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⁠Hidden Clauses in Your Health Insurance that You Need to Know

We all know that health insurance policies offer a long list of inclusions. However, exclusions are also a crucial aspect of every policy.

 

Overlooking policy documents can surprise you with hidden clauses that you didn't even know existed. To avoid such unpleasant situations and unexpected expenses during medical emergencies, it is crucial to uncover hidden clauses your health insurance policy may contain. When you buy health insurance online, make sure to know all about the policy before signing the document. 

From least known exclusions to waiting periods and conditions in the fine print, hidden clauses can affect your overall experience. To help you out, here are the top hidden clauses of a health insurance policy that you should know. 

Least Known Hidden Clauses in Health Insurance Policies

At first glance, a health insurance policy appears to focus on sum insured, coverages, ease of claim processes, and affordable premiums. However, there's much more to discover before you sign the papers.

Some of the hidden clauses that you may be least aware of are:

1.Sub-limit on Specific Diseases

Health insurance providers may have a list of specific diseases. These diseases may have sub-limits. This means you can up to a specific sum insured amount for the treatment of these listed diseases. 

For instance, suppose the sub-limit in a ₹10 lakh health insurance policy is ₹1 lakh or 20% of the claim amount for listed diseases. Now, if the insured individual requires treatment for any of the listed diseases, the maximum amount they can claim is ₹1 lakh or 20% of the sum insured. 

2.Room Rent Limit

Similar to listed diseases, hospital rooms may also have sub-limits. In such a situation, you can claim only a certain amount for the room rent. For instance, if the room rent sub-limit is ₹ 2,000 per day, any charges exceeding ₹ 2,000 will be payable by the policyholder. 

3.Co-Pay & Deductibles

Copayments and deductibles are two clauses that require the policyholder to pay. The copay is the portion of the claim amount that the policyholder is responsible for. Deductibles, on the other hand, is the amount that the policyholder has to pay before the insurance company starts paying. 

For instance, if the deductible is ₹5,000, the insurer will cover medical treatments exceeding ₹5,000. On the other hand, if the co-pay is 20%, you, the policyholder, will be responsible for bearing 20% of the total claim amount. 

4.Cashless Treatment Limitations

Cashless treatment is a preference of most people. With cashless treatments, you no longer have to bear the expenses and later raise reimbursement claims. Rather, the insurance company directly settles bills with the hospital. 

However, cashless treatments are usually available at select hospitals. If you seek treatment at a non-network hospital, you can only raise reimbursement claims. 

5.Waiting Period

The health insurance coverage do not start providing coverage from day 1 of the policy. That's only applicable for accidental injuries. Other than this, you need to wait for a specific tenure before you can raise claims. 

For instance, a policy may have an initial waiting period of around 30 days, a pre-existing disease waiting period that ranges between 12 and 48 months, a maternity waiting period that ranges between 9 and 36 months, and a specific illness waiting period of 12 to 48 months. 

You can only raise claims after the waiting period is over, or else the claims are rejected. 

6.Excluded Treatments

A health insurance plan does not cover all types of treatments. Apart from common exclusions like self-inflicted harm, war injuries, intoxications, etc., some other treatments may also be excluded. 

Depending on the type of health insurance policy you have, cosmetic treatments, infertility treatments, gender alteration treatment, etc., may not be covered. Some non-maternity health insurance policies also exclude maternity and childbirth expenses. 

How to Know About Hidden Clauses?

Since health insurance policies may have various hidden clauses, how can you debunk them? Following basic hygiene and tips can be enough. These are:

1.Read the Policy Documents

Before signing the documents, ensure you read them carefully. You must do it even if it seems boring, lengthy, and time-consuming. Health insurance is like an investment. So, do it wisely. 

2.Ask Questions

Do not hesitate to ask as many questions as you have to your insurer. If you do not understand a clause or term, remember that your insurer is there to help you. 

3.Understand Exclusions & Copays

  • Be very clear about the policy's exclusions, copayment, and deductible clauses. These can make a huge difference in the overall premium. 
  • A higher copay and deductibles mean lower premiums and vice versa. However, higher copay and deductibles also means higher claim burdens during times of need. 
     

To Conclude

 Young and healthy? Find out which of these plans rewards you with lower premiums. Click here to check now!

Author Bio

Paybima Team

Paybima is an Indian insurance aggregator on a mission to make insurance simple for people. Paybima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 21 years of experience. Paybima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

Over to You

Health emergencies don’t come with a calendar invite. Whether you're planning for your own future or looking out for your parents, choosing the right health insurance plan can make all the difference. That’s where a deeper look at the fine print helps. When you compare Star Health’s Red Carpet Plan vs Care Health Enhance Plan, what you’re really doing is choosing the kind of financial backup you want in your corner.

The Star Health Red Carpet Plan is made with senior citizens in mind. With benefits like annual preventive check-ups, it helps you or your ageing parents get covered without the usual hassles. On the other hand, the Care Health Enhance Plan acts as a top-up cover, ideal if you already have a base health policy and want to increase your shield without increasing your premium by too much.

While health insurance takes care of medical needs, don’t forget to plan for life’s bigger what-ifs. A term Insurance policy, especially a 1 crore term insurance plan, can be the long-term security net your family needs. Health and life coverage go hand in hand. And when chosen right, they help you face the future with confidence, not chaos.
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