Hello friends, Doctor prasoon here. There is no doubt you will need a health insurance. If you don’t have one, you should definitely take a health insurance for yourself and for your family. But, how will you choose the right
and the best health insurance which is available in India?. Which health insurance plan is the right one for you?. In this video, I am going to tell you some tips which most of the health insurance companies hide from customers.
These are some tips which most people overlook when they try to find the right health insurance plan for themselves. Welcome back to Dofody, Online doctor consultation. So let’s get started.
#1 Choose The Right Connected Hospital First
The first point that you should consider is The network hospitals Which the insurance company has a tie-up with. Instead of going behind insurance companies and searching for the best insurance companies, what you should be doing is, find out the best Hospital in your area. Select that hospital which has the most number of specialty doctors, which has all the specialty departments in it, which has all the facilities, and then ask the hospital with which insurance company they have a cashless claim tie-up. They will give you a list of insurance companies with whom they have a direct tie-up.
From that list you should select your insurance company. You can double-check that by visiting the insurance company’s website, selecting your state, then your district. You can find the list of hospitals with which the insurance company has a tie-up.These group of hospitals with which the insurance company have a direct tie-up, these are called as a network hospitals, who sometimes called as connected hospitals.
The advantages of a cashless claim is huge, particularly when an emergency condition such as a surgery pops up in your life. You don’t have to go run around searching for money, arranging the money to do the surgery or to pay off the hospital bills.Your insurance company will be directly paying the hospital, and you will not have to take a single penny out of your pocket.
#2 The Room Rent
The second point to note is the maximum room rent the insurance company lays down in its insurance plan. Most of the insurance companies have a maximum capping of the room rent which the customer can avail. For example, if an insurance plan offers capping of 2500 rupees as the maximum room rent per day, and if you are opting an air-conditioned room a single room with a room rent of 3500 per day. Normally what we think is that we will have to pay a difference of 1000 rupees every day for the period of hospital admission. But, that is far from the truth. Actually what happens is that there is something which is called as “proportionate deduction”.
I will explain what a proportionate deduction is. Based on the hospital fee structure, the service charges, the hospital fees, the doctors fee, the nurses fee, and everything will be different. For the patients who are admitted in a general ward, a shared room and in a standard AC room and even in a deluxe room.
All these charges will be different. So if you are thinking that you will have to just pay a 1000 rupees difference? you are wrong! Because in the AC standard room that you are chosen, the doctors fee will be higher, the nursing fee will be higher, the service charges will be higher, the procedure charges will be higher, and you will have to shell out the extra difference from your pocket, and this difference the insurance company is not going to cover this difference and that is called a proportionate deduction. So, Always keep in mind to choose the right room.
If you already have a policy or else if you are trying to find a new health insurance policy for yourself, try to find out those insurance companies which does not restrict on the daily room rent, or go for those companies which offers a single standard air-conditioned room without putting a maximum limit on the maximum room rent that you can avail every day.
#3 Health insurance With Minimum Waiting period
The third thing that you should be looking for is something called as the waiting period or the freezing period. Most of the insurance companies have a waiting period of one year or two years. That means, after taking the policy you will not be able to make any claims within the waiting period.Most of the standard companies have a waiting period of one to two years, and it will be different for different conditions. For example, the pregnancy charges the delivery charges will not be covered in the waiting period, a surgery will not be covered in the waiting period, and all these details will be given finally printed in the terms and conditions which you are obviously not going to read completely. So, always inquire these things before you finally make a decision to go with a certain specific health insurance policy.
Reveal your current health Condition
Point number four is revealing your pre-existing medical conditions or surgical conditions. Now what most people tend to do is that they hide whatever medical conditions they had when they are taking or filling up the form for the health insurance policy. You should never do this, because the health insurance company is anyway going to find out your previous medical history when you raise a claim, and when they find out that you had a previous existing medical condition for which you are raising the claim right now. They are going to deny it, They are going to reject it. So instead of keep on pressing the next button menu filling of the online form or when you are filling of the form offline in a paper, always reveal your medical conditions whether it be a high blood pressure, diabetes, a heart condition, a kidney problem, liver disease, whatever that you are suffering from that you have been diagnosed earlier. Reveal it, write it down, and let them know that you have these conditions.
The premium will be a bit higher. But you can be assured that these companies are going to settle your claim if god forbid something bad happens to you, and when you are trying to raise a claim at the time of an emergency, you are policy your claim doesn’t get rejected.
#4 Insurance With Pre&Post-Hospitalization Coverage
The next point is choosing an insurance policy which, covers pre-hospitalization as well as post-hospitalization expenses. A standard health insurance company is going to cover anywhere between one-month pre-hospitalization and 90 days post-hospitalization. Some companies even go up to 120 days of post-hospitalization. That means all the medical expenses all the expenses for the purchase of medicines after discharge, your ambulance fees, all the tests you’ve done before you got admitted in the hospital, all these things are going to be covered under these policies. So make sure that you choose a health insurance policy that covers at least one-month pre-hospitalization and 90 days post-hospitalization expenses.
If you don’t have a cashless claim, you should also keep in mind to keep all the bills reports the doctor’s prescription everything in original and duplicate and you should apply for the claim within one month of discharge.
#5 Stay Away From Third Party Administrators
The next point is something related to third party administrators. Now there are some insurance companies which do not have a claim settlement team of their own. So what they do is that they depend on certain other companies which are called as third party administrators to inquire into the claim. Now these third party administrators goes into the hospital checks whether the patient has got admitted or not, what all tests has been done, what are the procedures the patient has underwent. Now that’s the job of these third-party administrators. Now the problem with third party administrators is that they act as a link between yourself, your Hospital, and your insurance company. So if you are raising a cashless claim, it is going to be delayed When a third party administrator has got involved. Your discharge will be getting delayed. You will have to shell out some money from your pocket and the overall experience is not going to be so good when compared to another health insurance company which has its own claim settlement team.
Now this has happened to me when my father got admitted for an angioplasty procedure. Our hospital stay was not a pleasant one, there was a third party administrator involved in our case, and the discharge process got delayed. Even though we had a cashless claim the whole process got delayed because of the involvement of the third-party administrator. So what I recommend is that you should always go with a health insurance company which has its own or in-house claim settlement team.
#6 Top-up and Super Top-Up plans
Now there are some other special plans such as the cancer care plan and there are other topper plans, super topper plans, which you can get in addition to the policies that you’re holding. The topper plans and the superb topper plans will cover the amount in extra of what the sum assured you have been guaranteed. If you have hospital expenses in a year exceeds the amount which your policy has assured, then the super topper plans is going to help you out. The super topper plans will also come at a low premium.
So you should always consider buying a super topper plan if you’re some assured is on the lower side below two lakhs or below three lakhs, and you should always go for special plans such as cancer care plans if someone in your family has already been diagnosed with cancer, if you are at a higher risk of developing cancer in the future.
#7 Give Details About Insurance at The Time of Admission
Now another miss concept which most people think is that, if you disclose about the insurance at the time of admission, the doctors are going to over-treat you they are going to do unwanted procedures, unwanted surgeries and all.
Now this is actually a misunderstanding, because, all the insurance companies have their own team of medical doctors and these doctors are going to check in with your treating doctor whether the procedure was actually required or not, whether the diagnostic test your doctor has written was actually required or not, and for that reason the doctor who is treating you will be on the cautious side he is not going to write unwanted tests or do any unwanted procedures. So, this is actually a convenience. You can actually have a peace of mind because of the fact that you don’t have to spend any money when it comes to a hospital and admission, when it comes to an emergency hospital procedure or a surgery.
So if you haven’t subscribed to a health insurance policy, please do it right now. It is an absolute necessary in this age and if you already have a health insurance policy please let me know which insurance policy you are using whether you are raised any claims and how was your experience after raising an insurance claim.
So I hope you really liked this video, if you haven’t , please subscribe right now and when you do that, please click on the bell icon, so that you don’t miss out on any of our future videos. I will talk to you guys in the next video. Until then it is me Doctor. prasoon signing off. Take care, stay healthy and thank you so much for watching.