The general belief that only the old and susceptible to injuries or ill health is very much misplaced. Anyone could be laid low by a bout of severe illness at any point in life. As for the health services available in our country, the less said the better. Government hospitals run without life saving drugs, blood and often and also lack qualified and motivated staff. Recently in Bhopal, capital of Madhya Pradesh, four patient died in operation theatre because of sudden break down of electricity. And few months back in the same government (Hamidia Hospital) a patient was died because he was given animal injection. The expenses at private hospitals are beyond the reach of the middle class salary earner. Even the neighborhood private practitioner charges Rs 500 to 1000 per visit. These unexpected expenses could easily eat into your hard earned savings set aside for old age, children'seducation, car installment, housing loan installment, etc. The question is who will pay your bills if you have to bear unanticipated medical expenses. In such a dismal scenario, the only recourse left to the common man is to get medical insurance. There are number of insurance companies entered in our country but only four insurance companies are under General Insurance Company that is under government of India which offer medical insurance. They are New India Insurance, National Insurance, United Insurance and Oriental Insurance. Their common product caries brand name Med claim. Person of all age groups are eligible to take the policy. The policy does not cover all diseases like diabetes, arthritis, asthma, tonsillitis, epilepsy, pregnancy, etc. If the person applying for a policy has already contracted a health problem prior to taking the policy, this disease gets automatically excluded from coverage. The policy holder has to inform the company about diseases he/she is suffering from and all unforeseen eventualities occurring due to be covered by the policy. The insured is also required to renew his policy without break. If a policy is not renewed for a year, and the person acquires a disease during this interim period, this disease too gets excluded from coverage whenever person renews his policy. Another point to be kept in mind is that the insurer should keep increasing the amount of coverage as the years go by. If at 25 years, you acquire policy with Rs 1 Lac coverage, inflation will eat away the value of his money, and ten years down the line, it will not amount too much. Like life insurance contracts, here also the policy holder has to disclose all details to the insurance company. If these details are not with the insurance company, they could make excuses and reject your claim. Policy holders also read the terms and condition carefully before signing the contract. Once the claim is rejected, getting money from the insurance becomes very difficult. Your medical bills are reimbursed only of you are hospitalised. Hospitalisation expenses include boarding expenses, nurses? expenses, surgeon fees, expenses on anesthea blood transfusion etc. OPD expenses are not reimbursed. Expenses incurred prior to hospitalisation, like consultation fees, visiting fees or the medicine purchased on the basis of consultation are not reimbursable. Domiciliary hospitalisation expenses are also reimbursable. For a period not exceeding three days, if a condition required treatment at a hospital but the treatment is taken at home because of the condition of the patient or due to non-availability of bed in a hospital in such cases the insurance company will make an exception and reimburse your expenses. If a person retains the policy for a minimum period of 4 years then the company will reimburse medical check up once at the end of a block of four continuous free years. The policy becomes effective only after 30 days of purchase. The policy holder has to undertake treatment at specified hospitals only. The insurance companies have tie ups with good hospitals in all major cities/ towns in India, but the policy holder must ensure that the hospital to which he is admitted is an approved one. To claim reimbursement of expenses the claim should be submitted within 15 days from the date of admission into the hospitals with all relevant supporting documents due to competition in this area also now many of your costs are covered by a third party payer, not by you and hence allowing you to avoid future financial crunch. People opting for insurance can choose a sum between Rs15000 to Rs 500000. The premium rate is determined by the age of insurer and the sum insured. Additionally, one should remember the med claim policies taken in India are valid only in India. If a policy holder wants to use abroad, then he/ she has to go overseas traveler'smed claim policy. Policy holders also get income tax benefit u/s 80 D of Income Tax Act.
(The writer can be contacted at [email protected] and he is a recipient of National Award on Consumer Protection.)
