Common Myths Regarding Health Insurance-

Health insurance is a complex product with a host of legal terms and conditions. We would like to understand these terms without being bombarded with complicated information and technical language. In our busy lives the best way to gain knowledge is in bite size amounts. So, SANA is here to help separate fact from fiction.

1: I am covered by a corporate health plan; I do not need independent health insurance
Many companies cover their employees under corporate health insurance schemes. However, do not undermine the importance of having a personal health cover. In an effort to reduce high premiums employers may offer basic cover, often leaving employees underinsured. Corporate or group health insurance might end up excluding parents and / or dependents, or having employees bear partial payment of premium. Some plans offered by employers might have a co-payment clause (i.e. having to bear a part of bill out of pocket). Considering these limitations, it would be wise to take additional health cover by investing in a personal health insurance scheme that adequately provides for your family members and you.In these uncertain times, one may also change jobs. You don’t want to lose your continuity advantages and have to begin from scratch

2: I am young and healthy, so I don’t need insurance
There is a common misconception that fit and young people don’t need health insurance. We can fall sick or be a victim of an accident at any time, which can be expensive. Even people taking care of their health can be affected by contagious diseases like Covid-19, or vector-borne diseases like dengue and malaria. Good health insurance planprovides protection and prevents savings being depleted in emergencies for young and old, alike.Besides, you can get cheaper premiums as well as complete waiting periods early on

3: One can’t trust Online health insurance
Online purchases are flourishing, and insurance is no exception. Today, choosing and buying online health insurance is informative, simple and efficient.Health insurance can be purchased from the comfort of home or workplace with the ability to compare multiple plans online. Online plans provide detailed information clearly so selecting the best plan for you is very convenient. They may even have the advantage of a lower premium as there is no agent or commission involved. This benefits customers who can enjoy a lower premium on purchasing their policy online.

4: I should be hospitalized for a day to claim for expenses
Many policy holders hold the perception that in order to make a claim, a person must be hospitalized for a minimum duration of 24 hours. This is false as most insurance companies provide cover for day-care procedures which do not require patients to be hospitalized for 24 hours or more. Many health insurance companies cover up to 300 daycare procedures such as dialysis and eye operations.

5: Not mentioning pre-existing illnessesis smarter so I can pay a lower premium
Pre-existing diseases (PED) get covered under health insurance after serving predefined waiting period as specified by the insurer. During the policy term if a claim is raised for any medical condition, and the medical records confirm some PED, claims could get rejected for non-disclosure. Also, ifa condition arises that is connected to a PED, the claim can be rejected. So, it is always advisable to declare all PED to avoid future claim-related objections or denials.

6: I can buy health insurance once I need it/ face a medical situation
Health insurance policies mention waiting periods for specified conditions, treatments or ailments. These specific conditions might be different from pre-existing conditions. There are clauses under some insurance policies which restrict you from making a claim related to surgeries during the first 30-90 days. The list of specific conditions and treatments covered differs from each insurer, so it is important to read the policy wording before purchase. Any surgery, whether planned or unplanned, needs preparation. Similarly, it would be better to take health insurance well in advance, to be financially prepared for a surgical procedure in future.
7: Smokers cannot gethealth insurance plans
According to a survey carried out by a health insurance provider, nearly 49% of individuals who consumed alcohol or smoked were unsure about whether they would be eligible for a plan.
While smokers and alcoholics are at a higher health risk, this doesn’t mean they are ineligible for health insurance. Therefore, it is important to declare lifestyle habits, to ensure no future claims get rejected based on non- disclosure if caused by smoking. Their premiums may be slightly higher, and they have to undergo strict health tests.

8: All benefits of health insurance start from Day 1
Most health insurance plans come with an initial waiting period, which usually is one month, during which you cannot make any claim. Insurance policies do cover accidental hospitalization from the day the plan starts, as part of base or add-on cover. However, in the case of any pre-existing diseases and specified conditions, insurance companies define waiting periods before coverage starts to apply. Any claims related to those conditions will not be payable till waiting periods have been served. Pre-existing ailments can have a waiting period of up to 3 years on average. Also, health insurance does come with additional features such as wellness benefits, health check-ups etc. These, too, usually apply after a certain period (say after one claim-free policy year, for example). Read the policy wordings carefully to learn more.

9: In case of hospitalization my health insurance plan will cover all the expenses
There is a general assumption that all hospitalization expenses will be covered by health insurance unless the expenses exceed the cover amount. However, some health insurance policies can have exclusions, deductibles or co-payment clauses. Co-payment clause means that the health insurance plan covers only a part of the hospital bill while the rest is payable by the policyholder. A deductible clause would mean that insurers will pay only for claims above the deductible, so the deductible amount is borne by the policyholder. Additionally, room rent limits are specified for some health insurance policies as either a fixed amount or category. If exceeded, the differential amount has to be paid out of pocket.

10: Any health insurance plan takes care of all maternity-related expenses
Many plans have pregnancy and maternity coverage but are subject to certain conditions.Majority plans offer maternity cover as an add-on cover for additional premium (need to confirm).Some policies cover pre-natal expenses for fewer days than others. Some might cover a restricted number of pregnancies, while others have a larger waiting periodbefore covering pregnancy related claims. Therefore, when searching for maternity plans, make sure to check the terms and conditions.
To help you easily navigate and compare health insurance policies with unbiased information we invite you to visit our health insurance portal, is a digital platform that helps you choose the best health insurance, after comparing various policies available in India, suited to your needs.

Wish you a healthy and happy life!

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