10 Lesser Known Facts About Your Mediclaim Policy

Ramalingam K,
Certified Financial Planner and Investment Advisor
Director, Holistic Investment Planners
Chennai

In India, almost all working people have mediclaim policies be it group mediclaim insurance or private mediclaim insurance. However, do all they know the basic of this mediclaim insurance policy?

Read these answers to most frequently asked questions about mediclaim insurance and decide it for you!

1) Change of hospitals:

Change in hospitals while under treatment is permitted only under some circumstances and those are 1) in case of better treatments 2) approved by TPA on the merits of the case and as per policy terms and conditions.

So why not check the network of the hospitals provided by your mediclaim company for the best before hospitalization?

2) Benefits of sticking to one Insurer Company:

• If you are suffering from any pre-existing disease at the time of commencement of the mediclaim policy then
  

  
  
  

  complications of that disease will be covered only after 3 or 4 years of the commencement date.

• If you stick to your mediclaim policy for more than one year or so, company may offer you bonus or give discount in premium.

• After two years of mediclaim insurance commencement, you may get free health check-ups for every second year. Or you may get health services and product of market value up to 10% of your last paid premium.

3) NRI and Health insurance in India:

Yes, NRI can take mediclaim policy in India, only after submitting residence proof and other required documents. Cost of the treatment will be set against Indian parameter and premium has to be paid according to Indian actuaries. The applicant needs to come to India for the treatment, as he will not be compensated for it in his foreign country.

4) Documentation- Before and After:

• Whenever you go to buy any mediclaim insurance policy then agent or company will tell you about the things they are covering to the lengths but none of them will tell you about the exclusions and there lies the hitch. So before buying any mediclaim insurance, check about its exclusions thoroughly.

• After insuring yourself please always keep your all documents up to date. If you have, any pre-existing disease then its all history as it is (do not misplace a single prescription also)

• In case of planned surgery, intimate it to your mediclaim company in advance and take preauthorization of it from the mediclaim company. So at the time of actual surgery, you need not submit any document.

5) Accidental insurance:

If you are opting accidental insurance as rider to your mediclaim insurance policy then it will cover a very less amount in the case of accident or hospitalization due to accident.

So it is wise to opt for independent accidental insurance but do check all the exclusion before opting for it.

6) If it is working couple then are they double insured?

Yes they are! If you have group mediclaim insurance of Rs.2 lakhs and your spouse has it of 2 lakhs too then you both will be insured for Rs.4 lakhs. So if either of you met with an accident or hospitalized due to some sickness, and the expenses are about 2.5 lakhs, then you can claim 2 lakhs from your company and remaining 50000 from your spouse’s.

7) Cashless hospitalization:

You may be disallowed of cashless hospitalization if

•  Information about the treatment you submitted is insufficient to confirm the coverage

• TPA is not in timely receipt of the request for the pre-authorization. In such case, you need to bear the expenses first and then send claim for reimbursement.

•  If hospital in which you are required to take treatment is not on the panel of the company

8) Domiciliary hospitalization:

Is the case where treatment is required for more than 3 days but patient cannot be taken to hospital and confined to home. It will be permitted only under 2 circumstances: 1) patient is unable to move to hospital.2) Hospital is unable to accommodate the patient.

Cover for such treatment is depending upon mediclaim Company’s policy and you need to check it before opting for the mediclaim insurance.

9) Mediclaim Vs Critical insurance

Mediclaim is to cover the hospitalization expenses. Mediclaim covers even the hospitalization due to critical illness. But critical illness insurance is to cover the reduction or decrease in your earning capacity due to critical illness insurance. That’s why you will be paid the full sum assured in critical illness insurance regardless of the hospital bills.

10) Can I change the TPA?

TPA helps to settle the claims arising from mediclaim polices. They are also in charge for providing the cash less facility. TPA is appointed by the insurance company. If you are not satisfied by the services of your TPA, then you can’t change the TPA without changing your mediclaim insurance company.

Mediclaim is one of the risk management tools. If you are not covered with mediclaim, your wealth may erode just like that if there is a hospitalization. By taking a mediclaim policy you are actually protecting your wealth.