With the rise of healthcare costs, it is even more important today to take a comprehensive health cover to keep ourselves and our family members insured from medical emergencies in the future and make sure the immediate financial requirements are met. While the number of people covered under health insurance is fortunately on the rise every subsequent year, India is lagging fairly when compared to developed countries worldwide. Although, a section of the Indian populace is covered under health insurance policies, there are instances where health insurance claims get rejected due to lack of knowledge about health insurance plans and the claims settlement process. At the same time with newer technologies, we, as consumer of healthcare services, has been empowered to understand health insurance policies better and also experience an enhanced patient experience while we visit a hospital. Through this article, we are trying to spread awareness about the nitty-gritty's of health insurance policies for a smoother claims reimbursement process in future.

Choose the Right Policy: The policy must fulfil its primary objective - secure you financially against a range of situations including hospitalization/surgeries and serious illnesses that you may be at risk of due to your family's medical history. The policy must provide effective cover for three types of medical emergencies: Hospitalization due to any injury, sickness, or disease; surgery to treat any medical complication and treatment for critical illnesses. Any policy that provides lump sum benefit for these situations will enable you to face any medical problem without having to worry about your finances. For example, let’s consider a mediclaim policy. This policy pays for your hospitalisation, and covers expenses pre- and post hospitalisation. It also covers listed day care procedures. This is the health insurance policy that you need to get first. But before making up your mind, make sure you have gone through its features. There are many health insurance plans in the market, and choosing the right one is important.

Know your Policy Exclusions: While deciding a health cover, looking at what is excluded is critical. Observe what medical procedures are excluded, as well as the initial waiting period of the policy. The initial waiting period is that time when the insurer will not admit a claim. This is the first and the most common exclusion. However, there might be other exclusions in case of medical emergencies. Most insurance companies do not cover pre-existing diseases from day one. There is a pre-existing disease waiting period which can be anywhere between 30 to 90 days post the initial waiting period depending on the policy. Claims made for any ailment arising out of any pre-existing condition within this period will get rejected. For example, if you have been suffering from some blood pressure variations, any complications arising

In terms of medical procedures, your health insurance policy will not pay for cosmetic surgeries or dental treatment unless it is
out of it, like a low BP condition to a condition of stroke will not be accounted for. Thus, seek a health plan that covers pre-existing diseases and entails a low waiting period.

While the number of people covered under health insurance is fortunately on the rise every subsequent year, India is lagging fairly when compared to developed countries worldwide.

required due to an accident and requires hospitalization.Cosmetic treatments may have become common and popular, but such treatments are not covered under health insurance plans. This includes laser treatments, surgeries like liposuction, weight loss programmes amongst several others. All types of dental treatments are also excluded from health insurance, as it is considered as a cosmetic procedure by the insurers.

Hospital Networks: There are also hospitals that have a direct association or tie-up with the health insurance company. Most insurance companies have a tie up with a host of hospitals to provide their consumers with a smoother claims settlement process. The benefit of having network hospitals within the fold of a health insurance cover for you is that you can avail of the cashless facility, which considerably lessens the strain for finances on the patient and their family. So, look for a health insurance plan with a maximum network of good hospitals in or near your area. Moreover, if you are going for a pre planned hospital visit, you might just choose one among the network hospitals.

Premiums: This is one of the decisive factors while choosing a policy because you must pay this amount out of your pocket every month. Look for a policy which provides you a good sum insured after paying premiums on time. Please do keep in mind with a larger sum insured; your premiums will also rise. It is also important to understand what kind of ailments that you may need treatment for and choose a policy which provides you coverage for those diseases.

Share Complete and Accurate Information: Avoid providing incomplete or inaccurate information about any major previous hospitalisation or any existing condition. Any discrepancy at a later stage may lead to rejection of the claim. Hence, one must share all the relevant information at the time of filling the proposal form.

Hospital Expenses: Health insurance policies have a limit on the expenses incurred in hospitals, fee for ambulance, consultation charges of doctors and other miscellaneous hospital expenses. Room rent is one of the main expenses you bear during hospitalization. Many insurers have a cap on daily room rent. This decides what kind of a room you’ll be able to afford through your health plan. For example, you may want a private room instead of a shared room; therefore, you must ensure that your insurance plan provides you what you need. It is critical to know your eligibility for different expenses incurred in the hospital. Else you might have to pay an extra amount out of your pocket.

Co-payment: In co-pay insurance policies, you must pay part of the medical expenses, regardless of the sum assured.So, if you have a health insurance with a 20 percent co-payment clause, it means you must bear 20 percent of the hospitalization expenses each time you make a claim in a policy year.However, this doesn’t reduce the total sum insured and premiums for a co-pay policy are usually lower than otherwise. So, if you have a co-pay insurance policy, do understand the clause, and make claims accordingly.

Renew your Policy Regularly: As every health insurance policy comes with some waiting period to be able to claim for certain pre-disclosed ailments, it is imperative that all customers renew their policy regularly to avail of its full benefits.

A proactive approach will make sure you are able to get your policy to pay for your hospitalisation quicker and easily to a large extent. Also, since a lot of times hospitalisations are unplanned and urgent, a good policy and prior knowledge of how things work will help make the process that much smoother.