Buying a health insurance plan is one of the most important decisions that you will take in order to financially secure yourself. You never know when you are faced with a medical emergency, but it is essential to be prepared in such cases.
Now, when anyone buys a health insurance policy, they always check the benefits that a particular plan offers. This gives them an idea of whether the plan will prove to be useful to them or not. Learning about the different plans also helps in comparing them and choosing the best one. But learning about a health insurance plan in detail also means that you should be aware of its restrictions.
Let us take a look at 3 of the most common restrictions in health insurance plans:
Room rent & treatment caps
When you have to file for a claim, you should be aware that there are restrictions on the sum you are insured to receive for certain expenses. An ideal health insurance plan does cover expenses for the doctor’s visit, the room rent, and so on. But this does not mean that you will get full coverage for these charges.
When it comes to these charges, there is a certain limit up to which your health insurance plan will cover you, beyond which you will have to cover the rest of the expenses from your own pocket. The room rent is usually capped at 1 – 1.50% of the sum insured, based on your health insurance plan. This means that if you have a sum insured for Rs. 10 lakhs, the reimbursement for your room rent would be Rs. 10,000 (1%).
Claim restrictions for illnesses
A lot of people who buy health insurance policies are unaware of this restriction. When you first buy a health insurance policy, you are not eligible to get the plan’s coverage from the next day itself. There is a certain time limit within which you cannot file for claims. Most health insurance plans restrict you from filing for claims for a period of 30 days of buying the plan.
Unless it is a case of an accident, you will not be able to file claims for any new diseases. There is a waiting period even for pre-existing illnesses. This period could usually last for up to 3 to 4 years, depending on the insurance company you have purchased the plan from.
Cashless claims limited to network hospitals
There are two ways of settling a claim. One is the situation where you pay for all the medical expenses from your pocket, and then later get them reimbursed through your health insurance plan. The second is where you do not have to pay anything upon hospitalization, as the hospital will directly settle the medical expenses with your insurance company.
Obviously, the second option is much more convenient as it leaves out the stressful process of you having to take all the bills and file for a claim. But please know that in order to go with the cashless option, you are restricted to go to only those hospitals that are affiliated with your insurance company. So always check about the network of hospitals that your insurance company provides for a cashless settlement.
We hope this article has been informative to you. All the best!