Seven health insurance myths shattered

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People don't buy health plans readily possibly due to several misconceptions about them, as is evident from the most glaring myths and the reality behind them.

MYTH 1. Health insurance policies pay only in case of hospitalization.

REALITY: 22 companies offer day-care treatment cover. Nine out of 22 non-life insurers offer OPD benefits, which include:
  • Specialist consultation
  • Dental treatment
  • Diagnostic test expenses
  • Vaccinations
  • Alternative medicines
  • Hearing aid
  • Eye check-up, spectacles, and contact lenses
  • Preventive and wellness services

MYTH 2. Pre-existing diseases will be covered after a waiting period. No need to declare it.
REALITY: All pre-existing diseases have to be declared upfront at the time of buying the policy.

What Irda says about pre-existing diseases?
  • Any condition, ailment, injury or related conditions for which you had symptoms and/or received medical advice/treatment within 48 months of buying the policy.
  •  An ailment regularly treated and under control falls in the definition of preexisting disease.
  • Any such condition or ailment not declared by a customer is considered an undisclosed pre-existing disease and leads to claim rejection.

MYTH 3. I don't need health insurance if I am fit.
  •  Health insurance covers injuries due to accident or violence.
  • Many illnesses (dengue, malaria, food poisoning) can strike even healthy people.
  • Incidence of critical illness in the 26-35 year age group grew by 124% in 2012-13.

MYTH 4. I have group health cover so don't need a separate policy.
  • The group health policies have defined limits.
  • 12% of corporate claims for critical illnesses in 2013 were for more than Rs 2 lakh.
  • Claim size is rising for diseases; group cover may not be enough.

MYTH 5. One should choose a health policy on the basis of premium.
REALITY: Health policies have different features, so premium can't be the only factor.

Premium depends on the features of the policy and age of the person. Features that impact the premium:
  • Co-payment
  • Deductible
  • Sub-limits

MYTH 6. I will not get health cover need to declare it, because I smoke/drink alcohol.
REALITY: Insurance companies offer policies to people who use tobacco or consume alcohol.Though such cases are not out rightly rejected, the premium could be more given the higher risk.

MYTH 7. Only the earning member of the family needs health insurance
  • Unlike life insurance, health insurance should cover the entire family, including children and parents of the customer.
  • Claims data reveals that two out of three claims are of medical expenses on dependants.

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