In the times when diseases are caused by lifestyle and death rates are far from receding, health insurance is a must-have for everyone. Although, one is free to buy a health insurance policy according to specific requirements, you have to keep an eye on certain check-points, once you buy one, so that no difficulty arises at the time of claim settlement. Therefore, buying a mediclaim policy is just the beginning of  plan and you have to take care of some other factors to ensure that your policy works at the moment when you need it most.

Proposal Form:

Proposal must be filled in honestly and all the material facts about the existing and past ailments / treatments / surgeries must be declared with full details. If insurers find at a later stage that one or more material facts were not disclosed, not only they can reject the claim but they can also cancel the policy with immediate effect.

Renewal of Policy:

Ensure that your health insurance policy is renewed well before the date of expiry so that you get a continuous coverage over a period of time. If there occurs any break in renewal, the insurers may not accept your renewal and if they accept, the policy will be treated as a fresh contract and it will attract all the waiting periods and you will lose the credit earned in the past policies. This may sometime prove to be a costly proposition, if a claim happens to arise in respect of a disease falling in waiting period. Insurers are not bound to send any renewal notice and ask for renewal premium. You should be more than proactive to renew your policy well in time. Even if renewal is accepted in the Grace Period, remember that any hospitalization after the date of expiry of policy will not be covered in renewed policy.

Understand Waiting Period & Sub-Limits:

If you are diagnosed with a disease which falls under waiting period, discuss with the treating doctor and explore other methods of treatment, if possible. If there is no such option, please keep your contingency fund ready to meet such expenses if the claim is rejected by insurers. Similarly, check the policy condition about the sub-limit for Room / ICU charges and ensure that you do not take a room of higher amount and later lose proportionate amount under all other expenses. If your policy has any sub-limit for a specific surgery, try to find suitable hospital where surgery charges remain in your limit.

Go Cashless as much as possible:

Please read the list of network hospitals in your neighborhood. As far as possible, avail cashless facility because such hospitals have negotiated rates of treatment which reduce the cost of treatment.

Lesser the hospital bill, more is the sum insured available after the claim. If treatment is done in a non-network hospital, insurers / TPA may take a plea of towards the policy condition of “reasonable and customary charges” and it is possible that you lose some amount from your fully valid claim.

Keep copies of all past insurance policies readily available with you. You will need them to prove the continuity of coverage. This will ensure that your disease is not falling in any waiting period. Besides, keep your ID proofs ready for availing cashless facility.

Keep some emergency funds ready because Deposits, Registration charges, RMO charges, non-medical expenses may not be covered under cashless scheme and all similar type of expenses will have to be borne by you only.

Reimbursement Claims:

If cashless is not possible, you may go for Reimbursement but you have to observe certain precautions.  Ensure that the charges being paid are according to the terms which were agreed before starting the treatment. Also, ensures that the diagnostic tests and line of treatment are relevant to the diagnosis. Purchase medicines from a store where some discount is offered. Be meticulous in checking all details given in the Discharge Card and Final Bill of hospital. If any implant is placed by the doctor, collect its proof from the hospital. Be meticulous in checking all details given in the Discharge Card and Final Bill of hospital. The Final Bill of hospital and the payment receipts must have pre-printed serial number. Preserve all documents, bills, reports, prescriptions in a file and submit them to TPA / Insurers with a cancelled cheque but before the time limit stipulated in the policy. Bills for medicines and test reports must be supported by authentic prescriptions.

Keep a Xerox of all documents for future treatment. They will also help you in solving the queries, if raised by TPA / Insurers. Sometimes, such records are required for subsequent claims as well.

After submission of claim, keep a watch for further developments. If any queries are raised, the same should be complied with in the given time limit. Keep a Xerox of such compliance. Also ensure to take acknowledgement from TPA / insurers for submission of such compliance’s.

Steps after the Claim Payment is Received:

Check that the claim is paid in accordance with the terms / conditions / exclusions / sub-limits given in the policy. If any undue deduction is made by TPA / Insurers, be ready to raise your voice and get the same. If you remain passive, you will be the loser. It is important to be well aware of terms of policy so that you are not deprived of your rightful claim. If there is no query and your claim suffers an inordinate delay, you can revoke the policy condition which binds the TPA / Insurers to pay penal interest on the amount in question.

If the Claim is Repudiated:

Check the grounds for repudiation vis-à-vis the terms of policy. If the repudiation is on a technical ground, take the help of your broker or the treating doctor to understand the validity of repudiation. Many a time, the claims are repudiated on very silly and invalid grounds. You need to understand the disease in question vis-a-vis applicability of policy conditions. Be prepared for a tough fight even if your claim is genuinely falling in the scope of your policy. If your TPA / insurers is not giving proper response, escalate the matter to higher levels and don’t just give up

You have to be very careful at all the steps of taking the policy as well as getting the claim cleared from TPA’s / Insurers. It is a most important financial decision and any insufficient care will make a hole in your pocket. After all it is your hard earned money at the stake. So give sufficient time for a careful study of the product before and after buying it.