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Claim Your Health
April 11, 2022 COMMENT comment
Claim Your Health
By Niku Siddhu
"The art of medicine consists of amusing the patient while nature cures the disease," thought Voltaire. His analysis is turned on its head this century as medical costs soar. Do your homework when you get your health insured. Look for the highest cover affordable. Medical inflation in India stands at 15 per cent annually.
Till a couple of generations back every family had a list of dadi ma ke desi nuskhey (home remedies) for minor ailments and dos and don'ts in order to prevent illness. More often than not, treatments were found in the garden or kitchen. In the second half of the last century, our point of view began to shift. With leaps in modern medicine that seemed to have a panacea for every illness, our dependency on the physician increased. The simultaneous growth of the pharmaceutical industry handed us an over the counter "cure" for all our symptoms. 

And somewhere along the way our belief changed: technology is now superior to nature. The marvels of developments in modern medicine have meant a greater access to healthcare for all. The costs however can be exorbitant. A matter of ill-health can be compounded to become a situation of grave financial difficulty in the absence of insurance. The intent of taking medical insurance is affordable cover in the eventuality of an illness, accident or surgery requiring hospitalisation. Health insurance provides access to quality healthcare and a bigger pool of healthcare providers to help.

Remember, there is not a single plan or product which is a 'perfect match'. And you can only compare the features, terms and conditions that will affect your long term cover. Keep in mind the following:
1. Compare benefits and terms rather than premiums. Health insurance is a complex contract and one must seek guidance from an objective health insurance advisor. Note premiums in the higher age bracket, indicative of what you may be expected to pay later.
2. Go for a solid basic policy for the entire family rather than a fancy cover for one. Some offers may double your premium where the chunk of cover is for unnecessary frills.
3. Go for maximum renewable age policies. Maximum renewable age is the time beyond which the policy will not be renewed. With developments in medical science and better access to healthcare facilities, life expectancy in India is bound to go up from the current 70 years. An insurance umbrella which does not cover you when you need it most in old age is no insurance. Companies renewing for lifetime in the individual and family categories are Apollo Munich, Max Bupa, New India Insurance and ICICI Lombard while Bajaj Allianz General and Reliance have a maximum renewable limit of 80 and 75 years.
4.Check the list of exclusions and optimum payments for different treatments to avoid any nasty surprises. Most insurance companies specify the illnesses covered, not the reverse. Go through policy wordings. There may be a mention of an upper limit; for example, a cataract surgery where the maximum compensation is Rs 24,000 only.
5. Look for the highest cover affordable. Medical inflation in India stands at 15 per cent annually. A Rs 5 lakh cover may be inadequate after a few years. If in the interim, you are detected with a new disease, any chances for cover are next to negligible. This gap may be filled by a critical illness cover for diseases like bypass surgery cancer, stroke, et cetera. For example, if you have normal health insurance of Rs 5 lakhs, and a tumour removal surgery costs Rs 4 lakhs, any further hospitalisation due to complications or another disease will leave you with inadequate cover. Critical illness cover steps in here. Verify the diseases covered under critical illness before signing on the dotted line.
6.Go to an unbiased specialist who will access health care across the spectrum and give you a tailored plan. He or she should get you the best cover at lowest cost, diligently follow IRDA regulations and be a no-fee no-jargon person who routinely gives you updates on policy changes, reminds you about renewals and assists you at the time of processing your claim.
7.Check the history of the company you opt for, its credibility and claim settlement ratio. Read the fine print before deciding on a private or government insurance firm.

After a medical test, the responsibility of determining the condition of your health shifts to the insurer. They then cannot reject a claim on the basis of non disclosure or suppression of facts by you. "The insurance policies that skip medical tests are generally more expensive compared with those that insist on stringent tests. It's best to go for plans that require medical tests," says Sanjeev Pujari, appointed actuary of SBI Life.

"When I disclosed that I had undergone a stenting procedure for my heart, most companies refused to insure me," says Delhibased AD Singh who made a complete disclosure even when he applied to Max Bupa. Subsequently, he did manage a cover from them with the condition that any ischemic heart disease would not be covered for a period of four years and all diseases will be covered after that time period.
However, not everyone is as honest. A fifth of the people surveyed said they would not mention an existing illness while some said they would rather their agent fill up the details. If you submit incorrect information or hide key facts, it could lead to rejection of claim.
"Check the list of exclusions and optimum payments for different treatments to avoid any nasty surprises. Most insurance companies specify the illnesses covered, not the reverse."
"Insurance policies that skip medical tests are more expensive compared with those that insist on stringent tests."
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