In India, health insurance is one of the most widely neglected insurance covers. There is widespread ignorance about this precautionary measure. Any unforeseen accident or illness can get invariably overwhelming if one is financially shy and ill-prepared.
It is a secure backing for any unfortunate occurrences that one may come across. Like every insurance policy’s terms and conditions, health insurance plans also accompany numerous criteria to enable one to qualify for availing the benefits of this cover.
Various Coverage Options
Health insurance plans entail various coverage options for different scenarios of the insured. Benefits like pre-hospitalization and post-hospitalization expenses are offered in almost every health insurance package. Domiciliary hospitalization charges are also reimbursed where the patient is treated at his home.
Expenditure concerning domiciliary hospitalization like shifting of medical equipment from hospital to insured’s home, ambulance charges, general as well as specific, although many health insurance plans put forth a condition of extending services only to a specific network of hospitals.
A certain list of fixed networked hospitals is catered to in such plans. For example benefits like cashless payment facility and ambulance, charges are reimbursed only to these hospitals which fall in the network specified in the health insurance plan. Apart from that, other benefits include room expenses i.e. the insured is free to choose the room as per hisconvenience, and the same will be paidfor. However, this does not form part of every health insurance plan.
Catering to Budgets and Needs
Health insurance plans are categorized and implemented according to the budget, requisites and needs of different individuals. Generally, every insurance service provider designs a basic health insurance plan which accompanies all the benefits which a standard health insurance plan ought to entail.
Apart from the basic plan, the insurer also frames a much more specific and comprehensive plan with specific benefits. It is very likely for these plans to cost more than the basic plan for additional benefits. These benefits include a discount on claim free years and many more.
Plans differ based on the benefits they provide, premium rate, etc. but there is one condition which remains constant in every health insurance plan i.e. the existence of any pre-existing condition.
It is an important condition which determines the execution and validity of these plans. Any pre-existing disease which is not disclosed by the insured can lead to the insurance contract turning void.
Few health insurance plans include this factor of pre-existing condition on the term of payment of an additionalpremium, but it is never a part of the basic plans. The reason for the same is that this condition builds the foundation of any health insurance indemnity bond.
What is the Use of a Health Insurance Policy?
A health insurance contract protects the insured from the incidents which may or may not occur in the future. Therefore insurance contracts are termed as contingent contracts. The performance of these contracts is determined only by the occurrence of a future event. Pre-existing diseases which are not revealed by the insured destroys the very preliminary purpose of a health insurance contract. The bond between the insured and the insurer is meant to be performed only at the occurrence of a future event.
For example, if an individual who intends to get insured with a health insurance plan is on the medication to control his blood sugar or blood pressure does not reveal these conditions to his insurance provider, then he may get disqualified for availing the benefits of the insurance policy.
Do Not Hide Illnesses While Buying Health Insurance
The insured is supposed to reveal his detailed and entire medical history to the insurer. It is expected to be disclosed in the proposal form while subscribing or buying the health insurance plan. Insurance service providers give a particular questionnaire document concerning solely to the health of the insured. It contains specific questions which are needed to be answered for smooth processing of claims, especially in the times of dire emergency.
If the insured is hospitalized due to a pre-existing disease, then the insurer may deny his health insurance claim. Thus it is utterly essential to reveal the complete medical background and history to the insurer.
The insurance company includes every disease and any other pre-existing condition in the insurance deed to inform the clients the length and extent of the insurance coverage which is provided to the insured. It will mention a list of diseases which qualify as pre-existing conditions. Thus disclosure of every medical condition is important in an insurance contract.
Consequences of concealment of pre-existing diseases may not only lead to the shelving of the claim amount but also to some extreme states like the complete cancellation of the insurance coverage depending on the degree and severity of the non-disclosure. If the non-disclosure is minor, then the terms of acceptance may not vary.
Although subscribing to a health insurance policy after having a pre-existing condition may get you reluctant faces and reactions of insurance service providers, still one should not hide any material fact relating to health. The reason for the same is concealment of such facts may lead to a bigger disadvantage of altogether losing the coverage completely.
As mentioned earlier some companies do accept pre-existing conditions but only on the fulfillment of certain terms and conditions like additional premium, waiting period, etc. However, it must be noted that the insurance service providers are eligible to load your premium if any pre-existing conditions are present in the terms. But according to IRDA (Insurance and Regulatory and Development Authority) mandate, the insurer is not allowed to load the premium for any disease that occurs after the issuance of the policy and renewing it without any break.
Waiting period condition refers to extending coverage to the pre-existing diseases only after a waiting period of certain years. For instance, only after a period of two to four years, the pre-existing diseases will be covered in the insurance policy. This is a way of ensuring to retain the insured for at least few years if he has pre-existing condition.