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Myths and Facts about Health Insurance In India

29 June 2022, 3:10 PM

 In 1948, the first government-sponsored health insurance was launched, which was then meant only for white-collared employees. Now, a majority of the Indian population considers it absolutely critical to have health insurance for not only themselves but for each member of the family. A sudden medical emergency can result in a total washout of your lifelong savings if you and your family members are not covered by adequate Health Insurance. However, there are several myths that are widely believed by many across our nation which are far from the actual facts regarding Health Insurance.

Let us take a closer look at the popular myths and the actual facts which surround them.

  1. Myth: I am Too Young to Buy Health Insurance

The most popular myth is that only old people fall sick and hence need Health Insurance. Little do the young generation realise that the best time to get health insurance is when you are young, hale and hearty. This is owing to the fact that some diseases might lie dormant while you are young and start showing symptoms as you keep ageing. 

Fact: The fact remains that you can buy health insurance at a lower premium if you buy it at a younger age. All premiums for senior citizens are much higher than those of the younger people. Also, in the case of pre-existing diseases, there is a waiting period for 24 months to 48 months, when no claim is granted for such illnesses. So, it is prudent of you to take health insurance when age is on your side so that the waiting period is covered without any medical emergency.

2. Myth: I Don’t Need a Separate Health Insurance Policy as I am Covered Under a Corporate Insurance Plan

People who are covered under a corporate or a group health plan, feel that it is not important for them to buy a separate health insurance plan for themselves. There are various reasons for this. They are:

  1. In a Corporate Health Plan, the premium is mainly paid by the employer, though a part of it may also be paid by the employee.
  2. All benefits of individual health plans are more or less available to incorporate health plans.
  3. In the case of group health insurance plans, there is no waiting period for any pre-existing disease.

Fact: However, if you happen to lose your job, for any reason, then all your covers cease to exist with immediate effect. Also, even if you switch jobs, then the period in between is not covered under any health insurance. So, if your employer offers you any group Health Insurance plan, you should definitely take the offer but you should also take up a separate/ individual Family Health Insurance Policy to keep yourself and your family members adequately protected.

3. Myth: Lower the Premium, Better the Policy

On the contrary to this popular myth that a policy that comes for a lesser premium amount is better than those with a higher premium, is the fact that these policies, in all probabilities, do not offer all the required benefits. Ideally, the premium amount should be the last factor to be considered while choosing the best insurance policy. 

Fact: You should be very careful between policies of the same version should be done when you buy a health plan and the plan with the maximum number of benefits for a lower premium should be chosen to be on the safer side.

4. Myth: Benefits of all Health Plans Start from Day 1 of the Policy

Actually, no other disease or illness is covered from the first day of the insurance except for accidental coverage. 

Fact: No disease or illness claim is granted within the first 30 days of the policy except in the case of accidental claims. On the other hand, claims for certain diseases or illnesses are granted only after a certain time period is over. The waiting period for these diseases ranges from 1 year to a maximum of 4 years. Further still, claims for pre-existing diseases are covered only after all 4 years have passed without processing any claim. Many times, claims are rejected by the insurers owing to the waiting period of a certain illness.

5. Myth: Hospitalisation for a Minimum of 24 hours is a Must for Claims to be Honoured

In some cases, it is a firm belief that you need to be hospitalised at least for a period of 24 hours, to get your claims of health insurance honoured. But, with the advancement of Science and Technology, several surgeries or procedures require less than 24 hours of hospitalisation. 

Fact: Hence, nowadays, most health plans have day-care procedures covered under their schemes. About 140 such procedures are generally covered for day-care by the various health insurance companies. Some such procedures are, namely, kidney dialysis, cataract or eye surgery, chemotherapy, etc. There are a few health plans which also cover out-patient procedures like dental care.

6. Myth: Benefits are All Lost If the Premium is not Paid on the Due Date

It is extremely important to pay the premiums of your insurance plans on time. This ensures that you continuously enjoy the benefits of the policy without any break. 

Fact: However, the insurance companies provide a cooling period of 15 days for you to pay the premium. Once the premium is paid even during this grace period, the policy benefits continue to exist. But, if any claim is submitted during the grace period, you might have to face rejection as insurers do not settle/approve claims in the grace period even if the premium is paid. 

7. Myth: Not Disclosing Pre-existing Diseases Help

It is extremely important to keep in mind that it is always better not to hide any facts while buying a suitable insurance plan. If you try to hide your pre-existing disease, sooner or later you will be diagnosed with it and end up paying a fine or claims getting rejected, for not having disclosed it earlier. 

Fact: So, the fact remains that it is always prudent to come out honest and clean from the beginning to maximise the benefits of the plan.

8. Myth: Pregnancies do not Get Covered Under Health Insurance Plans

Till about a few years ago, pregnancies were not covered under health insurance policies. However, most insurance plans now cover pregnancy and maternity-related expenses under their schemes. 

Fact: Some insurance companies offer cover for a restricted number of pregnancies while other maternity health insurance policies cover the expenses related to pregnancy after a waiting period of 48 months is over.

9. Myth: Total Cost of the Treatment is Reimbursed by the Insurance Company

It is widely believed that the total expenses incurred during hospitalisation will be borne by the health insurance company up to the total sum covered. This is not entirely true. 

Fact: Depending on the type of policy there might be certain exclusions of some procedures or expenses incurred or a co-pay clause in the plan. Some policies have a cap/sub-limit on their bed-charges, some do not cover the cosmetic cost incurred during your stay at the hospital , some also have a cap on the cost of the medicines. According to the co-pay clause of certain policies, only a specified (%) of the bill will be paid by the insurance company, the rest has to be paid by the policyholder.

Also, certain items like consumables are not payable by a health insurance plan and hence need to be paid by the policyholder at the time of discharge.

10. Myth: Health Insurance Purchased Online is Unsafe

People believe that buying a health insurance policy online might land them in trouble or some kind of fraud. 

Fact: On the contrary, the insurance companies have all the details updated on their websites and have safe and quick payment gateways to facilitate the issuance of health insurance policies online. Proper comparisons can be made between various plans and the purchase of the policies can be done through the various insurance portals quickly and safely.

Summary

Now, that you are made aware of all the myths and facts surrounding health insurance policies, it will become all the more convenient for you to pick your best-suited policy and get covered, without any further delay!

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