Health Insurance Makeover
By Dr. Ghosh
A health insurance cover can go a long way in mitigating one’s health woes. Here’s why you need to continue your Health Policy every year.
Some dates hold special importance in our daily lives. We highlight them in our planner, our office calendar and even on the cell phone. But some times in our busy schedule, we somehow overlook them. And forgetting your health insurance renewal deadline can bring more worries than missing your anniversary date.
Insure Your Well-being
Globally, healthcare is threatened by confluence of powerful trends - increasing demand, rising cost, uneven quality of the products and misaligned incentives creating massive financial burden on the individual and family as a whole. It is imperative that everyone in the family understands the risks involved and takes right kind of insurance. The idea behind this is to reduce financial shock.
So what are the main principles that one has to consider in the entire process? The first refers to the cover that is desired. One has to first identify the extent of the cover required for the entire family. This can be determined by looking at the cost of medical expenses and the limits available. The next point is to ensure that dependant and elderly are covered. On the other hand, there has to be effective cost analysis undertaken because the premium will vary depending upon the liability. Many companies or employers have their own health insurance plans, wherein they have tie-up with one of the insurance companies. Thus, if you are employed and your compensation package consists of health insurance benefits, do check out whether they can also include dependents in the cover. Obviously, the employer will not pay premium for the coverage of the family members. But since such group coverage will be at a lower cost, it will be beneficial for you as your premium outgo will be lower.
There is no standard Health Insurance coverage for all companies. Different insurance companies in Nepal have devised various type of Heath Insurance Policy with varied sum insured, sub-sectional liability limit, price and exclusions. So you need to be careful while buying such products from the market and get your insurance right.
National Insurance markets Health Insurance Plan-A for individual, Plan-B for spouse, Plan-C for spouse plus one kid and Plan-D for spouse plus two kids. A single policy for the entire family of four is also available under a single sum insured with floater benefits. Floater benefit means the sum insured (as specified for a particular insured and the members of his/her family as covered under the policy) is available for any or all the members of his/her family for one or more claims during the tenure of the policy. For example, suppose that the Prakash’s family is covered under a traditional health insurance plan (Prakash Rs. 2 lakhs, his wife Rs. 1 lakh, their son and daughter Rs. 50,000 each) and they have paid premium for all these four policies. In an unforeseen situation, wherein surgery and post hospitalization bill of their son amounts to Rs. 1.30 lakh, the existing traditional policy will cover only Rs. 50,000. Thus, Prakash will have to bear the remaining Rs. 80,000 from his pocket. With Family Health Floater Insurance plan, each member of Prakash family is covered up to Rs. four lakh. Thus, Family Floater would have covered entire Rs. 1.30 lakh medical expenses of Prakash’s son.
Maintain Continuity of Policy
Health insurance provides expenses in case of hospitalization. It not only takes care of the expenses incurred during the hospitalization but also covers for pre- and post-hospitalization expenses.
The expenses incurred on treatment of following diseases within the first two years from the commencement of the Health insurance Policy are not payable: Cataract, Benign Prostatic Hypertrophy, Myomectomy, Hysterectomy (unless because of malignancy), Hernia, Hydrocoel, Fistula in anus, piles, Arthritis, Gout, Rheumatism, Joint replacements (unless due to accident), Sinusitis and related disorders, Stones in the urinary and biliary systems, Dilatation and Curettage, Skin and all internal tumours / cysts/nodules / polyps of any kind including breast lumps unless malignant / adenoids and Haemorrhoids, Dialysis required for chronic renal failure, surgery on tonsils, adenoids and sinuses, and Gastric and Duodenal ulcers.
In case the above illnesses are not pre-existing at the commencement of this policy, this exclusion shall cease to apply if the insured has taken Healthcare Policy and has been covered under the policy without a break for a period of two consecutive years immediately preceding the period of insurance.
Similarly, in case the above illnesses are pre-existing at the commencement of this policy, this exclusion shall cease to apply (other than Congenital Disease/Defect) if the insured has taken a Healthcare Policy without a break for a period of four consecutive years immediately preceding the period of insurance. So a break in insurance means the health insurance policy is a fresh policy.
Apart from it, most of the health insurance polices have waiting period clause of 30 days. This condition shall not, however, apply in case of hospitalization due to accidental injury or if the insured person is already covered under this scheme or a similar Health Insurance Scheme with any of the Nepali insurance companies for a continuous period of preceding 12 months without any break.
So, if you still haven’t marked this important date in your calendar, do it now.
(Dr. Ghosh is Manager for Nepal of National Insurance Co. Ltd.)
