Take 1: Remember all those Amitabh Bachchan movies where the perpetual mother Nirupa Roy would be shedding voluminous tears as her husband is in the hospital, there is no money to feed the children and there is no medical insurance to cover the costs of his hospitalisation
Take 2: An immensely forgettable film in which Sanjay Dutt in Tathastu decides to wield the gun as his son needs a heart transplant and he does not have the money. Even his trusted medical insurance company lets him down because he forgot to renew the medical policy.
Both cases give us a clear indication that having a medical policy and renewing it faithfully is extremely important for us to get the advantage when we need it. For this, you need to read the policy documents carefully. The insurer under the mediclaim contract pays the insured amount after the insured produces the relevant bills.
The amount of such expenses under different heads:
Room: Boarding Expenses as provided by the Hospital/Nursing Home.
Nursing Expenses: Surgeon, anaesthetist, consultants.
Specialists Fees: Anaesthesia, blood, oxygen.
Operation theatre charges: Surgical appliances, medicines, drugs, diagnostic materials, X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and costs of organs and similar expenses.
Note: Company's liability in respect of all claims admitted during the period of insurance shall not exceed the sum insured per person.
While the above is covered under your policy, there are a few exclusions that you need to know. Here are a few exclusions.
No to pre-existing diseases
The insurer is not be liable to make any payment for any injury or treatment of diseases that already existed at the time of taking the policy. For instance, if you are operated for stones in your gall bladder which was detected say, 5 years before you took the policy, you cannot claim the expenses from the insurance company.
Not in the first 30 days, please
The insurer will not make any payment for expenses incurred on hospitalisation/domiciliary incurred during first 30 days, except in case of injury arising out of accident.
Not the first year
Certain diseases are not covered during the first year of the operation of insurance cover. Some of these are cataract. benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma etc.
No to war
Injury or disease directly or indirectly caused by or arising from or attributable to war are not covered. Invasion, act of foreign enemy, war like operations (even if it is not declared) and by nuclear weapons/materials.
No to teething problems
Dental treatment or surgery of any kind unless requiring hospitalisation and cost of spectacles and contact lenses, hearing aids.
Not to treatment during pregnancy
Treatment arising from/traceable to pregnancy, childbirth including caesarean section.
No to nature
Any treatment that is done through naturopathy.
Now that you are aware of the exclusions in the policy, you should know how to make the claim so that there is no problems in getting your claim.
Claim it Right
- All communication has to be delivered in writing.
- All premiums should have been paid in advance.
- A notice has to be sent to the insurance company in the occurrence of any injury /hospitalisation within 7 days.
- All claims must be filed within 30 days from date of discharge from the hospital.
- All original bills/documents have to be provided. Also, more details, if required have to be provided In case the insured has more than one policy then the insurer will only pay their part of the portion.
The insurance company does not have the responsibility of reminding you to renew the policy. Also, the company may at any time cancel this policy by sending the insured 30 days' notice by a registered letter,
In short, awareness of the fine print of a mediclaim policy helps you facilitate a speedy recovery of the claims. This can only be achieved by timely submissions and true data from your side.
