5 Things You Might Not Know About Health Insurance Policy


4 min read

Updated on Jul 13, 2022

Things You  Don’t Know About Health Insurance Policy

Are you looking for health insurance policy? Read the blog below to know the 5 important things that you might not be aware of about health insurance plans.

For any unforeseen medical emergency, you need the best health insurance policy to get good medical care and support. Especially, in the current situation of pandemics and all, health insurance has become a must have for every individual.

But, there are many technical aspects of health insurance which confuse many policyholders. The insurance terms with their fine details might be difficult for the insured to understand. Though there has been a growing alertness about health insurance among the common public in recent times, these technical hitches might still pose a threat in the way of buying health insurance for many.

5 Things Everyone Should Know About a Health Insurance Policy

So, let us understand these fine details so that procuring best health insurance in India becomes hassle-free for one and all.

Below are 5 such things that you must know:

  1. Rejection of a cashless claim doesn’t mean that your claim is denied – Cashless claim is a facility offered by every health insurance policy provider, whereby the insurer directly pays the medical bills to the hospital to settle a claim. This makes the entire process easy and hassle-free for the insured. However, at times your cashless claim might not be approved by your insurance company because of any reason. But that doesn’t mean that your claim will not be settled by the insurer.  In fact, if a cashless claim is rejected your insurer might settle your claim via the reimbursement method.  So, in this case you will have to pay the medical bills on your own initially and later can make a reimbursement claim for the same. Further, you must note that every insurer has a claim redressal team where you can raise your grievance if your issue is not resolved by the insurer. You can also approach the court of law for a claim settlement complaint.
  2. Hospitalization Charges (for pre and post hospitalization) are reimbursement only – In almost all health insurances, the facility of cashless hospitalization is not offered in case of pre and post hospitalization. For all other things like treatment charges, hospitalization during treatment and other costs you can avail cashless facility. However, for pre and post-hospitalization costs, you cannot have a cashless facility. So, you can have your entire claim settled via cashless claim but the charges of pre-post hospitalization are done on a reimbursement basis. So, you need to keep your bills incurred on such costs safely and apply for a reimbursement claim to get it settled with the insurance provider. Also, even if small you should file for such claims and get them settled easily.
  3. PPN rates is a feature of many health plans –  Preferred Provider Network (PPN) is a feature in which particular hospitals tie up with an insurance company. These hospitals have specific charges called PPN rates specified for different treatments. So, if an insured gets treatment in a PPN hospital, the rate of the specific treatment might be different from that of the normal hospital charges. Here you may note that the treatments that fall under PPN rates mostly offer low costs and thus your bills are low and so is the claim amount. Under such a health plan feature, you can retain a greater portion of the sum insured to make other claims.
  4. Co-pay clause is zone-wise – In India, insurers segregate the different cities of the country as per different zones and tiers. For instance, the zone 1 or tier 1 cities are the main metro cities of the country like Mumbai, Delhi NCR, Chennai, Bangalore and Kolkata. Similarly, cities like Pune, Indore, Lucknow, Patna etc. are in tier 2 or zone 2. Other cities of the country fall in zone/tier 3. So, people buying health policy from tier 2/ 3 cities and availing the treatment in a hospital in tier 1 city might not get the full settlement of the claim. Also, the treatment offered in different cities differ as per the advanced technology used and the cost charged. Metro cities are, of course, more costly as compared to other cities and so the premium charged in such cities are high as compared to cities in zone 2/3. This is because location plays an important part while deciding the premium of a policy. So, if an insured buys a Covid health insurance or any other health plan from a lower zone and gets the treatment done in a higher zone, they are levied with co-pay charges by the insurer to restrict their claim liability.
  5. With time the premium of health insurance increases – This is another fact that you should understand. You cannot expect your health insurance premium to stay the same throughout your life. The premium increases with your age, as you move from one stage of life to another. Also, premiums are charged as per your claim experience. You can avail NCB discount for not availing a claim during a policy year or might get your premium increased if you have made any claims during the previous year.

Read More: Things That Are Not Covered Under Health Insurance Policy 

To Conclude 

So, were you aware of all these hidden aspects of your health insurance? You must note that you should be very well versed with your health insurance policy to be aware of what to expect from your health plan. So, keep these points in mind while you look for a policy to buy. Also, you must understand the claim policy and health insurance claim ratio well to have good knowledge of the claim process to make it a hassle free experience.

Further, while looking for a health insurance plan make sure to buy the plan with the best claim settlement ratio in health insurance.

Jun 12, 2022
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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 17 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.

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