In India the Health Insurance Penetration is estimated to be less than 10%. This pushes all the insurers to race for grabbing the Health Insurance Market share as much as they can. In the current budget Central Government has also announced the Rs. 5 lakhs health Coverage for BPL families which will help them from either not succumbing to the illness or not getting financially ruined due to the Health care cost.
The awareness or need for Individual policy is still not felt by the mass in India since majority of the employees are taking benefit of the Health Insurance coverage arranged by their employer, which will be available till the time they are in the employment. Secondly, In India majority of people misunderstand the insurance protection as investment hence they end up purchasing costly life insurance coverage and deficient/No Health Insurance Policies.
Further, lack of information on the nitigrities of the Health insurance coverage, the policy holder is always in a conception that He/She is adequately covered. However due to rising Claim Ratios on the Group Health Insurance Policies arranged by the employers, the coverage available there under is taking toll by way of –
- Capping on the claim towards few ailments
- Co-pay in the claim
- Deduction in Non-network hospitalization
- Proportionate deduction on the basis of daily Hospital Accommodation rentals
It is very much important for policyholder that when we purchase a Health Insurance Coverage, one should value the coverage not only from the cost perspective but also from the coverage perspective.
Many a times, on record we have health insurance policy, however it fails to take care of our Finances as it turn out to be deficient when the claim arises. This is the time when the policy holder feels that the premium saved by negotiation at the time of taking policy is negligible if compared with amount lost when claim arises.
To understand better about their available insurance coverage( whether Group/Individual) and assess its adequacy, one need to know whether my policy has-
- capping / Proportionate deduction on the basis of daily Hospital Accommodation rentals?
- *Co-pay in the claim?
- Deduction for admission in Non-network hospitalization?
- Capping for Ailments like Cataract, Hernia, appendicitis, Maternity etc.?
- Deduction for Higher Occupancy admission?
- Deduction as % of claim due to admission in higher Class of city Hospitals?
- Good Cashless Hospital Network?
- A Responsive TPA?
Note: Aforesaid are only indicative points.
Understanding this at the time of availing Health Insurance Cover helps in doing correct Financial planning and not being only cost conscious.
In case of any queries, please write to the undersigned.
Warm Regards,
L N Shanbhag,
+91 9833-63-5512 / laxminarayan@spectrumadvisors.in
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* Co-pay is basically some percentage of admissible claim which the policy holder need to bear first from each and every claim under the policy
Nice, informative and helpful.