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Buying health insurance? What you must know

By Priyesh Shah
Last updated on: August 12, 2009 11:27 IST
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It is said that 'just because you're not sick doesn't mean you're healthy'. We live in a world that is full of uncertainty and ambiguity. Sometimes a seemingly small illness can turn into a major one. Similar is the case with the recent threat of swine flu. It is spreading across India like a bio-terrorist attack and it is affecting more and more people.

Thousands of people are landing up in hospitals and are unaware about the financial consequences which they will have to undergo to protect themselves and their family members.

In such uncertain events, one should always have insurance protection. Health insurance covers are available in different forms like mediclaim, personal accident and critical illness covers. Each of them has unique differentiations and it is important to have the right cover required by you and your family members.

The most common amongst this is mediclaim insurance. Mediclaim insurance doesn't prevent the illness; instead it provides financial support for this illness. 

Mediclaim is an insurance cover which takes care of the hospitalisation expenses arising due to accidents, sudden illness or surgery which is required of any disease which has arisen during the policy period.

Also, domiciliary hospitalisation expenses, pre-hospitalisation expenses up to 30 days and post-hospitalisation expenses up to 60 days are covered. This is indemnity oriented, which means it pays your actual expenses within the limits of the policy. You can make more than one claim in a year, as long as total does not exceed the basic sum assured.

Illnesses for which mediclaim policies will not pay any claim

  • Domiciliary hospitalisation: Treatment of asthma, chronic nephritis and nephritis syndrome, gastro-enteritis, diabetes mellitus, hypertension, influenza, cough and cold, all psychiatric disorders, tonsillitis and upper respiratory tract infection and rheumatism or any treatment relating to illness or disease already in existence at the time of proposal
  • Any disease or injury during the first 30 days of commencement of the policy (accidental injury is not an exclusion)
  • In the first year of cover, cataract, benign prostatic hypertrophy, hysterectomy, hernia, hydrocele, congenital internal diseases, fistula, piles, sinusitis and related disorders or any pre-existing disease or illness, that is not covered during renewal also
  • Vaccination, inoculation, circumcision or cosmetic treatment, plastic surgery, dental treatment, unless requiring hospitalisation necessitated due to the accident or as a part of any illness
  • General debility conditions, sterility, venereal diseases, intentional self-injury, use of intoxicants
  • Any treatment related to pregnancy, childbirth and voluntary medical termination of pregnancy during the first 12 weeks of pregnancy
  • Cost of spectacles, contact lenses and hearing aids

This information will make you aware about the exceptions in mediclaim insurance policy and will avoid dissatisfaction or frustration on your insurance agent at the time of the claim.

Important points in case of a health insurance

It can be a bit of a challenge today to find the right insurance plan for yourself and your family because of the diverse options available. However, when you are choosing a good health insurance plan, don't simply base your decision on the cost of the monthly premium.

Following are some of the points which will help you decide choosing a health insurance plan that is most apt for you:

  • Understand your needs: Know what your needs and your family's needs are when you are deciding on what health insurance to get. Should the health plan cover just you or should it cover you and your spouse? Should it cover you and one child or do you need a health plan that will cover your entire family? Are members of your family in good health? Does anyone have any pre-existing conditions?
  • Good insurance agent: You should screen insurance agents and ask them about their knowledge about health. Also trust those agents who have stood by their clients in case of necessity. There are many agents who practically fail to guide their clients at the time of actually processing the claim and guiding them when it is actually required.
  • Know the details of the health plan: Understand the amount of cover available, number of people covered, nature of policy and claim process. Keep the health policy and health card at easily accessible location.

To conclude, I would like to reiterate the fact that, we all should have adequate health insurance cover even if we are not sick. The cost of future uncertain diseases can impact all your future plans. Let us take adequate protection and try to minimise the financial impact of any such diseases on our future planning.

Illustration: Dominic Xavier

Priyesh Shah is a certified financial planner. He can be reached at

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Priyesh Shah