The alacrity shown by agents when selling health policies is often not seen when claims are submitted. It is when claims are submitted that customers often come to know that there were so many riders attached with their policies that are grievous than the disease for which the claim is made. It is nice to have an idea about what to be careful about health policies.
When will the waiting period be over?
The health cover does not kick in as soon as the policy is taken. Even after the policy starts, all diseases are not evenly covered. One need to understand which all diseases are covered and when cover for all diseases would start. One also need to know whether diseases that existed before start of policy would be covered and if so, how many continuous years of policy payments are needed to get it covered. One has to have an idea about which all diseases are completely excluded from insurance cover.
Which procedures in hospital are covered?
One should not spend money on policies without having an idea on which all procedures in the hospital are covered. One should also understand which all in-hospital procedures are covered, whether out-patient charges are covered and whether recurring health charges are covered.
How much cover can you get?
In addition to the total amount covered, policies have limits on how much reimbursements can be availed under certain heads. For example, room rent, ICU etc have limits. One has to get written statements from the insurance company that the policy would not be canceled if expenditure on one item exceeds a limit. Some policies automatically reduce the policy cover if one spends more on one item, say room rent.
About cashless hospitalization
One should not believe the promise that companies would offer cashless hospitalization. One need to make a list of documents required for this and keep them ready. One should also know whether treatment without prior permission would lead to loss of insurance claim.
Higher bill for the insured
Those who have insurance are often charged more by hospitals under one pretext or the other. It is better to select hospitals that do not show such difference when imparting treatment.
Who can solve complaints during the claims process?
One has to keep a tab on complaints-redressal mechanisms that are available with insurance companies. Before submitting complaints to the ombudsman, one can approach the company and solve it with them. The responses from the firm need to be kept safe because the ombudsman would require them for verification.