5 Hidden Things in Health Insurance Fine Prints that you Should Know

A health insurance policy is advantageous for many as it provides them with an array of benefits. However, if you want to use your health plans, you may often face unpleasant experiences because most health insurance plans conceal real costs in the fine print. So, many times your claims may be either partially accepted or entirely rejected because you don’t know how health insurance works. So, you should understand the policy terms and conditions before purchasing a policy.

Here, we are focusing on 5 hidden things in your health insurance fine prints that you should know before opting for a policy. If you have a scant idea regarding how to choose health insurance plans, then this article will give you an idea of which terms and conditions you need to watch for.

Cashless hospitalization

If you are wondering how to buy health insurance policies, always choose a policy that offers you cashless hospitalization. Under a cashless facility, you don’t need to pay anything for your treatment; rather, your hospital bills are settled directly by the insurer with the network hospital. But in reality, cashless hospitalization is hardly cashless. Therefore, in some situations, you may not get the advantage of a cashless facility.

• In the case of a medical contingency, you may not get admitted to the network of hospitals of your insurer. So, at first, you need to pay your bills, and later, you can claim reimbursement.
• For an unplanned treatment, when you visit your nearby network hospital, your treating doctor couldn’t diagnose your condition, and so the hospital can’t provide all the required details to your insurer. As a result, the insurer may reject or partly accept your claim due to insufficient information. This means you need to pay a certain amount from your end.
• Some hospitals take a lot of time to settle cashless hospitalization. However, if you are critical, you can’t lose any time. So you pay upfront.
• When you and your treating doctor don’t fill a pre-authorization form on time, it will reach your insurer late. You need to intimate your insurance company once you get admitted to the hospital. Once you fill up the pre-authorization form, your insurer will decide if the admission will be cashless.

Sub-limits

Every insurance policy comes with a sub-limit clause. Your insurer will decide how much money it will pay to the insured policyholder for a certain treatment. These are called sub-limits. Most policyholders often overlook all limits and sub-limits on treatments. For example, if you purchased a policy of Rs. 2 lakh and need an appendectomy, your insurer will only offer the cost of treatment up to Rs 30,000 (according to the sub-limit clause). But if you purchased a policy of Rs. 5 lakhs, your insurer will give you Rs. 40,000. The remaining amount needs to be paid from your end. To keep the claim values low, insurers often impose these sub-limits. Because the more you claim, the company will lose more money.

Non-payables

Non-payable is another fine print in your health insurance policy. Non-payable expenses are included in your hospital bill, but the insurer will not bear their costs. These non-payables are housekeeping, PPE kits, face masks, examination gloves, crepe bandages, surgical items, bedpans, entrance passes, documentation charges, etc. For the COVID-19 treatments, private hospitals used to charge lakhs for these non-payable items. Every insurance company will give you a list of non-payable items in your policy.

Usually, non-payables contribute only 10% of your total hospital bill. But in this COVID-19 pandemic, people paid between 25% to 50% of their hospital bills as out-of-pocket expenses. This is because hospitals are free to decide their charges on these items. In unanticipated situations such as the pandemic, a patient can’t negotiate with insurance companies over the policy unless the government interferes and decides a fixed price for every consumable.

No-Claim bonus

You are eligible for a no-claim bonus if you don’t claim anything from your insurer in a policy year. You will either get a discount on your premium or will get more coverage at the same premium for every claim-free year. Generally, this bonus doesn’t exceed the sum insured. So, you will get this bonus from your insurer for every claim-free year till the bonus reaches its limit.

If you make a claim on your insurance, your bonuses would be reduced (usually 10%) or even removed entirely for that year. Therefore, your bonus will be lessened, but your base sum insured will remain the same.

Wellness benefits

Most health insurance policies come with wellness benefits. These benefits reward you for taking up healthy habits like quitting smoking, joining a gym, or getting regular preventative health check-ups. Sometimes, insurance companies also assign a wellness coach who will monitor your health conditions. Every insurance company has a list of things that they consider healthy habits. If you perform an activity from the list, you will get the point for wellness.

• Many people don’t incline to use wellness programs. When they don’t have any symptoms or ailments, people are not interested in tests.
• For these wellness benefits, an insured person must conduct much paperwork to save medical bills and request reimbursement.
• You will get a very low point for each wellness.

These are the top 5 hidden things in health insurance that you should be aware of before purchasing a health insurance policy. Always read the terms and conditions properly and then make your decision. If you are still confused or don’t have adequate knowledge on how to buy medical insurance, you must consult with a financial expert.