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Health insurance mythe assume to be true

23 Feb 2016
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Myth 1: my employer mediclaim would take care of my needs

Truth: if you are one of the many beneficiaries of the corporate group health scheme don’t write off the need for another individual health insurance. In an effort to reduce steep premium employers are rationalizing the cover. Some of the steps taken include, excluding parents, dependents, partial payment of premium, co-payment (bearing a part of bill from pocket) or offering medical insurance only for those who pay the premium on their own.

Also, buying a cover at the time of retirement would prove expensive and may be unavailable in case of adverse health issues. Those who hop jobs should beware of the period between jobs, when no cover would be available.

Myth 2: i smoke and hence won’t be offered a health cover

Truth: as per a survey conducted by a health insurance company 49% of those who smoked or consumed alcohol were in a dilemma whether they would be offered health insurance. Though such a set of people would be prone to health hazards, the good news is that insurance companies extend medical insurance to them. As the risk associated is high, smokers and alcohol consumers would need to pay a higher premium and also undergo a stringent health examination before being offered a health insurance policy.

Myth 3: i am fit, i don’t need health insurance

Truth: though you may be taking care of your health, unforeseen circumstances such as accidents and illnesses such as dengue, malaria can hit anyone. Footing a hospital bill isn’t as easy as before. A two-day hospitalization can force you to pull out savings worth rs 60,000-1 lakh or more depending on the severity.

Myth 4: i will get paid only if i am hospitalised

Truth: though there are caps in terms of minimum hours of hospitalization, the advent of technology has led to a situation where one need not get hospitalized even as s/he undergoes a surgery. Take for instance cataract operations, which hitherto needed the patient to be hospitalized. Now the patient can be home within a few hours after the cataract surgery. Such treatments, also called as day care procedures, are covered under the health insurance umbrella, even though no hospitalization is involved.

Today there are standalone health insurance companies and few others who even cover doctor consultations charges, dental treatment and ayurvedic as well as unani treatment costs under the health insurance policy.

Myth 5: i can buy health cover now and get the important surgery done to cover it

Truth: there are clauses under the insurance policy which restrict you from making a claim during the first 30-90 days. Select ailments also have a waiting period for instance hysterectomy. Also, if you hide details from the insurer before purchasing a cover and later it is discovered that the disease was existing prior to policy term, the insurer may even reject your claim. It is always advisable to disclose correct details. Pre-existing diseases have a waiting period of 2-3 years.

Myth 6: network hospitals, day care procedures: more the merrier

Truth: are you swayed by these lines highlighted in the health insurance policy brochure – “we have 4000 empanelled hospitals,” “our hospital network is 5,500 strong.” Well the numbers never matter as much as the hospitals. Chances are that the list would change and the proximate hospital would not be a part of the network.

Similarly, if you have been weighing the merits of a policy based on how many day care procedures are covered, then your assessment may be going wrong. The longer the list of day care procedures mentioned in a health plan brochure, the more particular and restricted would be the claims accepted. So, a cataract surgery covered, is better than a plan which covers eye surgeries such as “incision of the cornea”.

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