Health Insurance
Health insurance is a type of insurance coverage that helps individuals or groups manage the costs associated with medical expenses. It works by pooling risks among a large group of people, who pay premiums into a collective fund. In return, the insurer provides coverage for various medical expenses, such as doctor visits, hospital stays, prescription medications, and preventive care.
Frequently Asked Questions (FAQs)
Health Insurance is an important financial tool to manage your risk of falling sick.
The famous American novelist Susan Santog in her book, “Illness As a Metaphor”, says
“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”
- Susan Sontag in “Illness As Metaphor”
What she really means is that sooner or later everyone has to make a trip to the doctor. Good health cannot be taken for granted. You may be healthy today, (touch wood!) but can anyone be sure you would stay that way for ever. And God forbid if any situation does arise and you have to visit the Kingdom of the sick’ how well prepared are you financially to take care of it. Or would you want to put a stress on your near and dear ones?
Health costs are rising day by day and are averaging 14% to 18% year on year. This means that all the costs are going to double in just 8 years. New treatments are coming in rapidly and are much higher than conventional treatments. Are you prepared for all of this? The lowest sections of the society are taken care of by the Government sponsored programs. But how about you?
One never can predict one’s health and the best time to take a Health Insurance Cover is now.
Reach out to our experts and let them help you navigate through the best plans on offer to make a wise decision. Uniffy is an IRDAI approved Corporate Agency and has well trained insurance experts to guide you.
The famous American novelist Susan Santog in her book, “Illness As a Metaphor”, says
“Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”
- Susan Sontag in “Illness As Metaphor”
What she really means is that sooner or later everyone has to make a trip to the doctor. Good health cannot be taken for granted. You may be healthy today, (touch wood!) but can anyone be sure you would stay that way for ever. And God forbid if any situation does arise and you have to visit the Kingdom of the sick’ how well prepared are you financially to take care of it. Or would you want to put a stress on your near and dear ones?
Health costs are rising day by day and are averaging 14% to 18% year on year. This means that all the costs are going to double in just 8 years. New treatments are coming in rapidly and are much higher than conventional treatments. Are you prepared for all of this? The lowest sections of the society are taken care of by the Government sponsored programs. But how about you?
One never can predict one’s health and the best time to take a Health Insurance Cover is now.
Reach out to our experts and let them help you navigate through the best plans on offer to make a wise decision. Uniffy is an IRDAI approved Corporate Agency and has well trained insurance experts to guide you.
Navigating insurance feels like deciphering a cryptic code. But fear not! We're here to decode those policy documents with simple case studies and insights. From co-payments to room rent limits, we’ll demystify the jargon and empower you to make informed decisions about your coverage. Join us on this adventure to insurance literacy and gain the confidence to navigate the world of insurance with ease!
In this article we will help you navigate your way through the complexities of Health Insurance with simple examples and case studies.
1. Co-Payment - Is it worth it?
Imagine this: You’re on the brink of buying a health insurance policy, but you feel it is expensive. The agent presents you with an enticing offer – A policy boasting a generous coverage of 5 Lakhs at a great price. He says he can slash the price by 25%!. He says something about a co-payment of 20%. Sounds like a win-win, right? You eagerly sign on the dotted line, thrilled at the prospect of saving some extra cash.
What’s the catch with a co-payment? Suppose life throws a curveball and one has to spend time in a hospital, would the insurance company pay the entire bill? Well, if you have a co-payment clause of let’s say 20%, the insurance company would ask you to pay your 20% of the bill and pay only the other 80%. Now this may not look like a lot but imagine if the bill is for a big amount like 4 or 5 Lakhs. You could end up paying 80,000 or 1 Lakh from your pocket. One claim can put all your savings from the premiums away.
This cautionary tale serves as a stark reminder: co-payments rarely make sense unless they are absolutely necessary or tailored for individuals with pre-existing conditions. While they may initially lower premiums, the potential out-of-pocket expenses in the event of a claim can far outweigh any short-term savings. So before jumping at the chance to lower your premiums with a co-payment clause, think twice and weigh the long-term implications on your financial well-being.
2. Room Rent Roulette: Playing by the Limits
• So let’s say you are presented with a policy with a cap on the room rent of 1% of Sum Insured. Your sum insured is 5 Lakhs, so that is a reasonable rs 5000 for room rent. Now assume for some reason you haven’t got the room below Rs 5000 and the only available room is for Rs 10,000. You figure you’ve got to spend 2 days only and that shouldn’t be a problem, you would bear the rest of the room rent from your own pocket. After all, its just another 10K. Right? Wrong. Health Insurers apply something called Proportionality. You were eligible for only 50% of the room rent you incurred a bill for. Accordingly all the rest of the expenses including fees for medical services rendered within the room would be reimbursed for only 50% of the bill amount. Whoa!! Hold on! This seems ridiculous right? Well, not really
– hospital bills are generated according to the room and all prices are proportionately charged including procedure costs.
• Hence, exceeding your room rent limit may result in the policyholder bearing a significant portion of the medical expenses, including fees for medical services rendered within the room. So, when you opt for that swanky suite with the panoramic view, you’re in for a rude awakening. Your insurer foots only a fraction of the bill, leaving you to pick up the tab for the lavish amenities.
• It’s essential to carefully review room rent limits to ensure they align with your healthcare needs and preferences.
• At Uniffy, we recommend our customers to look out for policies with room rent caps. Luckily there are several good products in the market with no cap on room rent. The little extra premium you pay would be worth it in the long run.
3. Sub-limits Surprise: The Devil in the Details
You thought you were covered for all eventualities, but lo and behold, there’s a sneaky clause hidden in the depths of your policy – disease-wise sub-limits. Suddenly, your lofty coverage amount doesn’t seem so impressive when you realize there’s a cap on specific ailments.
Word to the wise: beware of lurking sub-limits that could leave you high and dry when you need coverage the most. It pays to read between the lines!
Our experts at Uniffy would find out products for you which do not have sub-limits. We wouldn’t want it ourselves and wouldn’t recommend it for you.
4. No Waiting for Waiting Periods: The Race Against Time
Waiting periods: the bane of every policyholder’s existence. You sign up for coverage, only to realize there’s a waiting game before certain benefits kick in. But here’s the kicker: life doesn’t wait for waiting periods. So, when that unexpected medical emergency strikes, you’re left twiddling your thumbs, praying for the clock to tick faster.
Bottom line: seek policies with minimal waiting periods to ensure you’re not left high and dry when you need coverage pronto! There are some good products in the market which even allow you to get coverage for pre-existing illness with a shorter or nil waiting period with the payment of some extra premium.
Choose a policy with the lowest waiting period to cover you from as soon as possible.
5. Restoration Revelation: A Second Chance at Coverage
Let’s say you have a policy of 5 lakhs and you happened to max it out. Now, you’re worried how you would be covered if something else happens or how your better half is going to be covered. Do not fret! Insurers have a cool feature called Restoration benefit. It is like the magical never ending bowl which replenishes itself every time it gets empty! Yes! You heard it right. In the same policy year, for the same illness or for any new one for you or any one else in the floater, the restoration benefit restores the Sum Insured back to the total amount after every claim. This superhero feature swoops in to restore your sum insured after a claim, giving you a fresh lease on coverage life.
So, don’t worry if you’ve maxed out your coverage – restoration benefit has your back, ready to revive your policy when you need it most!
6. Coverage for Daycare Treatments:
• Daycare treatments refer to medical procedures or surgeries that do not require overnight hospitalization but are performed within a hospital or clinic setting.
• If your policy does not cover daycare treatments
• Comprehensive health insurance policies should include coverage for daycare treatments to ensure policyholders receive financial support for a wide range of medical services.
7. Domiciliary Expenses:
• Domiciliary expenses coverage extends to medical treatments administered at home due to unavailability of hospital beds or specific medical conditions. While domiciliary expenses may not be a common occurrence, having coverage for such situations provides peace of mind and financial security for policyholders.
8. No Claim Bonus:
• No Claim Bonus (NCB) is a reward offered by insurers to policyholders who do not file any claims during a policy year. NCB typically involves an increase in the sum insured or a reduction in premiums for the subsequent policy year, incentivizing policyholders to maintain a healthy lifestyle and avoid unnecessary healthcare expenses.
9. Cover for Alternative Treatments:
• Some health insurance policies offer coverage for alternative or traditional medical treatments, such as Ayurveda, Homeopathy, or Naturopathy. While not essential for everyone, this coverage can be beneficial for individuals who prefer or rely on alternative forms of healthcare.
10. Maternity Benefits:
• Maternity benefits provide coverage for childbirth-related expenses, including prenatal care, delivery, and postnatal care. However, policies with maternity benefits may have higher premiums or specific eligibility criteria, making it essential to evaluate the cost-effectiveness of such coverage.
11. Outpatient Department (OPD) Coverage:
• OPD coverage reimburses expenses incurred for outpatient consultations, diagnostic tests, and treatments. While OPD coverage may seem advantageous, it can result in higher premiums or limited benefits, potentially outweighing the benefits for some policyholders.
In this article we will help you navigate your way through the complexities of Health Insurance with simple examples and case studies.
1. Co-Payment - Is it worth it?
Imagine this: You’re on the brink of buying a health insurance policy, but you feel it is expensive. The agent presents you with an enticing offer – A policy boasting a generous coverage of 5 Lakhs at a great price. He says he can slash the price by 25%!. He says something about a co-payment of 20%. Sounds like a win-win, right? You eagerly sign on the dotted line, thrilled at the prospect of saving some extra cash.
What’s the catch with a co-payment? Suppose life throws a curveball and one has to spend time in a hospital, would the insurance company pay the entire bill? Well, if you have a co-payment clause of let’s say 20%, the insurance company would ask you to pay your 20% of the bill and pay only the other 80%. Now this may not look like a lot but imagine if the bill is for a big amount like 4 or 5 Lakhs. You could end up paying 80,000 or 1 Lakh from your pocket. One claim can put all your savings from the premiums away.
This cautionary tale serves as a stark reminder: co-payments rarely make sense unless they are absolutely necessary or tailored for individuals with pre-existing conditions. While they may initially lower premiums, the potential out-of-pocket expenses in the event of a claim can far outweigh any short-term savings. So before jumping at the chance to lower your premiums with a co-payment clause, think twice and weigh the long-term implications on your financial well-being.
2. Room Rent Roulette: Playing by the Limits
• So let’s say you are presented with a policy with a cap on the room rent of 1% of Sum Insured. Your sum insured is 5 Lakhs, so that is a reasonable rs 5000 for room rent. Now assume for some reason you haven’t got the room below Rs 5000 and the only available room is for Rs 10,000. You figure you’ve got to spend 2 days only and that shouldn’t be a problem, you would bear the rest of the room rent from your own pocket. After all, its just another 10K. Right? Wrong. Health Insurers apply something called Proportionality. You were eligible for only 50% of the room rent you incurred a bill for. Accordingly all the rest of the expenses including fees for medical services rendered within the room would be reimbursed for only 50% of the bill amount. Whoa!! Hold on! This seems ridiculous right? Well, not really
– hospital bills are generated according to the room and all prices are proportionately charged including procedure costs.
• Hence, exceeding your room rent limit may result in the policyholder bearing a significant portion of the medical expenses, including fees for medical services rendered within the room. So, when you opt for that swanky suite with the panoramic view, you’re in for a rude awakening. Your insurer foots only a fraction of the bill, leaving you to pick up the tab for the lavish amenities.
• It’s essential to carefully review room rent limits to ensure they align with your healthcare needs and preferences.
• At Uniffy, we recommend our customers to look out for policies with room rent caps. Luckily there are several good products in the market with no cap on room rent. The little extra premium you pay would be worth it in the long run.
3. Sub-limits Surprise: The Devil in the Details
You thought you were covered for all eventualities, but lo and behold, there’s a sneaky clause hidden in the depths of your policy – disease-wise sub-limits. Suddenly, your lofty coverage amount doesn’t seem so impressive when you realize there’s a cap on specific ailments.
Word to the wise: beware of lurking sub-limits that could leave you high and dry when you need coverage the most. It pays to read between the lines!
Our experts at Uniffy would find out products for you which do not have sub-limits. We wouldn’t want it ourselves and wouldn’t recommend it for you.
4. No Waiting for Waiting Periods: The Race Against Time
Waiting periods: the bane of every policyholder’s existence. You sign up for coverage, only to realize there’s a waiting game before certain benefits kick in. But here’s the kicker: life doesn’t wait for waiting periods. So, when that unexpected medical emergency strikes, you’re left twiddling your thumbs, praying for the clock to tick faster.
Bottom line: seek policies with minimal waiting periods to ensure you’re not left high and dry when you need coverage pronto! There are some good products in the market which even allow you to get coverage for pre-existing illness with a shorter or nil waiting period with the payment of some extra premium.
Choose a policy with the lowest waiting period to cover you from as soon as possible.
5. Restoration Revelation: A Second Chance at Coverage
Let’s say you have a policy of 5 lakhs and you happened to max it out. Now, you’re worried how you would be covered if something else happens or how your better half is going to be covered. Do not fret! Insurers have a cool feature called Restoration benefit. It is like the magical never ending bowl which replenishes itself every time it gets empty! Yes! You heard it right. In the same policy year, for the same illness or for any new one for you or any one else in the floater, the restoration benefit restores the Sum Insured back to the total amount after every claim. This superhero feature swoops in to restore your sum insured after a claim, giving you a fresh lease on coverage life.
So, don’t worry if you’ve maxed out your coverage – restoration benefit has your back, ready to revive your policy when you need it most!
6. Coverage for Daycare Treatments:
• Daycare treatments refer to medical procedures or surgeries that do not require overnight hospitalization but are performed within a hospital or clinic setting.
• If your policy does not cover daycare treatments
• Comprehensive health insurance policies should include coverage for daycare treatments to ensure policyholders receive financial support for a wide range of medical services.
7. Domiciliary Expenses:
• Domiciliary expenses coverage extends to medical treatments administered at home due to unavailability of hospital beds or specific medical conditions. While domiciliary expenses may not be a common occurrence, having coverage for such situations provides peace of mind and financial security for policyholders.
8. No Claim Bonus:
• No Claim Bonus (NCB) is a reward offered by insurers to policyholders who do not file any claims during a policy year. NCB typically involves an increase in the sum insured or a reduction in premiums for the subsequent policy year, incentivizing policyholders to maintain a healthy lifestyle and avoid unnecessary healthcare expenses.
9. Cover for Alternative Treatments:
• Some health insurance policies offer coverage for alternative or traditional medical treatments, such as Ayurveda, Homeopathy, or Naturopathy. While not essential for everyone, this coverage can be beneficial for individuals who prefer or rely on alternative forms of healthcare.
10. Maternity Benefits:
• Maternity benefits provide coverage for childbirth-related expenses, including prenatal care, delivery, and postnatal care. However, policies with maternity benefits may have higher premiums or specific eligibility criteria, making it essential to evaluate the cost-effectiveness of such coverage.
11. Outpatient Department (OPD) Coverage:
• OPD coverage reimburses expenses incurred for outpatient consultations, diagnostic tests, and treatments. While OPD coverage may seem advantageous, it can result in higher premiums or limited benefits, potentially outweighing the benefits for some policyholders.