Understanding Policy Clauses In Health Insurance

The clauses that are related to limitations and exclusions may seem complicated at first but it is crucial to understand these before signing up. There could be some exclusions and limitations that may not affect you or your family at all while some may be important depending on your health history and hereditary family history. So while what is excluded for one person may not make a difference, it might make a huge impact for another. That is why it is important to understand what these are and how they impact and relate to you as an individual and to your family in general.

Exclusions are those conditions or expenses that are not covered by the insurance company. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it should ever arise. Some insurance companies will also impose a sub limit that is within the sum insured overall. Exclusions are those expenses that the insurance company need not pay for. The IRDA has standardized this with a list of expenses. There are also different waiting periods for different conditions.

One of the common exclusions for health insurance are pre-existing diseases. This is because the entire premise of insurance is based on uncertainty so if there is a disease that you are already suffering from, it will not come under the insurance. Usually, you can get insurance companies to cover you for a pre-existing disease after a specified waiting period is over.

Another thing that is excluded is pregnancy and expenses related to childbirth and later vaccinations. There could be a waiting period for pregnancy as well, after which there are some benefits that could be availed. Other things that are excluded from a health insurance policy are cosmetic surgeries, dental surgeries, alternative treatments such as Ayurveda and homeopathy, etc.

Sub-limits are another factor which should be carefully looked into at the outset before investing in an insurance policy. A sub-limit is related to exclusions that are associated with doctors’ fees, ambulance costs, rent for hospital rooms, etc. Knowing your sub limits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay for out of your own pocket.

There are policies which seem to have a whole list of exclusions and sub-limits and there are those that have a moderate amount of them. So knowing what is excluded and what is not will help you make a better decision regarding which health insurance to choose. This can be done easily by doing a systematic and meticulous comparison of health insurance policies taken from different websites or from the agents directly. Knowledge is power and knowing this beforehand helps you in better planning your future and that of your family.

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Ensure Financial Stability By Picking The Best Health Insurance Policy

With the rising medical cost, health insurance has become indispensable. Today, costs of medical treatment has reached at an all time high and are expected to rise even further. Absence of health insurance can cause a major setback to your financial condition. Medical emergencies like accidents, sickness or disease which may lead to prolonged hospitalization can bring you in severe financial crisis. A comprehensive health insurance individual policy provides coverage against the expenditure caused by unforeseen medical emergencies.

When it comes to buy a health plan for yourself, there are two common mistakes that people generally commit:

1. Often people don’t purchase an appropriate health policy at the right time. When met with an accident or any other disease, they come to realize their mistake and to over-compensate it they buy too much of insurance, which may or may not be that much useful for them.

2. A majority of professionals are provided medical insurance plans by their organizations. Employees are very much dependent on such covers to counter their health emergencies and fail to evaluate their health insurance requirements.

Importance of Personal Health Cover

1. Insurance Cover Provided By Present Health Care Policy

Most of the companies provide a basic health cover to its employees which may cover individuals from minor illness, giving a decent amount of coverage. Often this amount is insufficient in times of a major emergency. So, it is necessary that individuals prepare themselves for any health contingencies and get an health insurance individual policy.

2. Validity Of Insurance Provided By The Organization

The insurance plan provided by the organization is valid upto the time you are associated with the organization and lapses once you leave it. In case of retirement, job change or job loss, individuals have no health insurance cover and have to liquidate their assets or savings to meet any medical emergency. This may also affect their budget and further financial plans.

3. Tax Benefit

Opting a health cover also helps in tax saving. The amount paid for insurance premiums are eligible for tax deductions. Individuals with 65 years or below of age can claim a deduction of Rs 15,000 against the insurance premium paid for themselves, or for their parents, spouse or children.

Early Benefits

Buying a health insurance individual policy while one is young is cost-efficient and free from medical complications. Getting an insurance cover at an early age requires less premium and offers comprehensive coverage when compared to a health plan purchased at a relatively older age. The cost of the cover increases as the individual grows older. Besides, if one develops health issues, the insurance company excludes pre-existing conditions which demolish the purpose of buying a personal health insurance plan.

In addition, there are several insurance companies that set an upper age limit for their policies. This means the individual will have access limited options after retirement. Further, if the individual renews the insurance plan without asking for any claim, he can enjoy the profits of cumulative bonus in the form of no claim benefit.

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Important Points to Ponder Before Buying a Health Insurance Plan

A health insurance plan is an essential part of financial planning in this era of skyrocketing medical costs. Medical inflation has been aggravating at its full spree which makes it all the more important to buy a Health Insurance plan which could sponsor the hospitalization and medical treatment bills or expenses.

It is important to evaluate and look for the following parameters to get a best health plan for you and your family.

1. Check for the Waiting Period Clause

You must be feeling care free after taking an insurance, but your health insurance comes with a waiting period clause for specific conditions. There is an initial period clause which says that any hospitalization claim will not be admissible in first 30 days of the policy commencement apart from accidental hospitalization.The pre-existing diseases or conditions are also not covered immediately after you purchase a policy.There is a waiting period ranging from 2 years to 4 years as per the plan conditions in the industry. Also, there are certain surgeries and treatments like hernia, cataract, joint replacement, etc. which can be treated after a specific waiting period of 1 or 2 years.

So,it is important to check the waiting period clause before you finalize the health plan.

2. Check for Sublimits

There are certain capping or sublimits in your health plan which says that the specific kind of expenses are paid by the insurance company upto a specific limit and beyond that the insured or customer has to bear them at his own. For example: Room rent charges are capped on per day basis for different health plans. Some health plans also come with a mandatory co-pay where the portion of the admissible claim is to be borne by the insured and the remaining is paid by the insurance company.

Check for the sublimits in your health plan to avoid any last minute surprises at the time of claim.

3. Check for Network Hospitals

The insurance companies offering health plans have certain empaneled network hospitals with whom they have a tie up. Any hospitalization or treatment taken in the mentioned or specified network hospital list is done on the cashless basis subject to policy conditions.

Check for the list of network hospitals of insurance company and ensure you have network hospitals of the insurer near your place of residence in case of any emergency hospitalization. Also, a treatment in non-network hospital may not offer cashless treatment and some insurers have a co-pay clause if you take a treatment in non-network hospital.

4. Check for the Claim Process

Different insurance companies have different claim procedures. Some settle or administer claims through Third Party Administrators (TPA’s) and some have their own in house claim settlement unit to foster quick and hassle free claim processing. Also, check the claim settlement ratio of the insurer you intend to buy a health plan from to have a clear picture on the number of claims settled by the insurer.

It is important to have a handy information on claims procedure to have a smooth and hassle free treatment in the times of hospitalization.

5. Compare & Buy Online

It is important to take a right buying decision which can be done by comparing the available health insurance plans online. You can compare the price, key features, policy benefits, value added benefits, eligibility, exclusions,etc. of multiple health insurance plans to make a right informed choice of your own without any interference of the agents. Buying online health insurance plan is a hassle free process which required least documentation and quick policy processing. There are certain online portals which will enable you to make an easy comparison and will assist you in choosing the right Health insurance plan.

Online buying of the health plan is economical as companies offer discounts on premium for buying a policy online. The reason for an insurance policy to be cost effective if bought online is because the intermediary cost of the premium component is removed. When there is no intermediary in between, Co.’s save on the commission and policy issuance cost, which the Co. transfers it to the customers.

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Should You Join A Prepaid Legal Plan Service?

A legal plan service or membership program, is a concept that has been around for a number of years. Legal plans became popular in Europe in the 1930′s, and they remain popular and well-known there today. In America, legal plans have also become increasingly popular, as more companies have offered different plans, and individuals and business have seen their value. Legal plans work by providing basic coverage and attorney services for a membership, or a prepaid fee, that is usually paid monthly or yearly. By paying the membership fee, you have access to an attorney and their services, where without the plan you would have to pay, in some cases, a substantial fee. Having a legal plan service can make good sense, but it won’t solve all your legal issues.

Most of these plans focus on preventative legal care, so you can get legal assistance and advice before you start having legal difficulties. They also cover some basic issues that many individuals or businesses need legal assistance with. You will be able to have a free consultation with an attorney at no additional cost, often initially by phone. You can usually call the attorney on as many different legal issues as you want, you will receive a free consultation for each question or issue. This can be a powerful tool, as you can often get many of your legal questions or issues handled this way.

Other services are also included in legal plans. Normally a free will will be included, with yearly updates. Many plans will also write a letter or a make a call on your behalf. This is a valuable service if you are having a dispute, as an awareness of attorney representation can clear up many issues with a 3rd party. In addition, you will also have coverage for contract or document review, where your attorney will review documents, such as agreements or sales contracts, and answer any of your questions. If you need more legal assistance, such as an appearance in court, or extra legal help, you will get a discount on the attorney’s hourly fee.

There are a variety of legal plans available. The most basic plan is the individual or family plan, but many legal service plans also offer business coverage, where they provide basic legal services tailored for a business. There are even more specialized legal plans available, such as one designed just for truck drivers. A great way to join is to see if you workplace offers a plan as an employee benefit package, many do. In many cases, you can join for free or reduced cost.

There are some limitations. Prepaid legal services are not designed to solve preexisting or ongoing legal issues. There focus is on preventative care and access to an attorney for a consultation. If you have a major legal issue, such as a law suit, a divorce, or bankruptcy, a legal plan will be of limited assistance, although you will probably get a discount of the hourly rate you would normally pay an attorney. A legal plan service is a way for middle class Americans to have the access to attorneys that used to be the province of the wealthy. Having a plan is a great way to help keep yourself out of legal trouble with preventative assistance, but it won’t solve all of your legal problems.

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