Recently in the newspapers, we read about a promising cricketer, James Taylor from the England Cricket Team being diagnosed and hospitalized with a serious Heart ailment and was instructed by his doctors to retire from the game as well as refrain from any concerted physical activities, which could further intensify his ailment. The said cricketer is just 26 years of age when it was revealed to him about this ghastly health condition. Back home in India, we all have heard about Yuvraj Singh being diagnosed and treated for Cancer disease, just after he had a magical Cricket World Cup tournament in 2011. Yuvraj Singh was just 31 years, when he fought this great battle against the dreadful Cancer disease and emerged victorious. The underlying message from the above two incidents involving cricket personalities is about, how critical health illnesses are no longer only associated with the aged or non-active individuals. Though the above two personalities were able to achieve timely medical treatment, not everyone is fortunate to afford medical treatments, especially in India, considering the rising cost of treating a health condition in a specialty hospital.
The rise of lifestyle related diseases and unhealthy living environment due to air pollution and water borne diseases, has seen many individuals across the country, falling victim to critical illnesses at a very early stage of their lifetime. India is the only country in the world where the majority of the population is below the age of 35 years. The hectic work commitments and strict project deadlines have pushed many among the working class to adopt an unhealthy lifestyle, therefore inviting health complexities when detected with a disease or ailments. Parallelly, the cost of medical treatments in India is on the rise with each passing year. Medical inflation is now around 15% or above, towards cost of medicines as well as treatment of health issues at a hospital. Though not all employers in India are extending Group Health Mediclaim facilities to their employees and their families, whatever little is being addressed through such group policies remain inadequate considering the number of people insured in a family and the unprecedented rise of health issues. By considering opting for an alternate independent Health Insurance cover for oneself and the dependent family members from an early age, an individual can shield the rising cost of medical inflation and treat the ailing member of the family with quality medical treatment.
While opting to buy an independent Health Insurance policy over and above the medical cover provided by the employer, a new time buyer should understand the scope of covers being provided to him by the insurance company. A clear understanding would ensure no hassles arise during any claim settlement.
(Standard Health Cover):
At a very rudimentary level, the standard health insurance cover will pay for the medical expenses that an individual incurs, while he is hospitalized due to any health emergencies caused due to any accident or health issues, which requires him to be treated at a hospital. The cover is extended up to a certain threshold i.e. Sum Insured/Assured. The medical expense over and above the Sum Insured has to be paid by the individual. The Health Policy will typically take care of room or boarding expenses, nursing expenses, surgeon fee, physician, operation theatre charges, medicines, medical tests and a lot many other necessary expenses.
Based on the policy opted, some Health Insurance companies also cover pre and post hospitalization expenses and further help you with certain amount of daily cash allowance during hospitalization under ‘Hospital Cash’ benefit.
The premium towards such health protection cover depends on your age, city of residence, current health condition and the amount of insurance that you take.
Insurance companies have tie-up with a large network of hospitals across the country to provide Cashless facilities to their customers. Under the Cashless process, the customer need not pay any upfront payments towards admission in the hospital. An intimation to the insurance company would suffice during any emergency. The cashless service would also ensure that medical treatment is further carried out in conjunction with the Sum Insured and the insurance company is kept in the loop about the medical treatment. For admission in non-network hospitals, the customer can file a Reimbursement Claim towards medical expenses incurred at the hospital towards the treatment of the patient. Proper paper-work and necessary medical reports are required to be kept in order and shared during the reimbursement process.
Exclusion under Standard Health Cover:-
It is very critical and imperative for a policyholder to know about certain exclusions under a health insurance which an insurance company will not cover due to certain non-disclosure of health facts during policy purchase.
If a person is suffering or has been diagnosed with any pre-existing disease as mentioned under the list of diseases by the insurance company, the policy will not cover any medical treatment related to that particular health disease. However on pro-actively disclosing the pre-existing medical condition, the insurer would cover the said pre-existing disease after a certain period of time, usually 2 or 4 years. The decision on the waiting period differs from insurer to insurer and therefore to avoid claim rejection, it is prudent to disclose about any existing health issues as well as family history of health problems.
Among the exclusions that distinctly stand out include dental treatment and prescription glasses in case of defect in eye- sight. Another important exclusion is Sexually Transmitted Disease (STD). Treatment cost for such infections are usually excluded under the permanent exclusions part of the health insurance policy. For you to benefit the most from your health insurance plan, it is recommended you know what your policy covers and what is excluded.
Hospitalization towards Pregnancy is not covered under the standard plan. However, on disclosing about family planning, insurance companies do have special plans that cater to pregnancy treatment as well as health cover for new born babies for a certain period of time.
On regular and timely payment of premiums and with a claim free year, insurance company will extend certain benefits towards customers by increasing the Sum Insured. Also on completion of the waiting period for any pre-existing disease, the company will include the individual under the health cover and pay towards medical treatment for any health complications arising out of the disease from the next year onwards.
Therefore it will be prudent to opt for an insurance cover if you are young and healthy and are not suffering from any pre-existing health complications. For those, who think they have delayed the decision, should not give up the thought and should pay timely premium for a certain period to cover any health emergencies arising out of their pre-existing disease.