Points To Check While Buying A Health Insurance Policy | Clauses In Policy | CA Rachana Ranade
Published: 2022-10-08
Status:
Available
|
Analyzed
Published: 2022-10-08
Status:
Available
|
Analyzed
Predictions from this Video
Incorrect: 0
Prediction
Topic
Status
Insurance companies must settle or reject a claim within 30 days of the final document submission.
"within 30 days of the last document submitted the insurance company either has to settle the claim or they can reject the claim"
Pending
If a health insurance claim is rejected, policyholders can email the grievance redressal cell. If no satisfactory response is received within 15 days, they can approach the Insurance Ombudsman.
"if your claim is rejected then what step number one you can go back to the insurance company basically you drop an email to the grievance redressal cell you can drop the email and if you don't receive a reply within 15 days or if you receive the reply but the reply is not satisfactory then you can approach to the insurance Ombudsman"
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The Insurance Ombudsman can handle claim disputes up to ₹30 lakhs.
"here the redressal can be done only up to rupees 30 lakhs"
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If the Insurance Ombudsman does not provide a satisfactory resolution, policyholders can escalate their complaint to IRDAI.
"if you don't receive a proper reply from the insurance Ombudsman then what then you can approach irdai which is the insurance regulatory Development Authority of India"
Pending
Waiting periods for non-emergency medical conditions like cataracts in health insurance policies can extend up to two years.
"if you are talking about certain medical conditions which are which don't fall into the emergency category something like a cataract in that case the waiting period could be a shared higher it could go up to almost even two years"
Pending
For emergency hospital admissions, insurance companies must be intimated within 24 hours of admission to ensure a cashless claim; otherwise, it will be processed as reimbursement.
"in case of emergency situations whenever the patient is admitted within 24 hours from the date of admission you have to intimate the same to the insurance company if you don't do so if 24 hours laps then it will be more of reimbursement rather than a cashless claim"
Pending
Reimbursement claims for health insurance must be initiated within 7 to 30 days of hospital discharge, depending on the policy terms.
"after the discharge is done within 15 to 30 days of the rate of discharge or in some policies it is given within seven days of the date of discharge you should initiate the claim process"
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Policyholders should always check for a co-pay clause in their health insurance policy.
"always remember if you are going ahead with an insurance policy check whether there is a copay clause in your policy or not"
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Consumers should review all clauses in their health insurance policy before making a final purchase decision.
"so please check your insurance policy before you take your final decision"
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It is crucial to check the waiting period details in your health insurance policy before proceeding with the purchase.
"again how much waiting period is there in your policy please check that first and then proceed"
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It is advisable to choose a health insurance policy without room rent restrictions.
"so what is a better choice better choices that select an insurance policy which does not have such a restriction"
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Expenses related to adventure sports are permanently excluded from health insurance coverage.
"if we are talking about Adventure Sports they are a permanent exclusion from your health insurance policy Please be aware about this point that these expenses will not be covered by your health insurer"
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Costs associated with drug or narcotics abuse are permanently excluded from health insurance policies.
"if you are doing any sort of drugs or narcotics abuse that will also be forming a part of your permanent exclusion"
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Cosmetic surgery expenses are permanently excluded from health insurance coverage.
"and if you are doing any cosmetic surgeries they will also be permanently excluded"
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A 30-day waiting period from the policy commencement date is standard for health insurance claims.
"from the commencement of policy for a period of 30 days his uh his claim will not be accepted that is nothing but a waiting period"
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Health insurance premiums are typically higher for individuals with pre-existing conditions due to the expected higher claims.
"in such cases premiums will be typically higher why of course the insurance company knows that there is going to be an outflow at their end so typically premiums will be higher"
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Choosing a hospital room exceeding the limit stated in the health insurance policy can lead to only partial coverage of related expenses.
"if you are choosing a room which is higher than the room limit which is mentioned in your insurance policy"
Pending