Buying a mediclaim policy? Things to watch out for

Drop us a line and our expert, Harsh Roongta, CEO of Apnapaisa.com, will answer it.

Please write to us at getahead@rediff.co.in with the subject line as: Health insurance query.

Given below are five questions most frequently asked by a large number of our readers.

What is the ideal health insurance coverage?

The sum assured can be decided based on the number of family members you need to cover under the policy and their age. You also need to estimate the cost you expect on the treatment in case of any hospitalisation and the amount of premium you are willing to pay.

While calculating the cost of hospitalisation you should keep in my mind the city you are staying in, the hospital you would like to get the treatment and various other factors. Given the rise in hospitalisation costs it is essential to have a cover of at least Rs 3 lakh each for every member in the family. Visit this link to understand why you should preferably go in for an individual cover for each family member and not a family floater (http://www.apnainsurance.com/health-insurance-india/indiviual-floater.html).

Apnapaisa is a price comparison engine that allows consumers in India the ability to compare the EMI, interest rates and other fees for home loans, car loans, personal loans, business loans, credit cards, compare online quotes and features of life insurance, health insurance, car insurance, travel insurance and other general insurance policies in India.

What are the hospitalisation covers available? Does it include pregnancy and how to avail of such health covers?

We are not an insurance provider or insurance agent, we help you to compare various insurance products and empower you to make a right choice.

Apollo's easy health individual-premium offers maternity however with a waiting period of 6 years for a maximum sum of Rs 15,000 (normal delivery), Rs 25,000 (Caesarean delivery including pre/post natal limit of Rs 1,500 and new-born limit of Rs 2,000) for sum insured of Rs 3 to 5 lakh and for a sum insured of Rs 7.5 lakh, the maximum amount is Rs 25,000 (normal delivery), Rs 40,000 (Caesarean delivery including pre/post natal limit of Rs 2,500 and new born limit of Rs 3,500).

I am 50-years-old and working in central government. I underwent angioplasty in 2006 and my office paid for the expenses. Whether advisable to have health insurance for future?

It's always good to have an additional health insurance policy. Due to changing circumstances you may not necessarily work in the same organization in the future, and your new company may/may not offer any health cover or may have a lower health insurance cover.

Also, on your retirement, if central government health insurance is not available or available only for a limited sum then it would be difficult for you to get a cover at an advanced age. Hence it's always good to be well equipped than arranging for huge money at times of crisis, as illness or hospitalisation never announce their arrival. However make sure you disclose your entire medical history and pay additional premium if needed in this account.

It is also possible that heart related problems might not be covered for the first 4 to 5 years of the policy that you take. You may also have difficulty getting a mediclaim policy in the first place.

I am 23-years-old. Want to take mediclaim for parents? How to do that and can I claim tax benefit for the same?

It is always advisable to have separate individual cover for your parents, as over the years claims are likely to be significant. You can get a separate deduction of Rs 15,000 (Rs 20,000 if any of your parent is 65 years or above) for the premium paid on the policy of your parents.

I am 42-years-old having wife and 2 children. Working in central government office. Have office medical reimbursement facility in the present place of posting. Want to go for a health insurance for the entire family. The insurance should be have the following characteristics like 1) low annual premium 2) available for all hospitalisation 3) all diseases 4) doctor's fees 4) medicines 5) all clinical check up 6) validity throughout India 7) should be available at all hospitals in India.

The kind of policy you want does not exist. All policies have certain permanent and temporary exclusions.

Common examples of permanent exclusions are hospitalisation exemption for HIV/AIDS or sexually related diseases, losses due to act of terrorism, non-allopathic diseases, and radioactivity from nuclear waste from the combustion of nuclear fuel. Temporary exclusions are normally hospitalisation expenses incurred on or after 30 to 90 days of the policy such as cataract, hernia, dialyses, etc.

Also they cover costs of hospitalisation only (pre-hospitalisation expenses leading to hospitalisation and post-hospitalisation expenses related to the stay in the hospitals are also covered for a limited period).

Most policies will exclude hospitalisation costs arising from pre-existing diseases.

Most policies of course tend to be valid across the country and will also cover eligible expenditure incurred in any validly registered hospital (although cashless facility may be available only for a limited number of hospitals). Most policies will cover doctor's fees and medicines paid during hospitalisation though some have a sub-limit of these expenses within the over-all limit. Very few policies cover expenditure incurred on an outpatient and that too up to very small amounts only.