ARTICLES

Though many of you invest in a health insurance policy to secure your finances and be prepared for any unforeseen medical contingencies, there are some technical aspects of the plan that stump many. This might prove costly because limited knowledge is a dangerous thing.

So, here are 5 important things that you might not know about your health insurance policy –

Co-payment Clause

Many health insurance plans have many types of co-payment clauses. 

Co-payment is when a part of the claim needs to be mandatorily paid by the insured, irrespective of the total claim amount.

(a) Zonal Co-payment:

Under a Zonal Co-payment clause, the cities are divided into different zones. Metropolitan cities are in the top zone and they include higher premiums. Then, there are subsequent zones containing other cities depending on their development. 

If you buy a policy in zone 2 and then make a claim in zone 1, there would be a co-payment. This is because cities in lower zones have lower hospitalisation costs. As such, the premium for those cities is also lower. So, when you pay a lower premium and then avail of hospitalisation at a costly place, co-payment would be applicable. A part of the claim would have to be borne by you. 

(b) Senior Citizen Co-payment:

Some plans have mandatory co-payment for senior citizens if you opt for a health insurance plan after the age of 60 years. However, if you had taken the plan before turning 60, the co-payment clause cannot be added once you cross 60 years of age! So, if you continuously renew your plan (from before turning 60), then this clause would not be applicable.

Restore Benefit

Some plans have this benefit but name it differently such as Restore or Regain Benefit. Under this benefit, if you exhaust the sum insured in any specific policy year, the same can be renewed within the same tenure. However, some plans might have certain restrictions regarding the same, such as:

• It could be applicable only for an unrelated illness, other than the previous hospitalisation.

• It could be availed only on complete exhaustion of the entire sum insured, similar to top-up or super top-up plans.

• It could be restored once or multiple times during the policy tenure.

The benefits of this feature vary from plan to plan and hence needs to be understood specific to your plan.

Cashless rejection ≠ claim rejection

Sometimes, your cashless claim approval might not come through. The company might reject your cashless claim. However, it does not mean that the claim is rejected altogether. The claim rejection might be due to missing paperwork or any other formality. You can still go for a reimbursement claim. Just pay the bills, collect them and submit them to the insurer. Your claim would be settled on a reimbursement basis.

Room rent sub-limits are a spoiler

If your plan has a room rent sub-limit, be careful about which room you choose for hospitalisation. If your room rent exceeds the sub-limit, the whole claim for inpatient hospitalisation would be reduced. Even though your claim falls within the sum insured, the full settlement would not be allowed if the actual room rent exceeds the sub-limit. 

The No-claim bonus does not become zero after a claim

If you have accumulated no claim bonus in your policy and you raise a claim, the bonus does not fall to zero. It merely reduces by a specific percentage. You can still retain a part of the bonus that you have earned. However, this is true in the case of cumulative bonus only wherein the sum insured increases every year. If the plan allows a premium discount, then the discount would be zero if there has been a claim in the last policy year. 

Health insurance is a critical decision and it is imperative to opt for the “right” plan which best suits your needs. For opting for the ideal plan for yourself and your family, you need to have a relook at your health insurance policy. Know these things so that you can make the most out of your policy and then make an informed decision.