THE TREATMENT COST
Quite often hospitals induce policy holders to take a higher class room, saying cheaper rooms are not available. In this case the cost for doctors, operation and treatment goes up correspondingly.
Your doctor may also up his fees when he knows that you have a cover. You may not get back the full amount, so check it out with your agent before you opt for the deluxe suite.
ADDITIONAL PREMIUM FOR SENIOR CITIZENS
By allowing individuals paying medical claim premium for their parents an additional deduction of Rs.15, 000 under I Section SOD of the Income-Tax Act, Budget 2008-09 has offered a gift to the elderly. This is the irony as those are the ones who actually need the insurance. There is a lack of willingness among the insurance companies to sell such products to them mean that even if you want to buy a health cover for your aged parents, you may be unable to get them adequately covered. One deterrent to insuring the elderly on the health front is the lack of incentives for agents. In a subtle arm-twisting measure, because the higher age segment is more vulnerable to health insurance claims, public-sector insurers offer lower commissions to agents for bringing clients over 60 and a higher rate for clients less than 60 years. Besides, it is not unusual to come across people over 50 years who have been denied a medical claim cover. Of course, the insurance companies have an explanation for every refusal. A common grouse is the high cost of such covers where one is allowed entry at an older age.
KNOW YOUR RIGHTS
If you have a problem of claim/refund with a health insurance company, first write to the company giving all the relevant facts, dates, copies of tests, reports and bills, doctor’s opinions and procedures done. If you get no satisfaction, write to a higher up in the company. The next step is to write to the CGSI or ACA5H (Association for Consumer Action on Safety and Health) your next approach, with the help and guidance of these organizations, is to the following quasi judicial courts set up under the Consumer Protection Act. The consumer courts are required to provide inexpensive redressed within 90 days.
THE KINDS
Some of the programmes offered by medical insurance providers
1. Personal Medical Care: Reimbursement of hospital expenses, doctor’s fees, medication and such up to a fixed sum in relation to your-age.
2. Comprehensive Insurance for the whole family at a discounted rate.
3. Senior Citizens Plan You pays a one-time premium which decreases according to your youth. You reap the benefit after your retirement. Pre-existing diseases are not excluded.
4. Cancer Insurance Policy You has to be a member of Cancer Patients Aid Association. After a medical checkup, you are covered for the treatment of the disease and get free annual cancer check-ups to detect the disease. You pay either a lump sum or the annual fee.
5. Birthright Insurance Scheme has to be taken by a pregnant woman before she is three months pregnant. If the baby is born with a defect, you will be paid for the treatment according to whether it is curable, partial or total.
6. Critical Illness Policy covers cancer, bypass surgery, kidney failure. Though Medical Insurance companies do not deny you the right to a specific procedure, they may not meet all the expenses, but only support you.