Less Known Facts About Health Insurance

Many people are aware of the benefits of Health Insurance, its features, how to compare the plans, etc. But there are things about Health Insurance that are still obscure to many people. Careful reading of policy documents and interpretations of policy clauses give a clear picture of the benefits covered, features, pitfalls, etc. Here are some features of Health Insurance that many people may not know about.

Waiting Period

After purchasing a Health Insurance policy, our common thinking would be that it readily starts covering all our medical expenses. But many of us fail to recognize that the waiting period plays a crucial role in Health Insurance coverage. There are different types of waiting periods in Health Insurance, and the most common ones are the initial waiting period, PED waiting period, and specific disease waiting period.

Usually, the coverage will not start immediately after purchasing a medical insurance policy. There will be an initial waiting period of generally 30 days from the date of commencement of the policy, only after completion of which the coverage starts. However, there is no initial waiting period for claims related to accidents, as they are covered immediately after the policy purchase. Similarly, there are waiting periods for pre-existing diseases (PEDs) and some specific diseases listed in the policy documents. The policyholders can avail the coverage for claims related to them only after the completion of the respective waiting periods.

Maternity Coverage

One of the most asked questions about maternity coverage is, “Can I get maternity coverage after becoming pregnant?” Generally, Health Insurance plans, especially Family Health Insurance plans, cover maternity-related expenses but only after a certain waiting period. So naturally, many medical insurance plans do not provide maternity coverage immediately if the person purchases the policy after becoming pregnant because pregnancy is considered a pre-existing condition and will be covered after a waiting period.

Sub-Limits

One of the common disputes people have with insurance claims is that the Health Insurance companies do not settle the full claim amount even if the sum insured limit is not exhausted. This could be due to the fact that many might have missed reading or understanding the sub-limits clause. Many Health Insurance plans place a cap, also known as sub-limits, for specific treatments, diseases, or procedures. Despite the sum insured, the insurer is liable to pay the claim amount only up to the mentioned sub-limits. If the claim amount exceeds the sub-limits, then the remaining claim amount should be paid by the insured.

Coverage for Accidents

It is a known fact that Health Insurance provides coverage for accidents that too from the date of inception of the policy without any waiting period. But many of us think that Health Insurance coverage is restricted only to road accidents, and that is not true. According to Health Insurance, an accident means a sudden, unforeseen, and involuntary event caused by external, visible, and violent means. Hence, any forms of accidents, including road accidents, are covered under Health Insurance.

Waiver of Waiting Period

As many know, there are different types of waiting periods for Health Insurance. The most common one is the Pre-Existing Disease (PED) waiting period. Normally, the PED waiting period ranges between 12 and 48 months, which means that the policyholders need to wait until the completion of the waiting period to receive coverage for their PEDs. However, some policies provide an option to waive the waiting period by paying an extra premium. Likewise, Star Comprehensive Insurance Policy from Star Health Insurance offers an option to reduce the PED waiting period from three years to one year at an affordable premium.

Tax Benefits

Purchasing a Health Insurance policy is not an expense but an investment. People can save up to Rs. 1 lakh on income tax by purchasing a medical insurance policy. Understanding the significance of Health Insurance, the government, under Section 80D of the Income Tax Act 1961, provides income tax deductions for investing in Health Insurance plans. This deduction is applicable for both Individual Health Insurance as well as Family Health Insurance.

There are many features that need to be clearly understood by people before purchasing a policy. Knowing these and other features helps dispel doubts and save the last-minute hassle.