Health insurance as a risk protection mechanism needs periodic reviews by the policyholders to ensure its effectiveness. The test of insurance is at the time of claim and loopholes leading to rejection at a crucial juncture should be avoided. Policyholders should keep the policy ready for claims and calibrated for coverage, and should be abreast about the latest advances in health insurance as well.
Securing claims
Securing a health claim can be ensured by updating disease information and personal information. Disease information pertains to informing the insurer about any health developments that have taken place in the policy term. Even after a policy has been issued with the appropriate medical check-ups and disease declarations, it does not absolve the policyholder of updating any health-related information. For instance, if one develops a chronic condition well after a policy has been issued, this information is critical to the underwriter of the policy. If not done, the insurer can deny a claim based on incomplete information for any related or unrelated ailment.
Personal information must be accurate at the time of issuance itself. For instance, policyholders may sometimes leave the height and weight column empty while filling a form. Even a trivial miss as such can lead to claim rejection later if the insurer claims such information is critical to underwriting the policy. In some instances, the pin-code relating to residence is unavailable in the drop-down list leading to wrong entries. This can be interpreted as wrong information to reject a claim, though it is more prevalent in term insurance than in health insurance. Policyholders can ensure accurate and up-to-date information every year to eliminate any such risk. Updating a nominee is important for health insurance as critical illness or other riders depend on such information.
Another aspect of claims is cashless Vs reimbursement, and cashless should be the preferred option for convenience and possibly better claim amounts. The case for reimbursement arises if one is admitted to a non-network hospital. Keeping abreast of the expanding network list of the insurer and request for adding a nearby facility to the list can help policyholders at the time of claims.
Well-rounded coverage
For policyholders on employee provided health insurance alone, adding a personal or a family floater health insurance can be considered. Employee health insurance generally has lower coverage by design as it is focused on aiding lower intensity medical care. For the big health risks only, a personal cover can address the risks. Family inclusions and exclusions should also be considered as a hygiene check in health insurance along with any health incidents in the year gone by.
Coverage amounts have ballooned in the last three years; even ₹1 crore health insurance is not out of reach for the average policyholder. Policyholders should look to maximise the coverage to address the rising medical inflation and rising age of the policyholder. Older age is when health insurance becomes even more critical. To aid the policyholder beyond the base amount, top-up and super-tops also can be useful. These add-ons trigger after a limit is breached in the base policy, and can extended coverage by ₹25 lakh to ₹1 crore at a reasonable cost to the policyholder.
Add-ons and riders are useful features that can be checked. OPD consultation, consumables, critical illness, accidental death are some useful add-ons that can be tagged to the base policy. Earlier add-ons can be reconsidered for usefulness in the periodic reviews.
Limits/waiting periods
A policyholder should be aware of the waiting period, that has been served for pre-existing diseases, and should be periodically confirm it with the insurer. All diseases do not have the same waiting periods ranging from two years for piles to four years for diabetes. Moratorium period (earlier eight years, and five years in new policies) is a period after which policyholder claims should expect least resistance from the insurer at the time of claims. The remaining moratorium period should also be confirmed periodically and the benefits that accrue on completion.
Day care procedures are a list of medical treatments that do not need hospitalisation owing to technology. With advances in technology, the list keeps expanding; policyholders can periodically review if the ailment most likely to impact them is covered. Cataract, dialysis, and prostate surgery, for instance, may be covered by a new insurer if not covered by the existing insurer.
Finally, poicyholders should shop around for better health insurance periodically. In the last one year, getting coverage for international treatments, a robust wellness plan that rewards a healthy lifestyle, renewal bonuses that are 5x the original coverage, and day care treatments that cover robotics aided surgery are made available. All by product innovation in health insurance. A policy signed a decade ago can be updated along with accumulated benefits by porting; policyholders should review the existing marketplace for such improvements.
