Bhilai-based mechanical engineer Amrit Sahu was in for a shock when his health insurer deducted Rs 50,000 on account of a higher room rent. Sahu was aware about the room rent cap and he had opted for a room costing Rs 4,000 when the cap was Rs 2,000. He thought thus: along with the administrative charges, he would have to give an extra Rs 2,000 for the five days he was hospitalised. But, Rs 50,000 was a higher-than-expected penalty.
Sahu is not an isolated case. Most treat a room rent cap as just a cost fixed on only room cost. But, that’s untrue. All hospital charges increase in line with the cost of a room in the hospital. For instance, if Sahu would have opted for a room costing Rs 2,000, his operation and doctor’s fee would have been Rs 15,000 and Rs 25,000, respectively. But, he has to pay Rs 25,000 and Rs 50,000 as he was staying in a room costing Rs 4,000.
Shriraj Deshpande, head (health insurance) at Future Generali General Insurance, says hospital charges, such as doctor’s fee, medicine, operation and costs of other services, are related to room rent. “But, the policy contract should be worded saying this clearly,” he adds. “If not, the policyholder can claim back the extra money deducted.”
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Explains a senior doctor from the Bombay Hospital: “To compensate for the patients hospitals treat free of cost, they charge those who take up above average room facility. Based on the type of room you have opted for, you are made to pay for other services including the doctor.”
That’s why, say insurance experts, policyholders are again and again reminded of being aware about their policy with special emphasis given to room charges.
Here are some more points you could be aware of while choosing and claiming against your health cover:
Apart from the inner capping that health plans can have on diseases like cataract, policies can have a co-payment clause depending on your age. Experts say if you have a claim history and are 55 years or more, you could be asked to share the burden of your hospital bill up to 25-30 per cent. Importantly, many policies can refuse to honour claims for one-two day hospitalisation if you’ve claimed more than once in a year or have very little cover left. They may reason that it may come handy when you are hospitalised for long next time as you have a claim history.
Similarly, there is no stipulated entry for health insurance plans till now. (Recently, an Irda draft guidelines on health insurance has proposed to make it 65 but that is not effective today.) But, most insurers claim they give policies for those up to 60 years. Unfortunately, most do not sell policies to those above 45. At best, a few allow for those up to 50; in rare cases, it is extended to 55, says Deepak Yohannan, CEO of MyInsuranceClub.com.
There are many who wait and start shopping for a policy when they are near retirement, as they already have a employer provided cover. Such individuals are most likely to be rejected a cover, or may be sold one for sky-high premiums.
All these intricate details are mentioned in the policy document. “Unfortunately, most individuals read the policy document given on the insurer’s website before buying it,” notes Yohannan. “But, these are not the original wordings. A health insurance policy document is handed to you only when you buy the plan. Unfortunately, till now there is no free-look period in this case.” That’s why it is important to ask all that you are doubtful of before buying the policy from the sales person.
