in zone 2/3. This is because location plays an important part while deciding the premium of a policy. So, if an insured buys a Covid health insurance or any other health plan from a lower zone and gets the treatment done in a higher zone, they are levied with co-pay charges by the insurer to restrict their claim liability.

With time the premium of health insurance increases

This is another fact that you should understand. You cannot expect your health insurance premium to stay the same throughout your life. The premium increases with your age, as you move from one stage of life to another. Also, premiums are charged as per your claim experience. You can avail NCB discount for not availing a claim during a policy year or might get your premium increased if you have made any claims during the previous year.