Missing out on maximizing health insurance benefits

When Mr. Viren Singh had a heart attack last year, his medical insurance policy had covered all the charges that were applicable for the surgery.

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5 mins 54 secs
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Last Updated - September 6, 2023
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When Mr. Viren Singh had a heart attack last year, his medical insurance policy had covered all the charges that were applicable for the surgery. Post the surgery though; Mr. Viren was forced to spend a large amount of money on post operation medical expenses, which his current insurer did not cover. Obviously Mr. Viren was not aware that there are quite a few riders available in the market, which provide assistance for post surgery expenses, at minimal costs? 

Mr. Viren is one among a large number of customers who are unaware of the advantages of having additional riders which come in handy at the time of claiming the policy. Customers can maximize their benefits via riders, helping them to be cautious about their future medical insurance. 

There are various aspects one needs to look into while purchasing health insurance policies:

The right age to purchase the policy

The appropriate medical tests the customer needs to go through prior to purchasing the policy

Ways to maximize the returns from your policy

The appropriate riders or add-ons that go hand in hand with the policy purchased

The ailments the policy covers

Family history of critical illnesses, when the customer is advised to go for a smart health critical illness cover

These are the specific pointers that customers should be aware of, while purchasing the policy. At the same time, it is of utmost importance for both insurers and agents to educate the customer when the decision to buy the policy is being made.

The minimum age for a customer to buy a policy is usually between 5 years to 65 years with certain brackets on renewal period.

For Eg:  65 yrs (renewal up to 75 yrs)

60 yrs (renewal up to 70 yrs)

55 yrs (renewal up to 65 yrs)

It becomes really important for customers to choose the right insurance policy at the right time, and it is imperative that they have the accurate information available at their finger tips.

Customers need to be cautioned regarding the medical tests that need to be taken prior to purchasing a policy. This is based on the age of the customer. For example, if a customer is 46 years of age and above, it is mandatory for the customers to go through medical tests and submit relevant test documents at the time of purchase. Additionally, the tests are mandatory for a customer with pre-existing diseases or ailments.

Customers have to be adequately educated on ways to obtain maximum benefits from policies they have purchased. For example, they need to be made aware that it is necessary for them to purchase a few value-added products, along with their regular policy. This will help enhance their advantage of having an insurance policy and in addition, cover quite a few of the expenses incurred during hospitalization. A lot of insurance companies in the market offer a number of value-added products. A few crucial ones are listed below:  

  • Hospital cash allowance
  • Home nursing
  • Parent accommodation as a companion for children
  • Ambulance charges
  • In-patient physiotherapy charges
  • Accompanying person’s expenses
  • Children’s education fund

Hospital Cash Allowance: This particular rider or value-added product will help the customer pay all the expenses incurred at the hospital during the treatment, apart from the consultation fees and medicine charges

Home Nursing: In situations where a customer is advised to opt for home nursing (which most companies do not offer) can be covered by this rider 

Parent accommodation as a companion for children: In cases where the insurant is a child and needs his/her parent at the hospital and regular insurance policies do not cover such charges, this current rider could act as an important substitute

Ambulance Charges: The ambulance charges that the customer pays during the time of an emergency are not covered by a regular policy cover; in such cases, this rider will help the customer to get additional benefits

In-patient physiotherapy charges: During the course of the treatment, customers sometimes are bound to avail physiotherapy, which regular policy does not cover; such charges are adequately covered by this rider

Accompanying Person Charges: Regular insurance policies do not cover the charges for the person who accompanies patients at hospitals; these charges are covered by this rider

Children’s Education Fund: In situations where the insurant may not be in a position to work for a long time depending on the type of the disease or ailment, this rider plays a vital role in helping the insurants children’s education fund

Apart from all the above benefits, there are situations where the customer may be associated with a family history of critical illnesses which a regular health insurance policy may not cover. For example cancer is one such critical illness which most of the regular insurance policies do not cover, in such a case, the customer should be sufficiently educated about this kind of a situation and should also be advised to go for a critical illness policy which covers such diseases.

In-spite of a detailed explanation of all the benefits that a customer can get; there are few benefits from the government as well which most of the customers fail to utilize. The customers are eligible for tax deduction under section 80D of the Income Tax Act for all the months of premium paid towards any insurance policy purchased.

Purchasing an insurance policy is a serious and deliberate, long-term decision and it becomes the responsibility of all agents and healthcare insurance professionals to impart and make the necessary education available to all customers to aid them in this decision. 

When a customer is educated with all the information, then customers like Mr. Viren can get hassle free and maximum benefits from the policy they purchase.

This contribution has been submitted by Mr. Subrahmanyam B, Senior Vice President& Head – Health Vertical & Commercial Lines of Bharti AXA General Insurance.

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Deepak Yohannan is the Founder & CEO of MyInsuranceClub. He enjoys writing on Personal Finance and focusses on explaining the basic concepts of insurance in simple language.