Tag Archives: healthcare insurance

Got a new Health Insurance Plan this year?

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Here are five steps that can help smooth your transition to a new plan.

Every year, many Americans like you take the opportunity during Medicare’s Open Enrolment period to change insurance plans. Regardless of whether you are changing a Medicare Supplement, an Advantage Plan or a Part D Prescription Drug Plan, there are a few things you can do now to avoid problems now that your new insurance has gone into effect in 2016.

  1.  If you are going from a Medicare Supplement to a Medicare Advantage Plan, make sure you have cancelled your supplement coverage. Your Supplement is not automatically cancelled when you switch to an Advantage Plan. Although some companies will cancel and make changes over the phone, others require a written request so give your Supplement Plan insurer a call and ask what they require.
  2. Cancel your automatic withdrawals for the old plan. I recommend you cancel your withdrawal with the insurance company and then follow up with a call to your financial institution to make sure the automatic withdrawal is cancelled.
  3. Tell your doctor that you have different insurance. If your doctor unknowingly files for reimbursement with the wrong insurance company, it will cause confusion and delays in payment. Let your doctors know about your new plan the first time you see them in the New Year.
  4. Check your Prescription Drug coverage to find out what pharmacies are the preferredpharmaciesof your new plan. If it’s a different pharmacy than the one you’ve been using, arrange to transfer your prescriptions now so they have your information on hand. You should also present your new health insurance Plan cards to your pharmacy before you need your next prescription. Don’t wait until you need a refill or have an emergency before you make this change.
  5. Determine whether your new plan has different requirements for prescriptions. Some plans may require a pre-authorization before your prescription will be filled. Take steps ahead of time to let your physician know what’s required by your new plan.

[Source: https://theseniorinsider.blogspot.in/2016/01/got-new-health-insurance-plan-this-year.html?%5D


Maximize Benefits from Your Health Insurance Policy

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The term comprehensive means that it is all inclusive. The same goes with comprehensive health insurance; it is a policy that gives the advantage of covering various benefits. You wouldn’t have to invest in many policies if you choose the best comprehensive health insurance policy that covers many benefits. Thus, you save time on choosing and maintaining various policies when you invest in the best comprehensive health insurance policy. You can choose additional covers along with your basic health insurance policy depending on your needs and preferences.

Why Invest in an Individual Comprehensive Health Insurance Policy?

We often believe that a health insurance policy offered by our employer is sufficient. But, if you don’t invest in an individual health insurance policies, other than the one offered by your employer, it might create challenges in future. As you age health challenges mount thus, the cover offered by your employer’s health policy might not suffice. It’s vital to have a standalone comprehensive health insurance policy that can cover rising medical costs. It proves to be useful if you switch jobs.

These are Some of the Benefits that You Can Add to Your Basic Health Insurance Policy:

Critical Illness

A health insurance plan covering critical illness insures you against the risk of serious illness. It provides you with the security of a lump sum cash amount if you are diagnosed with critical illness. All companies have their respective list of critical diseases covered. Some of the critical illnesses that may be covered are cancer, coronary artery bypass surgery, first heart attack, kidney failure, major organ transplant, permanent paralysis of limbs etc.

Hospital Cash

Sometimes the hospital expenses may rise and you might have an extended stay at the hospital. But, these expenses can mount and burden you suddenly. There are also incidental expenses like the transportation cost, money spent on travelling from hospital and back home, and nursing expenses. These costs will be taken care of by the hospital cash cover added to your comprehensive health insurance policy.

Extra Care

Extra Care is an add-on cover to the existing base health insurance policy. For example if you have a base health insurance policy of 3 lakhs you might choose an Extra Care cover of 7 lakhs. How does this help? If you are hit by a sudden health challenge and you exhaust 3 lakhs of the basic cover, you don’t have to worry. The Extra Care cover triggers, which you can use during this critical period. So when the basic health insurance policy doesn’t suffice, the Extra Care cover comes to your rescue.

Personal Accident Cover

The Personal accident cover is a compensation for bodily injury or death caused due to an accident. In these times of serious crisis it’s vital that you have a solid financial support, which is provided by this personal accident cover. Some of the benefits from the Personal Accident cover are:

  • 100% of Sum Insured would be paid to the nominee in case of death due to accidental bodily injury of the proposer
  • 200% of the Sum Insured is paid to the proposer in case of the Permanent Total Disability due to accidental bodily injury

There are other benefits too that you are entitled to with a personal accident cover. It is advisable to study the exclusions under the personal accident cover.

You can make the most of your health insurance by choosing the best comprehensive policy with additional covers to your basic policy. So when you think of health insurance, think about investing in the best comprehensive health insurance plan.

[Source: https://www.demystifyinsurance.com/maximize-benefits-from-your-health-insurance-policy/%5D

Your Guide towards a Smooth Health Claim Settlement

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Insurance is an assurance given by an insurer to the insured, to help the latter at one’s most needed, financially trying times like a health scare or an accident. Yet when such an event occurs and one’s insurance claim is denied or delayed, it can be a very distressing situation, which compounds an already stressed time. The fact is that the onus of getting a claim honoured also lies in the insured’s hands. True that a claim may be denied for various reasons by the insurer, with clearly stated reasons for the denial. Yet there are those precautions which if taken care of can ensure a smooth and hassle free claim settlement.

Furnish Complete Information

Did you know that incomplete information and non-disclosure of facts in the proposal form followed by intentional or unintentional misrepresentation of facts are the most common reasons for claim repudiation or delay in claim settlement? Lata, a diabetic patient when going in for a health insurance policy failed to disclose her pre-existing health condition on the proposal form. Five years later when she developed a medical complication due to high sugar levels and had to be hospitalized, she filed for a claim, which got repudiated. She was in for a surprise when her claim was not honoured on the grounds of “non-disclosure” of pre-existing medical condition. So how could a health policy holder make sure that they do not ever face a situation like Lata?

Here are a few pointers

Read and fill in the complete proposal form. Make sure you disclose all relevant information about your family’s and your health status in the proposal form. Disclosing all information will also ensure that there is no conflict during the claim settlement procedure, especially with respect to any pre-existing ailment. The bottom line is “Honesty at the time for proposal pays”.

Also ensure that you provide correct information pertaining to your lifestyle and habits as well. For instance, state the truth about your smoking or drinking habits.

In case the proposal form is being filled by your insurance consultant or an agent, make sure you go through the details filled in thoroughly before signing the document. It is always advisable to fill these documents yourself. In case of Lata, she had signed the document without verifying the details filled in by the agent which led to inaccurate information being given as a consequence of which her claim was not honoured.

Understand your health insurance cover. This is an extremely important aspect which has been discussed in details below.

Do Not Misrepresent Facts

In India, misrepresentation of facts is another common reason for claims not being honoured. Misrepresentation is usually in terms of manipulated information while procuring the policy or submission of fake bills and documents while making a claim. Raju, who suffered from a bad bout of food poisoning, was consequently hospitalized for 3 days. When he submitted the claim for reimbursement it was observed that the cost of medication administered to him was much higher than what is usually given to patients suffering from a similar condition. He submitted a total bill of Rs. 50,000, when the average cost of treatment of the condition is not more than Rs. 20,000, keeping in mind the category of hospital he was hospitalized in. Upon scrutinizing the documents, it was discovered that the medicine bills were manipulated and exaggerated to make a taller claim. This lead to the claim being rejected and it also led to his policy being cancelled due to his intent to make a spurious claim leaving him and his family without any health insurance cover. Had he submitted the correct bills, his claims would have been approved.

A recent survey done by Accenture in India revealed that exaggeration of bills was considered a justified act by many in India. This may be due to the fact that most of the people are unaware that this is actually a fraudulent act. The other instances of misrepresentation which have been observed are, when a claimant

Claims for an Outpatient department treatment (OPD)as an Inpatient department treatment (IPD)

Backdates documents to showcase that the claim they have made is covered under the current policy period.

The next and the most vital aspect – is that of the insured not understanding his/her health cover.

Know your health insurance covers

Your health insurance cover, be it a cover given by your employer or a cover you have taken separately for your family and self, may have various limitations that are important for you to be aware of.

These are:

Sub-limits: Some health policies have a sub-limit on certain features like room rents or select treatments. Make sure that you are aware of these sub-limits while making a claim. It is also important that you know what aspects your claim will not cover. Most often, these would be service charges, administration charges, registration charges, all non-medical expenses, private nurse expenses, telephone calls, laundry charges, etc. You can go for an add on cover instead for instance Bajaj Allianz Hospital Cash that will help you recover these miscellaneous expenses.

Co-payment: Some health plans have a co-payment clause wherein the insured shares a certain amount of the claim. This would vary from insurer to insurer, and plan to plan. In order to be aware of what amount would be payable by you, it is a good idea to check about co-payment in advance.

Waiting period: When purchasing health insurance, make sure you are fully aware of the waiting period applicable for certain illnesses. Also, since the waiting period may differ from plan to plan and insurer to insurer, it is important to keep a note of these.

Claim against Day Care Procedures – Certain insurers provide policies that also cover Day Care Procedures such as surgery of cataract, chemotherapy/radiotherapy, or minor surgeries involving local anaesthesia; you can opt for a day care procedure. You must check beforehand on whether the medical procedure required by you is included in the cover. This may be a better option since you would not have to spend the minimum 24 hours in the hospital, as is mandatory for normal health insurance plan. This would also help you save on your hospitalization expenses, hence, conserving the sum insured.

Ensure the claim settlement is smooth

While the basic procedure for claim settlement remains standard, there are some nuances to consider between cashless claims and while getting your medical expenses reimbursed from the insurer. Another important aspect to consider is the mode of claim settlement i.e. through a TPA or in-house. Usually, insurers which deal with hospitals/policyholders directly have a faster turn-around-time for the claim settlement. It is therefore essential for you to consider the given aspects while selecting your health insurer.

[Source: https://www.demystifyinsurance.com/your-guide-towards-a-smooth-health-claim-settlement/%5D

Health Insurance Companies: Top 10 Companies

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Health Insurance Companies: Living without Health Insurance is a steady stretch and stress. Not just arrives a pestering risk of something genuine event – where a week in the doctor’s facility can cost as much the same number of make in a whole year – however, even the expense of basic specialist’s visits and solutions can purge your wallet quicker than you can fill it. It’s excessively extravagant; excessively complex; excessively elite.

Top 10 Health Insurance Companies

Main top 10 rundown incorporates Health Insurance Companies that offer scope in the United States. Try not to concur with the rundown? Vote in favor of a current thing you think ought to be positioned higher or on the off chance that you are a signed in, includes another thing for others to vote on or make your own particular variant of this rundown. With the significance of health protection comes the need to pick the best health insurance agency for your needs. To help you settle on the right choice, we’ve welcomed criticism from other people who have involvement with the health insurance agencies you need to look over.

E Health

eHealth is an online commercial center helping purchasers, in each of the 50 states and Washington, D.C., discover health protection. It lives up to expectations with more than 180 health insurance agencies and gives more than 10,000 items.

Health Plans America Surveys

Health Plans of America is a useful asset for those hoping to buy health protection. Notwithstanding their quest element of discovering an arrangement, the organization additionally prompts on picking the right arrangement.

United Healthcare has a system of specialists and offices that give health protection to people and superintendents. They are an in-system just organization, which implies clients must utilize suppliers that are secured under their arrangement.

Humana Health Insurance Surveys

Humana is a revenue driven health insurance agency that works with numerous sorts of shoppers. The Louisville, Kentucky-based organization serves families, seniors, military individuals and independently employed people.

Aetna Health Insurance Surveys

Aetna is a huge health insurance agency established in 1853 in Hartford, Connecticut. The people like, superintendents, social insurance experts and different clients with human services and therapeutic administrations.

Kaiser Permanente Insurance Surveys

Kaiser Permanente is a group of more than 17,000 doctors. They work with more than 9 million clients and can alter treatment choices that permit clients to pick specialists in view of their particular history and bios.

Cigna Health Insurance Surveys

Cigna is an insurance agency that works with 35,000 representatives to give social insurance items and administrations to more than 75 million clients. They exist in 30 nations and have been working with patients for more than 200 years.

What Elements Matter Most About Health Insurance Companies?


Deductibles are sums shoppers must pay out of pocket. The higher the deductible, bring down the human services premium.

o Higher deductibles on cataclysmic health protection: Some health protection highlights high deductibles so shoppers pay for routine visits out of pocket.

o Non-complete deductibles: Routine visits don’t number towards these deductibles, so shoppers dependably pay for them out of pocket.

o Cumulative deductibles: Consumers who have more than one relative on their strategy can utilize every secured part’s human services visits to decrease total deductibles.

Home Medicinal Services Administrations Scope

Health protection may take care of the expense of home medical services, administrations for individuals who oblige them.

o Full-time helper: If a patient needs a full-time medicinal services specialist to help him or her with fundamental self-mind, the associates’ pay may be secured by health protection.

o Visiting medical attendant: Some protection arrangements take care of the expense of a medical caretaker weighing in with a patient at home on an every day or week after week premise.

[Source: http://blogs.rediff.com/healthinsuranceindia/2016/06/27/health-insurance-3/]

Health Insurance Reviews – How they rise, as you grow older?


health-insuranceimgLet’s face it. Most of us are “deal hunters”. We want the maximum “juice” from a product/service in the minimum price. No wonder the big branded stores, in that flashy mall are full with the so called “end-of-season dhamaka sale”

OK. Agree, buying a short term product (like clothing, accessories, electronics), in an off-season sale can help you save huge money, but what about buying a long term product or service?

Buying a long term paying product or service based on short term costs and benefits can be one big blunder. A blunder, you may not even realize till it is too late to migrate from the product.

Let’s look at Health Insurance. Health Insurance is a complex long term product, where both premium and benefits rise, renewal after renewal. While health insurance premium increases on a change of age bracket, you cross over the waiting periods or time bound exclusions in your mediclaim policy for specified illness and pre-existing illnesses, making for a wider health insurance cover.

Health Insurance products in India are under a free price market. Prices are not governed by any government or quasi government body. Health Insurance companies price their products based on the design and construct of the policy, and their internal pricing guidelines/philosophy. The same product with the same features could be priced differentially by two Health Insurance Companies. Moreover the pricing methods could be different as the customer’s age progresses.

As recommended in our earlier blog posts on Health Insurance Reviews, we therefore always recommend that you look at future premiums of your selected health insurance policy, besides comparing current year premiums. This gives you a flavour of the price increase you can expect in the future.

Health Insurance Premiums –  How they increase?

We have attempted at making this exercise easy for you. We plotted the current premium of top health insurance products on a graph,  and here’s what came out.

Premium below is for a Rs. five lakhs family floater for Self + Spouse + 2 Kids, 35 years of age, living in Mumbai.

Notes to the chart:

•             In case where health insurance plans convert into individual plans at older ages (Oriental & Star) we have taken a Rs. 3 Lakhs Individual cover plan for each member till 75 years of age.

•             All Premiums above, are inclusive of service tax.

What do you make out of this trend?

We observe the intensity of change of premium is not the same for all health insurance policies. We noticed that some health policies had very steep premium rise, post 45 years. If you look deeper, it seems that the premium rise was drastic for all the mediclaim policies that have no limits, lower restrictions vis-à-vis mediclaim policies that had limits (room rent limits, surgery limits) and more restrictions.

Are you surprised by the drastic premium rise? You shouldn’t.

Health Insurance Reviews, by design, is a community fund, where the healthy pay for claims of the sick, through premium. If the claims made are even slightly extravagant and unreasonable, in terms of choice of hospitals, choice of rooms, by the community members, just because the policy is “no limits”, it is but natural that the premiums, in turn, would be unreasonable. Frequent jack-up of premiums, could be the price you pay for a “no limits” product. On the other hand, when you buy a policy which has so short term restrictions or limits on expenses, you take a call that you would take care of such deductions from your own pocket.

What should you do?

You should either be prepared to pay for a premium product you have purchased, or you should settle for a balanced product, one which requires you, (rather forces you) to be prudent in your hospital expenditure, your selection of hospital, room etc.

Here’s what I recommend:

•             Do not buy your health insurance policy only based on comparison of the current features and premiums, ensure you look at how the health insurance premiums rise in the older ages.You now need to take a call between a top-end product with super benefits but coupled with steep rise in premium in old ages, or settle with a health insurance policy with basic core benefits, some restrictions on claims, but with more stable rise in premiums.

•             If you are already holding a health insurance policy, and find the premium unaffordable, with the above calculation, explore the possibility of using health insurance portability to port the policy into a more balanced plan.

•             If you aren’t able to port your policy, due to old age, or a past claim, do not get upset, and discontinue your policy, as even at the price you pay, you will definitely be better off than being without a health insurance cover, facing all the healthcare expenditure of your old age, on your own savings.

[ Source : http://healthinsuranceplanindia.blogspot.in/2016/06/lets-face-it.html]

Look for the best health cover for family welfare

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Health policy is an effective way for people to plan for their uncertain medical expenses. It has many benefits for the individuals and family provided you choose the right health insurance policy for them. However, the industry expansion is so vast in past decade that there are around hundreds of health policies being introduced in market by various insurance providers. It is often a dilemma to choose the best health insurance in India for ourselves and family.

Often people think the one which is cheap is the best but it is not this way. Your best policy will be the one that is optimum for your needs and covers you adequately. Getting adequate and right health policy to cover accidental, critical illnesses or other ailments has gained importance amongst people now.

Here are some points you ought to consider in your quest for the best health insurance in India.


No amount of financial back up is sufficient when it comes to health or critical illnesses of our family. But practically speaking you have to come to some consensus to choose suitable amount which depends upon your income source and family requirements hand-in-hand. Always choose premium well within the income source else if you cannot pay in future the policy might lapse.


It is important  you review all the benefits of your health insurance policies such as floater plan, cashless claims, hospitalization, room rent limits, critical cover, medical subsidiaries etc. being covered in your plan well.

Compare policies

Comparison of policies often helps you discover the best health insurance in India for you. Since there are many insurance companies offering a health plan, it is a good idea to do a little homework before selecting the health policy. For this, compare health plans across insurance companies. Internet is the based medium for this. Many health insurance companies have online presence and most companies make their websites really interactive and friendly for visitors seeking online quotes or even basic plan features.

Cashless Claim

Often Cashless claim proves to be the best feature in health plans. Majority of policy holder prefer this option. With a cashless policy, you don’t have to pay single penny if admitted to hospital in case of medical emergencies. The hospital gets the go-ahead from the insurance company for the operation and related procedures upto a maximum of the sum assured of the health insurance policy. Beyond this it’s your dignity in front of family members and a friend which stays intact as you don’t rely on them or borrower money from brokers for getting cured well.


Also, take policies that are renewable till your life time. Else, it will prove very costly for you to pay premiums at higher age also waiting period is more and some disease might also be not covered which are bound to happen during ageing days.

The best health insurance in India is the one that fulfills individual needs at optimum costs with maximum benefits. It should incorporate following characteristics:

  • Designed for health needs of majority of people such as family floaters
  • Purchased at optimum costs
  • Cashless hospitalization should be offered in a wide network of hospitals
  • Higher sub-limits in case of coverage offered
  • It is should be good insurance provider with well reputation in customer service and hassle free claim
  • Claim process should be easy and simple

[Source: http://healthinsuranceplanindia.blogspot.in/2016/06/look-for-best-health-cover-for-family.html]