The common form of health insurance is called as the indemnity insurance policy, which is also known as fee-for-service, in which the insurer pays for the cost of covered health care services after they have been provided with the bills and money receipts. In most indemnity insurance plans, the patient is free to choose his own doctor or hospital. However, some diseases are not covered by such plans. The person opting for insurance has to check it out before hand. Moreover, there is a certain time limit, for example, Mr. X has paid his first premium on the first day of the current calendar year. If he fall sick, say within fifteen days time of the first premium paid, then he may not get the coverage. The Insurance Companies thus goes for a thorough medical check-up of the person prior to issuing the health insurance policy to someone. Therefore, prior to opting for a health insurance, one must see all the rules and regulations attached to it, which may vary from companies to companies. What you have to do at the first hand is, read the concerned health insurance policy in details. Ask any queries which might disturb you to the representative of the concerned Insurance Company. You have to make your self sure that, you understand precisely what your policy does and does not cover. Thereafter, there is very little chance of coming across with unpleasant surprises at a later stage. Here is a checklist of some aspects, which are to be surely clarified prior to taking out a policy. The check list includes: i) whether the said policy cover only the treatment including operations ii) Is there any restrictions Because, many available policies in the market will often exclude different factors such as: treatment for alcohol and drug abuse; dental treatment/ surgery; HIV/AIDS-related illnesses; infertility treatment; normal pregnancy; cosmetic surgery to solely enhance appearance, etc. This list is not exhaustive and you should ask the insurer for details about your particular policy, iii) what is the coverage period , iv) what is the mode of payment of premium, renewal of policy, v) no claim bonus in case you renew the policy later, etc., and so on and so forth.
In todays competitive world, there are various types of health insurance, and more choices, than ever before. The Insurance Companies are competing with each other and every one of them has to survive. Therefore, many flexi plans are available for the people. You may be the first timer to buy a health insurance plan, or you may already have opted for a certain health insurance plan but want to consider changing plans. You may be a single person or a married one. You may want to cover both yourself and your wife, you may have children or without any issues, having old dependent parents; all this will be covered and answered by different plans available in the market. Help line numbers of the Companies or the Insurance agent will provide you assistance regarding how to choose a health insurance plan and which best meets the needs of you and that too as per your budget.
Moreover, the medical insurance document requires so many declarations from your end. You must declare everything on the application form, even if you think it is boring and unimportant on your part. Take some pain and fill-in-up all the information sought in the application form or any other form supplied by the Insurance Company. There should not be doubt in mind that, you are giving all true and accurate information as it forms the basis of the contract you make. If certain information is inaccurate or has been left out, or has been found incorrect later on, the insurer might refuse to pay your claim. In addition to this vital information, some other important aspects are as follows: the health insurance policies generally only cover you for disorders which have not affected you in the past. There are so many conditions attached to it. Any of your suffering, which is going on or has suffered from in the past, is known as pre-existing conditions. Most of the individual policies including some group policies generally not cover pre-existing conditions. Provisions are there that, some policies cover a pre-existing condition but only after a specific period of time has lapsed since your last treatment or visit to a doctor for the same condition. In this regard, the Insurance provision will allow you for a waiting period. For example, you might have a waiting period of between six months and two years before coverage begins. Therefore, make it doubly sure that, you checked your policy carefully to make sure if you can be denied coverage for a pre-existing condition.
Now, let us have a discussion about another important aspect, i.e. how to claim for a health care insurance. The health Insurance companies have to deal with thousands of claims every day. All the claims needs to be processed as per framed guidelines of the Company and subsequently passed for payment or to be denied, if does not meet the terms of the provision. Since, majority of the claims job is related with paper work, spot verification, etc. therefore often, it may take some time to release the fund. It is a very tedious job. Everyone seeks that; their claim should be cleared within a short span of time. Many smart companies give smart services to its customers. But, many other Companies, especially in country like India; some Companies are Govt. owned Corporations, which takes unnecessary time to settle claims. Whenever you want to make a claim, it is advisable to contact the insurer before you actually receive treatment, or going for hospitalization, if possible. Subsequently, the insurer can confirm the specifics of your cover and can also check that the treatment is within any relevant limits. Then, the company would provide you with the related information like whether you have to make payments first and then be reimbursed or whether the insurance company can make arrangements to pay directly to the Hospital against your bill. On your part, it is very vital that, paper work should be in order and complete in all forms after submitting the claim. Under any circumstances, you are not supposed to claim falsely. Otherwise, if you caught in such a situation, companies may file legal action against you. Dont forget to keep a full set of Xerox copies of all relevant papers with you.
Now, very particularly a question will come to our mind. This irksome question is, what kind of action can we take in case; the insurance company rejects a claim, which we feel as a valid claim In such a situation, if the company refuses the claim, the most advisable part is to insist for a reply in writing from the companys end. Moreover, re-submission of claim can be another solution. Many other matters of concerns can be settled across the table through discussions. For this, we have to ensure that, our problem has been told in clear language. In such cases, citing of Policy number, submission of all medical records such as test reports, prescriptions, cash memos of medicines, doctors records/advise, discharge certificate, etc. must be submitted. Moreover, copies of all earlier correspondences must also to be kept. But, if it is an injustice, dont hesitate to get the best service even with the help of Insurance regulatory Board and law of the land and also to protect our rights.
In the developed countries, both form of Health Insurances, i.e., private health insurance and public health insurance is present among masses. But, in a developing country like India, the private health insurance is more common among people rather than the public health insurance schemes. Many of the public health insurance schemes are very good on papers, but in reality, it is not reaching to the poor. In this regard, another answer can be the Community based health insurance (CBHI) programmes. This type of programme in rural or semi urban areas in India is an alternative arrangement to provide health insurance to the poor, i.e., low-income groups. In India, the Prime Minister has launched an universal health insurance scheme which is similar to CBHI as mentioned above, which can take care of the poor and downtrodden in the society provided it runs as per its policies and goals and reaching rightly to the target group. Moreover, the development of private health insurance can bring potential risks and benefits in terms of health care access for the clients including poor. Moreover, even the private health insurance market lacks development due to the want of regulatory decisions on the supply of health services and the demand for health insurance.
In country like India, the insurance business is still a monopoly of the private Insurance Companies. In fact, for all practical purposes, the only medical insurance policy available for the people in India is the Medi-claim policy. This policy is available through the subsidiaries of the General Insurance Corporation (GIC) of India. Moreover, in India, the government has some schemes meant for its employees such as the ESIS (Employee State Insurance Scheme) and the CGHS (Central Government Health Scheme), etc. After the economic liberalization in India, many foreign Insurance companies entered in to Indian market. They also cover the health insurance sector under its various schemes. In India, now-a-days, many employers provide medical insurance as a standard perquisite to many of their employees, through the group insurance schemes, where the premium is less than a personal insurance policy. The premium is either paid by the Employer or deducted from the medical benefits enjoyed by the employee. In many cases, the employer pays a part of the cost. Not all employers, however, offer health insurance to its employees. Therefore, it is a fact that, in India, health care is still lagging specially with regard to poor and lower middle calls category.
Therefore, once again it is a repetition that, the insurance business in India is still a monopoly. The question arises to the common man is, whom to insure, only to himself or some or all the members of the family; and how much amount to insure for each one of them. Obviously, this is a very confusing situation. This situation is not the same in countries like USA. In USA, there are a wide variety of medical insurance schemes available for the citizens. A person can choose a policy from the health maintenance organization (HMO) or from preferred provider organizations (PPO). But, this brings confusion to all most all the policy buyers. Therefore, one has to be very careful at the time of buying a policy. It is a very simple matter that, once money has been spent for treatment, it should be realized through the Insurance policy. But, the insurance company will be more happy in case of low reimbursements from their part and receiving higher premiums from your end, you have to be very careful to choose the right policy and therefore to take guidance from all Help Lines and also from the Professional Agents. Health to all is still a distant dream in developing countries like India. By opting for health insurance policies, you can protect yourself and your family members from odd situation of life arising out of illnesses, etc.
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