For a hawk of health insurance business, convolutedness of the insurance cover is not a hard nut to crack but for a gullible buyer, it is not a facile task to comprehend its intricacies. Amid growing awareness for the insurance coverage due to the high cost involved in medical treatment at super speciality hospitals, InnoHEALTH magazine interviewed seasoned player of the insurance discipline Mr Sethi, Vice President Insurance Foundation of India and sought answers for simple queries by people.

Mr. Sethi, who is closely following recently announced National Health Protection scheme by the Union government for ten crore poor people and enthusiastically await roll out of the full scheme, said it would herald a new era in the health sector as the country has pan India facilities to implement the plan, but “ only little bit intelligent planning” is warranted.

Also Read: Ten Crore Poor People to Get Health Insurance

EXCERPTS ABOUT INSURANCE

How is the Health Insurance Premium determines?

It depends on the age, sum assured, whether a person to be insured has any pre-existing disease or adverse health conditions. The rates are fixed (approved by IRDA) and are available in the brochure published by the insurance company.

My employer provides me with health insurance coverage. Is it advisable to take another policy on my own?

If the sum assured is good and the company is doing fine then you should think positive and do not go in for the additional sum. When you plan to leave the organization then you must verify from the new employer whether they have suitable sum assured available for you as part of compensation package. If no health insurance is available, then you must buy Health Insurance immediately so that 30 days cooling off period of the new policy (purchased by you) is matching with last 30 days with your employer. Try to have this health insurance from the same Insurance Company.

Will the agent be helpful in settling of claims in future?

Yes, your agent will be helpful. But he is getting 100% of his income from the insurance company and he may be getting .001 % of his income from you. If he has to make a choice, it is natural that he will favour Insurance Company. You are the best person to decide whether to buy directly from the company or through an agent. Theoretically, the agent is supposed to help you in claim settlement, but time will tell when the claim is to be lodged. Be positive and buy it through an agent but better buy through an Insurance Brokerage Firm as it offers a wider choice and is large enough to protect your interests.

How much should you invest in health insurance?

You have to invest according to your health the requirements and the resources you have. You can invest by deciding about your budget for health insurance. If your budget is not a constraint, you can invest by deciding about the sum assured and services required by you.

I might be laid off soon. Should I see my doctor before I lose my insurance?

No purpose will be served by seeing your doctor. You should consult an Insurance Brokerage Firm and buy a health insurance, the policy which should be issued at least 30 days before your last day in your present company. This protects your interest.

Will my health insurance coverage Clinical Trials?
We feel that if treatment is;
1. Part of hospitalization in a reputed hospital like AIIMS, capable of conducting clinical trials under controlled conditions.
2. Under the supervision of a reputed doctor
3. Medical Council (Ministry of Health) approves clinical trials

Then it will be payable. If it does not fulfill these conditions, then you may have difficulty in getting it paid as the issue is around treatment as well as the price of the medicine.

I own a pet and my vet bills are sky-high. Is there such a thing as health insurance for animals?

It depends on a pet. But definitely, it is not part of Health Insurance policy which is for human beings only. Cattle Insurance covers cow and buffalo.

Should I pay my premiums through the agent?

If he is ready to provide you with the service – yes. It is your duty that cheques should reach the insurance company well in time. Not picking up on the cheques by the agent is no excuse. If your cheque has not reached the insurance company on time, your policy may have a break and you may lose the benefits. You can also pay the premium online.

I already have a health insurance policy. Should I still buy a life insurance policy with the riders?

Health Insurance Policy covers your hospitalization needs. Life insurance covers your retirement needs. Adding of critical illness rider will take care of incidence of you getting a critical illness like cancer. Every product is different and fulfills different needs. Study it carefully and make a decision.

Are the new clinical and pathological tests, not available in India and done abroad covered under the mediclaim rules of the country? If no, are efforts being made to do?

Some insurance companies permit you to take the opinion. Your suggestion is very good, and we feel Insurance companies will start offering the same. If the Textile industry is permitted to get flammability tests done on garments in Hong Kong then why Insurance companies should not permit clinical and pathological tests (not available in India), which are to be conducted in the foreign country.

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