While Covid has led to an increase in awareness about health insurance benefits, there are still lot of misconceptions surrounding the category. Many people still don’t have clarity about how a health insurance cover works. Most of the communication related to health insurance, including policy wordings too do not help much in clearing customer’s doubts. This gives rise to some of the most common myths around health insurance, which need to be busted:

24-hour hospitalisation is mandatory for a claim – One of the most common mythpeople believe in is that they need to be hospitalised for over 24 hours to be eligible to get a claim. The reality however is different. With advent of new research-based medicines and advancement in modern treatment, many treatments today do not require 24-hour hospitalisation. These are referred to as Day-care treatment. This would include but not limited to dialysis, chemotherapy, radiotherapy, cataract operation, kidney stone removal, etc. Most of the Day-care treatment procedures are generally covered under health insurance. Going a step further, oral chemotherapy for cancer is covered under all indemnity health insurance policies. 

Availing higher sum insured or if one is beyond a certain age need to mandatorily go for pre-issuance medical test– Not every health insurance policy asks for a medical examination before policy issuance. Higher age or higher sum insured doesn’t always require an obligatory health check-up. For example leading health insurance policies may not have a pre-defined set of medical tests. Specific medical tests are called for only in exceptional cases, to evaluate the current health status if the applicant has some health condition. 

Insurance company will pay or reimburse the full invoice amount –Typically health insurance policies do not pay for list of items referred to as ‘non payable items’, standardized by the regulator. These include things like PPE kit, Mask, bandage, nebulizer kit, etc. There also may be other policy restrictions such as co-payment, room rent and doctor consultation charges capping which may limit the amount which will be paid to the customer. While this is true of most of policies, specific policies may offer to pay for consumables which has to be ensured by going through the policy document.

Cooling off period discriminates between healthy and non-healthy people – The cooling off period is the time period after the patient’s recovery, during which an insurer may not offer a new policy to him. Many people believe that cooling off period should be done away with and feel that insurers only want to give health insurance policy to those people who are actually healthy and may not require hospitalisation. This is not true. The logic behind having a cooling-off period is that it allows a reasonable time to the insurer to assess development of any complication post treatment completion. In many conditions like COVID or some surgeries which achieve complete cure, this helps customers avail a much richer coverage as insurer may not treat these as pre-existing. Also helps significantly reduce any ambiguity at the time of claim. 

You can get cashless claim at any hospital if you have an insurance policy – Today, insurers are focussing on making the claims settlement process as easy, convenient and as transparent as possible. There are two ways to make a claim - cashless and reimbursement. For availing cashless service, it is mandatory that the hospital you are admitted in, is an empanelled partner in your insurer’s cashless hospital network. For reimbursement, you need to submit all the necessary documents for the insurer to verify the viability of the claim request. Cashless is a preferred route as it does not burden the customer with arrangement of money at the time of discharge, thereby making discharge process seamless. 

We need to understand that insurance business is all about pooling of public money. As a custodian of public deposits, insurers always honour all genuine and reasonable claims. While insurers are doing their bit by de-jargonising the policy documents for easy comprehension, it is imperative for each individual to carefully read the policy documents before making a purchase in order to avoid unnecessary hiccups at the time of claims. With our combined efforts, we would definitely be able to bust all the myths about health insurance.  

The author is Director Underwriting, products and claims, Niva Bupa Health Insurance