The Hindu Business Line : Protecting your health

The massive cost of treatment is a double-whammy for many who already have to contend with the illness. For instance, rectifying a coronary block can set you back by some Rs 2 lakh.

You not only have to go through the agony and pain of the illness, you would also have to worry about supporting your family as your lifetime savings may well go on the treatment. A health cover can at least relieve you of the financial burden.

In these days of skyrocketing healthcare costs, a medical insurance cover has become indispensable. You get access to quality healthcare by paying just a fraction of the cost as premiums on the policy.

You do not even have to think of making a stopgap arrangement for payment of your bills as insurers now provide cashless facility in network hospitals.

What's on offer?

You primarily get three types of cover — complete health, hospitalisation and critical illness.

There are also special policies, for instance such as a policy to cover medical expenses post retirement from New India Assurance, or a life-cum-healthcare cover from Tata AIG.

Complete health cover

Under comprehensive coverage schemes, the benefits include:

Payment of hospitalisation expenses: The entire expenses incurred during the stay in the hospital including surgery charges, doctor fees, medicines, investigations and so on are covered.

Pre- and post-hospitalisation expenses: If the illness requires treatment pre- or post-hospitalisation such expenses are covered up to a maximum 60 days prior to hospitalisation and 90 days after.

Charges incurred during this period, such as follow-up check ups, doctor consultation, tests and medicines will be covered. Some insurers, such as New India Assurance and Royal Sundaram, offer only 30 days of pre- and 60 days of post-hospitalisation cover.

Minor treatments: The policy also covers certain minor surgeries such as cataract, which might nor need more than a day or two of hospitalisation. The number of such illnesses covered could vary from product to product.

Cashless facility: This is the main advantage of a health cover. You can get treated in the "networked" hospitals and do not have to worry about the bills, which will be passed on to the third party administrator (TPA) and settled directly. The number of hospitals under the network is an important criterion as it gives wider access to facilities. Check if a hospital in your town is covered under the network.

If not, you will have to bear the expenses upfront and submit a claim later.

Add ons: In addition, you may also get some freebies such as ambulance service and a health check-up. This again could differ from product to product.

Bonus: You also get a bonus of 5 per cent for each claim free year. The bonus accumulates up to a maximum of 50 per cent of the basic sum assured, that is for 10 years. In any year, if there is a claim, the accumulated bonus gets reduced by 10 per cent. You also get a discount of 5-10 per cent if you take a cover for your family members.

Waiver of pre-existing conditions: Health policies do not cover pre-existing conditions. But after certain number of years, say, four or five, you can get a waiver from this clause. If you have a policy with Royal Sundaram for five years, from the sixth year onwards, you may be covered even for existing illnesses.

Exclusions

Medical insurance schemes do not cover any treatment abroad. The only exception is New India Assurance, which extends the cover to Bangladesh and Nepal. New India Assurance also gives you the option of extending the cover overseas on payment of an additional premium along with the base policy.

The cover is available only for allopathic treatment and not for alternative medicines. New India Assurance, however, covers ayurvedic treatment expenses up to 20 per cent of the sum assured or Rs 25,000 whichever is less.

There are a number of exclusions such as maternity expenses, pre-existing conditions and so on. The list is exhaustive. Go through them carefully. There are five features to look for:

The number and type of hospitals covered under the network for obtaining the cashless facility.

The number and type of minor illnesses covered.

The speed at which the claim is settled.

The number of days for which pre- and post-hospitalisation expenses are covered.

Freebies and services such as ambulance facility, health check-up and so on.

The premium charged will depend on these features:

Hospitalisation allowance

You receive a flat allowance per day on hospitalisation under the scheme. The allowance is paid based on a certain number of days of hospitalisation regardless of the number of times you visit the hospital during the policy year.

The premiums will depend on the allowance per day payable (between Rs 500 and Rs 2,000), the insuree's age and the number of days you seek cover. You do not have to provide any bills. You only have to submit a discharge card to claim the benefit. The benefit can be extended to the family even if they are not dependants.

Critical illness cover

A critical illness cover pays a lumpsum on diagnosis of any illness covered by the policy. The payment is made upfront on just diagnosis regardless of how the money is used. You can use the funds for either paying for surgery or just keep aside the money for your family. Another advantage is that you can use the money to fund a treatment abroad.

Health policy for retirees

Worried that you may not be eligible for a health policy after a certain age? Even if you are, the insurance cost could be prohibitive. How about saving for future medical expenses when you are earning? New India Assurance's "Bavishya Arogya Insurance Policy" is targeted at such individuals.

You pay premiums till a certain age (retirement age). Any medical expense after such a date throughout your life up to the sum assured is covered under the policy. The premiums are affordable.

A health insurance policy can also be extended to dependant parents and children. Usually, the insurance cover up to age 75 is provided under such covers.

The price that you pay for getting an insurance cover is small when compared to the shock of footing the entire bill and the mental trauma that you undergo.

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