9 common health insurance myths debunked

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An health insurance cover helps in tiding over medical emergencies and saves our hard-earned money for rainy days. But just because you have an health insurance policy does not mean you understand it. There are several myths surrounding health insurance policies that one quickly falls for. Here are 9 health insurance myths debunked for you:

1) All pre-existing ailments are covered after 48 months

Insurance policies come with a waiting period of 2-4 years for illnesses that already exist at the time of purchasing the policy. After the completion of the waiting period, the policyholder becomes eligible for claims relating to pre-existing diseases. This coverage of pre-existing conditions depends upon how honestly the information was submitted when filling the proposal form. It is the duty of the policyholder to share all relevant information without hiding any facts at the time of signing the dotted lines. Moreover, your policy might have some in-built permanent exclusions. Check with your insurer for illnesses that are excluded or have certain time-exclusion.

2) One needs 24 hours of hospitalisation for claim

An health insurance policy pays for hospitalisation expenses, provided the minimum stay in the hospital was at least for 24 hours. But, certain illnesses do not require hospitalisation and are covered under daycare procedures. For example, certain surgeries such as dialysis, chemotherapy, and eye surgery require less time with technological advancements.

3) Entire hospital bill will not be reimbursed

There are many factors, because of which hospital bills might not get reimbursed fully. For example, many policies come with a ‘co-pay clause’. The co-pay clause indicates a percentage of the claim amount that the insured person bears. The insurance company bears the remaining amount. Similarly, there are room sub-limit and non-consumable items which health insurance plans do not cover.

4) Coverage from day one

Almost all plans come with a waiting period of 30 days from the date of commencement. Before the completion of 30 days, you cannot file a claim with an insurance company. However, hospitalisation due to an accident gets covered from day one. In addition, apart from pre-existing illnesses, some diseases have time exclusions where they are covered only after the expiry of a specified period.

5) New policy to be issued if not renewed

If you do not renew your policy on the due date, then your policy gets lapsed. But the policy lapse doesn’t mean that you lose all your continuity benefits. Insurers generally give a 15-30 day grace for payment of the premium. This helps to keep the health benefits intact. But a claim arising during the grace period are generally not covering by the insurance company.

6) Group policy is sufficient

It is common to have a group insurance policy from your employer. But the sum assured might not be enough to cover your entire family. In such a case, it is advisable to buy a separate retail plan for your family so that you remain covered even while changing jobs or during sunset years.

7) Premium comparison is enough

There are thousands of health insurance policies in the market. Each policy comes with its own sets of terms and conditions. Hence, mere comparing premium rates is not enough. Instead, you need to look in terms of coverage what the particular policy offers. If you find comparison cumbersome, you can consider buying standard health insurance policies under the nomenclature of “Arogya Sanjeevani Policy”, which offers standard plans across insurers. Here premium rates are considered one of the key differentiators.

8) All policies cover hospitalisation cost

Not all policies cover the hospitalisation cost. For example, there are also benefit plans that pay one lump sum amount on the critical illness diagnosis. In such policies, no medical bills are required. Similarly, daily hospitalisation cash plans offer a certain amount up to a certain specified number of days for covering expenses over and above the hospitalisation cost. Hence, you also need to understand your policy’s type of coverage before going for one.

9) Pre and post-hospitalisation costs are not covered

Generally, insurers reimburse you for 30-60 days cost incurred before hospitalisation. However, the limit for the number of days may vary from insurer to insurer. Similarly, expenses up to 60-90 days post-discharge also get covered.

Policyholders should always read the policy document carefully before buying a policy.