You have the pre-existing condition of diabetes and recently renal complications have added up and your doctor has stated that you require an in-patient care. As you have health insurance coverage, you will not have any worry about finances. But, when you reach the hospital, a big shock awaits you as you get to know that your insurance does not cover complications related to diabetes. To avoid these sudden shocking things, it is important that you will have to get some doubts clarified from your health insurance company.
In the present situation of increasing medical expenses, it is important that you should have a health insurance coverage for averting any financial disaster. But, the coverage varies from one company to another and one policy to another as well. So, before taking a policy, it is important to get certain clarifications like those mentioned below:
Does the policy cover accident, outpatient treatment, ambulance expenses, surgical expenses and maternity care?
Even though, most policies cover accidents and surgical procedures, they do not encompass outpatient treatment, maternity benefits and ambulance expenses. So, it is better to get clarified in this regard. Also, ask about the amount of coverage. For instance, some companies provide coverage to maternity expenses, but they limit the same to a low percentage of the total coverage.
What is not covered?
Generally, treatment expenses for some health issues are not covered for the first year of the purchase of policy. They offer coverage generally after a waiting period of 48 months. Also, the list of health issues covered will differ from one policy to another. So, identify the coverage that will best suit your requirements and most of the insurance companies, do not cover pre-existing conditions. So, it is better to get a complete understanding of what is covered and what is not. Most do not cover intoxicating alcohol and drugs, aids, venereal diseases, general debility, cost of specs and hearing aid.
What are the additional benefits covered?
Some policies offer additional benefits like surgical expense benefits, critical illness benefits, hospital cash and other special and additional benefits. These may come along with your policy or they should be purchased separately. Even, some policies pay for specific expenses related to general health check up one time in a few years and you can ask whether such a facility is available.
How is premium determined?
In general, most of the insurance companies take age as an important factor in determining the premium to be paid by the policyholder. The older an individual is, higher will be the cost of premium as old aged people are more prone to illness as against younger people. Another determining factor is the previous medical history. For those without any pre-existing condition, premium will be lower and if you do not claim the money for a number of years, some companies may also give certain discount on the premium as well.
So, to avoid future problems, it is better to get the above-mentioned clarifications with the insurance company before taking a policy.