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Private
Sector Options
If you prefer private sector insurers, you have Iffco Tokyo, Tata
AIG, Reliance General Insurance, Royal Sundaram, and Bajaj Allianz
to choose from. Most polices resemble Mediclaim's, though the minimum
assured sum is higher (Rs 1 lakh, typically). Otherwise, these insurers
set themselves apart by throwing in some extra services, such as
24-hour helplines, discounts on health checkups, free ambulance
facilities and online access to your family's medical history, apart
from information on hospitals, illnesses, and medicines. Some seek
to exploit the big crack in Mediclaim's armour: the fact that you
must pay your bill first, and then claim the money. ''The key feature
of our Health Shield product is the cashless facility available
through a nationwide network of over 135 hospitals in 25 cities
across India,'' says Antony Jacob, Deputy Managing Director, Royal
Sundaram Alliance.
As of now, all health policies are entitled to tax rebates under
section 80D of the Income Tax Act, though whether this continues
is still under question.
Private insurers also offer life
insurance policies with 'health riders'. But remember, says Sam
Ghosh, Managing Director, Bajaj Allianz General Insurance Company,
that riders cover only 'critical ailments', a rather short list
of popularly perceived scares.
Check Before You
Buy It's important that you read the fine print on any policy before
signing on. Check for coverage exclusions, first and foremost, and
be clear about definitions of such terms as 'disabled'. ''Medical
cover in India is really a sickness cover and not strictly a medical
cover,'' says Dr. Nayan Shah, Managing Director, Paramount Health
Services, a third party administrator (See Here Come The TPAs).
Let alone common ailments, don't expect any coverage for dental
treatment, pregnancy abortion, renal dialysis, psychiatric help,
or general debility and prior health problems.
Then there's the fine print on making claims. For a planned surgery,
the insured might have to inform the insurer at least three days
in advance. An emergency hospitalisation claim must be filed within
two days of discharge, with all paperwork in. A word of caution:
claims can be rejected for incorrect medical information provided
at the time of taking the policy. Honesty, as ever, remains your
best policy.
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They make life easier for both the insured
as well as the insurer.
Another acronym to bother about, but they could save everybody
a lot of bother, too. TPAs are third party administrators. They
are intermediaries appointed and paid by insurers (and approved
by the Insurance Regulatory and Development Authority) to smoothen
the settlement of claims. ''All an insured has to do is call
us and inform us about the medical need. We arrange for the
admission to one of the wide network of hospitals in most main
cities across the country, and the consequent treatment, with
the insured having to pay nothing out of his pocket," says Dr.
Nayan Shah, Managing Director, Paramount Health Services, a
TPA working for several insurers.
What service do they provide insurers? First, validating the
genuineness of the illness, and second, negotiating with hospitals
for competitive bulk deals. |
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