Read The Fine Print Of Your Mediclaim

Published: 15th June 2012
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• Are medical conditions excluded?
• Are special conditions covered?
• Are regular medical expenses included?
• Are there age limits?
• Are there hospitalisation clauses?
• Is your hospital in the TPA Network?

You have made the right decision of going in for medical insurance, protecting your interests in the event of illnesses to you or to your family members. You would need health cover to ensure that you are not taxed exorbitantly when you have health issues bothering you anyway. Your health insurance policy is an important piece of document that would give you financial freedom just when you needed it the most. However, how familiar are you with your mediclaim document? How much have you familiarised with the terms and fine print of your health insurance policy? And how does it impact on your health cover?

Here are a few aspects that you need to check for, before you go in for your medical insurance.

What are the exclusions? Your health insurance policy could come with exclusions and it is important to know where you stand with regard to the excluded conditions and clauses. Check if you are covered for the diseases that you may develop in the first year of your medical insurance, see if pre-existing conditions are covered and ensure that your health cover has not left out any surgery or other treatment options for specific health conditions and illnesses.

Are special conditions covered? If you or your dependants are likely to incur pregnancy related expenses, check if your mediclaim document has included coverage for pregnancy-related illnesses. It is a similar case with chronic illnesses as in the case of arthritis or Tuberculosis, which may well be exempt from being covered by your health insurance policy.

How about the regular expenses? Sometimes, you may not have cover for routine medical care, the costs that you would incur on medicines or the amount that you would have to shell out on OPD calls and expenses. See if your health cover is inclusive of such expenses, if you are prone to certain conditions in the category.
Are there age limits? You cannot take things for granted when it comes to the fine print of your mediclaim document. Your health insurance policy comes with strings attached and you need to be sure that your elderly parents are not excluded on account of age limit clauses.

What are the clauses in hospitalisation? Now, that’s something that should catch your attention when it comes to your medical insurance being of use to you. Your health insurance policy may stipulate a minimum number of days of hospitalisation that you need to take into account before you decide on health cover. You may also want to see if there are restrictions and limits on room rents that you may be eligible for, as these could also have implications on the total expenses that you can incur on your illness.

Which hospitals are covered? If you have a favourite hospital, you need to check if your medical insurance has recognised it for your health cover. You may not want to discover after you have finalised on your health insurance policy that your hospital is not on the Third Party Administrator (TPA) network or that you may not be able to avail of cashless mediclaim with your existing medical insurance.

These are but some of the clauses and conditions that you would have to look out for in the fine print of your mediclaim document before you could go ahead with your health cover. Your health insurance policy is much more than what you see underlined and highlighted in bold.

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