For instance, while most health insurance policies exclude cosmetic and sex change surgeries, a few others include such health issues as well. Similarly, in some medical insurance policies, pregnancy may not be covered, while others may cover it.
Take a look at some crucial terms that you may spot in your policy document.
Day care treatments
Often you would have come across a term called “day care treatment,” which many of you do not understand. Let’s simplify this term in your policy wordings so that it becomes easy to understand it.
Day care treatments comprise of a surgical procedure or medical treatment that is done under local or general anaesthesia. This is performed in a day care centre or hospital within 24 hours. The spontaneity of such treatments can be attributed to technological advancement.
Whether you receive the medi-claim or not totally depends upon whether you are an in-patient or an out-patient. If you are an out-patient, you can get the check-up done on common diseases in OPD and leave immediately after visiting the doctor. You can receive medical benefits through insurance policy if you choose to become an ‘in-patient’ and get admitted for just 24 hours.
Let’s understand this with an example.
Angiography is usually done to check the blockage of heart arteries and values. This medical procedure is usually termed as an “operation” or “surgery” by the hospitals. However, due to technological advancement, you can get it done within a few hours, post which you can be discharged.
As this procedure is expensive, people try to get their angiography expenses covered in medical insurance under day care treatment clause.
Understanding Special conditions
Many people fail to understand why their medical policy did not cover a disease that was diagnosed in the hospital. The answer lies in the term called “exclusion of pre-existing disease.” If you have been admitted to a hospital for the diagnosis or treatment of a medical condition that you have been suffering for years, it shall not be included in your medical insurance.
Pre-existing diseases are covered by the health insurance policy companies only after 48 months of the continuous coverage of the yearly sum insured of Rs. 1 lakhs and Rs. 2 lakhs for remaining period of 24 months.
Specific Ailments and Waiting Period-
The list of ailments covered differ from one insurance company to another. There is a waiting period of 24 months before you claim money for certain treatments and illnesses. Some of these ailments can include cataract, kidney stone, all kinds of hernia and many more.
To successfully claim your medical expenses from your insurer, it is important that you skim through your policy document. Read carefully and understand the terms that have specific or certain implications. If you fail to understand something, do not hesitate to ask your insurance provider.
Lack of knowledge is equal to zero knowledge
Zero knowledge is equal to ignorance
Ignorance is equal to your loss
That’s why is it important to stay updated on all essential terms mentioned in your policy document.
You never know when life could pull you down with medical bills and expensive medical procedures. Having a health insurance policy always comes handy at the right time.