What is co payment in health insurance policy

 

In health insurance claims many times we encountered problems of deduction of certain percentage of claim and insurance company named it as Co-pay deduction. It means that even someone is covered under health insurance still he must bear some portion of claim amount. On the one side it can have burden on your pocket at time of claim, on the other side it may be pocket friendly while we are depositing insurance premium.

The proportion of medical expenses shared between the insured person and the insurer is called the co-payment of health insurance. In other words, it is a cost-sharing mechanism in which the policyholder bears part of the medical expenses and the rest is borne by the insurance company.

Health insurance policies often include co-pay designed to help reduce your overall medical costs. The insurance company can charge a lower premium than if the policyholder were to pay all medical expenses out-of-pocket.

You pay for many medical services, such as doctor visits, hospital stays, laboratory tests, and prescription drugs from out-of-pocket. The co-payment amount vary depending on the insurance company.
For example, health insurance may impose a 20% co-pay on him for room rent cost. This means that the policyholder will cover his 20% of the room rent costs and the insurance company will cover the remaining 80%. If the room rent costs Rs.100, the policyholder will pay Rs.20 and the insurance company will pay him Rs.80.
Co-pay also help encourage policyholders to think more carefully about their medical costs. When policyholders have to pay a portion of their medical costs, they are more likely to choose cheaper treatments and avoid unnecessary medical procedures.

 However, for some policyholders, out-of-pocket costs can also have a negative impact. For example, people with pre-existing medical conditions or high medical costs, out-of-pocket costs can be a financial burden.

When policyholders need frequent or expensive treatments, out-of-pocket costs can quickly add up, making it difficult to finance medical expenses.
In addition, co-payments may discourage policyholders from seeking necessary medical care. If policyholders must bear a significant portion of medical costs, they may delay or avoid necessary medical procedures to avoid financial burden.  

In conclusion it is important to choose Co payment clause carefully while taking health insurance. 

What is waiting period in health insurance policy

 

Health insurance is among the fastest growing segment in entire general insurance segment. There are so many health insurer like Star Health & Allied Insurance Co.Ltd. (www.starhealth.in), Niva Bupa Health Insurance Co Ltd.( www.nivabupa.com) The New India Assurance Co. ltd. (www.newindia.co.in) are in market. Every insurer has so many health insurance plans depending upon need of individual. It is important to choose correct health insurance plan depending upon need of individual. While choosing right health insurance plan there are various factors which need to be considered.

It is not only important to choose correct coverage, amount (Sum Insured) but it also important that one should be aware about waiting period in ones health insurance plan.

Every insurer does not cover all diseases from day 1 and there are various diseases which are excluded for certain period. It is important that individuals must be aware that which disease is excluded and for how much period??

Waiting period in health insurance is the amount of time you must wait for your health insurance coverage to take effect. During this waiting period, the insurance company will not cover any medical or treatment costs. Waiting periods are usually used by insurance companies to prevent people from getting health insurance only when they are sick or injured.

The length of the waiting period may vary by policy and insurance company. It can last for days, weeks, months even years and is associated with a particular disease-based hospitalization or waiting period may apply for certain period for all diseases.

For example,

1.      Generally, insurance may have a 30-day waiting period for hospitalization or surgery for all diseases. Generally, these type of waiting period exclude hospitalization due Accidents.

This type of waiting period generally applies to new policyholders and not to those who maintain ongoing coverage with the same insurance company.

2.      Insurance may exclude certain diseases like Cataract, Hernia, Knee replacement, Hypertension etc for specific period i.e. 1 year, 2 year etc.

Additionally, some health plans may waive the waiting period for people switching from similar coverage with other insurers.

There are some diseases which are “generally” excluded in almost every heath insurance for specific time period. Some of them are

1.      Cataract

2.      Mental illness

3.      Congenital external and internal disease

4.      Benign ear, nose, throt

5.      Hernia

6.      Arthritis

7.      Piles, fissure and fistula in anus

8.      Hydrocele

9.      Gout

10.  Skin disorder, and so many other

While purchasing health insurance this is among the most important parameter and one should ask from insurance agent or insurance company about all details of waiting period like

1.       What is waiting period at inception?

2.       Which disease are excluded?

3.        What is time duration of exclusion for each and every diseases appearing in waiting period of plan?

4.       Is there any rider, add-on to cover all disease from day 1?

What is room rent restriction in health insurance policy

 

What is room rent restriction in health insurance: For huge hospitalization expenses Health insurance could work like blessing in disguise. But choosing a correct health insurance is tricky one as there are various sub limits in health insurance and these sub limits can have severe impact on your health insurance claim. One of them is Room rent capping.

Room rent capping: Room Rent Restriction in Health Insurance refers to the limitation of coverage for hospitalization expenses related to accommodation and boarding, such as food and beverages, laundry services etc., provided by the hospital or nursing home. This means that if you require staying at a private ward during your treatment then the health insurer will only cover up to a certain limit which has been pre-decided. The rest of the amount would have to be paid out of pocket by the policyholder. Hospitalization costs can quickly add up when one needs to stay in a private ward due to their medical condition. Room rent restrictions are put into place by most health insurers so they do not need to pay for all the additional amenities offered by hospitals and nursing homes. These restrictions vary from plan to plan but generally speaking, it’s usually limited to basic necessities like bedding, linen, furniture and air conditioning. Anything beyond this may not be covered under the terms of the policy. It should also be noted that some policies might offer partial coverage for luxury items such as cable TV, WiFi access.

If a policyholder chooses a room that exceeds the specified limit, He will have to bear the extra costs out of his own pocket. Now this extra cost not only include your room rent bill, but it will also reduce your bill for all your medical expenses  like doctor fee, investigation report bills, other expenses apart from medicine bill.

So, check your room rent limit.

References:: Data from different Indian insurance websites and their policy documents

1.   www.irdai.gov.in

2.   www.newindia.co.in

3.   www.uiic.co.in

4.   www.icicilombard.com

5.   www.starhealth.in

6.   www.bajajallianz.com

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