Clearing CobwebsMediclaim provides for reimbursement of expenses incurred for hospitalization for certain injuries, illnesses, and/or diseases. It not only covers the expenses incurred during hospitalization but also the pre and post-hospitalization expenses. Then there is facility of cashless settlement, which enables the individual to get admission in any hospital without any initial payment. However while choosing policies many individuals find comparisons of products difficult due to confusing terms and myths. I have tried to clarify a few.Floater PoliciesThese cover two or more members of the family in a single policy while offering a discount on the combined premium .The family is covered for one single sum s with no upper limits per member. The discount in these is a great attraction but can leave you under insured. The risk in floaters comes when all family members fall ill at the same time. Floater policies give an impression of a high cover, but may not necessarily be a good product. It is preferable if each family member has a separate cover. To give you an example, Mr. Ramesh Rajan has a floating cover that covers self spouse and both parents for a sum of 5 lakhs. Looks like a decent cover on the face of it. Now the family meets with a road accident in which all four were injured. Ramesh's father has major fractures and his medical bill comes to over 4 lakhs. The other three incur an expense of 1 lakhs each. Total Medical bill comes to Rs.8 lakhs. Unfortunately the whole family will only get 5 lakhs of bills reimbursed. This would not have been the case if each were covered for a sum of Rs. 5 lakhs each. Even a lesser cover of Rs.3 lakhs each would have covered them better. (An out of pocket expense of only 1 lakh as compared to 3 lakhs with the floater scheme).A case of mistaken identity: Hospitalization CoversHospitalization covers are not mediclaim policies. Hospitalization covers typically give you a lumpsum amount for every day of hospitalization. This means that if the cover offers Rs. 5000 per day up to 180 days will give you the sum of Rs. 5000 irrespective of actual medical bills for the number of days you are hospitalized subject to a limit of 180 days If you are hospitalized for 2 days you get Rs 10000 and so on . These covers are not a substitute to proper medical insurance policies.Senior Citizens above 60 years Yes, Senior Citizens above 60 can get medical insurance. The products offered are few but available. Even diabetes and hypertension can be covered and so are pre existing diseases subject to ' no claim' years ranging from one year to three years. Bajaj, Star Health, Oriental and National Insurance offer these covers.Company offered Mediclaim coversConsider these as bonuses only. You must have your own cover as a job change or a sudden stopping of premium payment by companies (due to rising costs of medical insurance) can leave you exposed. If the company insurance is large you can opt for a floater policy as a cheaper option.Points to note will make comparisons1. Pre hospitalization and post hospitalization expenses - Whether covered and for how many days?2. Cashless facility and list of hospitals where available - If you have some preferred medical service providers check if they figure in the list3. Whether no claim bonuses are provided - a no claim bonus ensure that your cover increase with the rate of inflation (if not entirely at least to some extent) during the initial years.4. TPA (Third Party Administrators)-Run a check on the distribution network of the insurance company or it's TPA. It is preferable to have at least one of their offices in a location close to you for ease of payment receipts on claim. It will be good idea to check on the service record of such TPA too.5. Certain Medical Expenses may not need a 24 hour hospitalization. Check if your policy covers such treatments. 6. Check for upper limits on expenses - For example limit on surgeons fee, limit on ambulance charges etc. A 'no limit ' cover is always preferable. 7. Try getting hold of policy document before you buy. Even after buying you can return the policy in 15 days without loss if you find anything in the policy document that does not suit your requirement.
