- Sum insured - This is the amount of money that you will receive (or be reimbursed for) in case of a medical problem.
- Cashless treatment - Some insurance companies have a tie-up with certain hospitals and hence, they settle the bill directly. This is a good option for the patient as there is no hassle of claim settlement and documentation.
- No Claim Bonus - If the person doesn't file any claim for treatment in the previous year or a certain period, the insurance company gives an advantage in the form of increment of the sum insured or discount in the cost. This can also be availed during renewal of the policy.
- Sub limits - These are monetary caps that the insurer includes in the policy in order to limit the amount of claim they may have to pay you. These are usually included in the policy and it is very important to understand them well before buying a policy, because these essentially imply that there is a certain cost that you will have to pay even though you have the insurance.
- Exclusion cause - These are the list of diseases and expenses that are not covered in the insurance. They may include -
- These include any internal congenital disease, non-allopathic treatment, pregnancy and childbirth-related conditions, and cosmetic, aesthetic and obesity-related treatments.
- Expenses arising from HIV or AIDS and related diseases, misuse of liquor, intoxicating substances or drugs as well as intentional self-injury.
- Diseases or treatments arising out of wars, riots, strikes, acts of terrorism, and nuclear weapons.
6. Empanelled Hospitals - These are the hospitals which have are connected with your insurer, and you can obtain cashless treatment only in these hospitals.
7. Family Floater Policy - As the name suggests, this policy covers the entire family instead of an individual. The policy has a single sum insured which can be utilised in case of sudden illness, surgeries, accidents, etc by any/all the members insured, subject to the maximum limit.
Dos and Don'ts for Health Insurance
- This point cannot be emphasised enough, read through the entire policy very carefully and pester the middle agent until you understand every term to your satisfaction. Don't skip any parts of the policy and don't accept an ambiguous explanation.
- Disclose all details about your pre-existing illnesses and medical history, otherwise you might have to pay a price for it.
- Pay attention to all the sub limits, and take someone's advice on whether they are reasonable or not.
- There is a certain grace period, usually 15 days, after getting the policy during which you can return the policy if the conditions are unacceptable to you.
- Co-operate with the insurance company by duly disclosing all the details and taking health checks.
- Make sure that you renew your policy religiously
- Always take a transferable policy in case you wish to switch. According to the latest changes, IRDA allows you to switch between policies without losing any benefits attached to the previous policy.
- Avoid unplanned visits to the hospitals.
- Don't hide any health-related details from the insurer or you can face problems when it comes to settlement.
- Do not accept facilities which have upper limits and various sub-limits to avoid out-of-pocket expenses.
Be healthy, be safe.