Mediclaim guards you against any heavy expenditure that may have to be incurred on medical treatment, in hospitals or at home. Without the cover, when you come face to face with such situations, you have to fall back on your income, which may not be sufficient and therefore, you might be forced to eat into your capital. In most cases, even that may not suffice.
The policy covers reimbursement of expenses incurred on hospitalisation or domiciliary treatment in India for illness, disease or accidental injury.
Some Finer Points
Before buying a health policy, make sure that you do not face a situation where you have a policy that covers a few lakhs but your claim even for Rs. 5,000 gets rejected. Most often it is your incorrect understanding of the terms of the policy that is at fault. You must get your agent to explain these terms.
The following are various aspects you should examine carefully —
Hospitalisation cover is the biggest part of your policy, covering room rent, surgical procedures, nursing expenses, doctor’s fees, cost of medicines, diagnostic tests, ambulance charges, day care treatment, etc. On some of these expenses, there are limits specially those connected with day-care, which do require an overnight hospital stay, thanks to the advancement in the technology.
Pre and post-hospitalisation usually covers doctor’s fees, expenses on medicines and diagnostic tests that are incurred before planned hospitalisation and for some months after discharge. Only those expenses that are linked to the illness which led to hospitalisation and have been incurred up to 30 days prior to the insured being hospitalised, are admissible.
Pre-existing diseases or symptoms of diseases that exist at the time of taking a new health insurance policy are excluded from policy cover.
On new policies, there is a wait for 1-3 months during which only accidents are covered.
In some instances, typically, in top-up policies, the insurer does not entertain small claims. For instance, on a policy of Rs. 10 lakh, a claim will be settled only if it exceeds Rs. 3 lakh.
Once you cross that a certain maximum age, your policy cannot be renewed. Some insurers, renew for lifetime.
Most policies go cashless only if the hospital is empanelled with the insurer. If you go outside the network, you will have to pay for the treatment and get the bills reimbursed later.
The higher deduction is not Useful
The recent FA15 has raised the limits up to which deduction available under Section 80D on health insurance premia paid, along with expenses incurred on preventive health check-up, by an individual for himself and his family members from Rs. 15,000 to Rs. 20,000.
The additional deduction for covering his parent/s has also been raised from Rs. 15,000 to Rs. 20,000. In both these cases, if the insured person happens to be a senior citizen, the deduction has been raised from Rs. 20,000 to Rs. 30,000. However, the aggregate deduction available to any individual in respect of health insurance premia and the medical expenditure incurred would be limited to Rs. 30,000. Similarly aggregate deduction for covering his parents is also limited to Rs. 30,000.
Now, this special deduction u/s 80D would prompt one go to doctor regularly. We sincerely hope that this facility will not be misused by obtaining a fake certificate from a friendly doctor.
Now, another difficulty. Can one go to a doctor practicing Homeopathy, Ayurveda, Unani, naturopathy or any complementary and alternative medicines? Clarity is required.
(The authors may be contacted at wonderlandconsultants@yahoo.com)
A N Shanbhag
