Online health insurance is vital for covering network hospital expenses and medical procedures, ensuring financial stability in your portfolio. Despite increasing awareness, policyholders often need help to grasp the finer details of their policies.
Here Are 5 Such Things That You Might Not Be Aware Of, Along With The Truth Behind Each.
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Denial Of Cashless Claims Is Not The End Of The Road
Every health insurance plan for families provides a cashless claim settlement option to simplify the claims process. Even policyholders favour cashless claims because it relieves them of paying for hospitalisation medical care and offers several health insurance benefits. Even though insurers have made the cashless claim facility simpler, the cashless approval may occasionally be delayed or even rejected. Thankfully, that is not the case. Claims are subject to terms and conditions set forth under the health insurance policy.
Reality – Your claim would still be resolved even if you didn’t receive a cashless claims approval; it would just be settled on a reimbursement basis. Claims are subject to terms and conditions set forth under health insurance policy.
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Claims For Both Pre- And Post-Hospitalization Are Always Resolved Through Reimbursement
Your hospitalisation costs, treatment costs, and other related medical expenses will be paid on a cashless basis if you receive a cashless approval for your claim. The cashless option is not available for pre- and post-hospitalization costs, though.
Reality – The medical bills for diagnostics and consultations would need to be gathered, the reimbursement claim form would need to be completed, and the form and the bills would need to be submitted to the insurer. Claims are subject to terms and conditions set forth under the health insurance policy.
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There Is A Concept Of PPN Rates In Some Plans
Preferred Provider Network is known as PPN. It represents particular network hospitals affiliated with the insurer. The cost of the treatment would be different from what the network hospital typically charges if you were admitted to the PPN hospital and underwent a procedure on the list.
Reality: The advantage of PPN rates is that they permit listed treatments at lower rates, lowering the claim amount.
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There Might Be A Zone-Wise Co-Pay Clause
Numerous insurers categorise Indian cities into zones and tiers. Zone or Tier 1 includes major cities like Delhi NCR, Mumbai, Kolkata, Bangalore, Chennai, etc. The rest of the cities fall in the third zone, while Patna, Pune, Indore, Bhubaneshwar, and other populated cities fall in the second zone.
Reality: The zone-based classification is because different cities have different treatment costs. Compared to India’s less developed or sparsely populated cities, metros and other developed cities have higher costs. As a result, the location is taken into account when determining prices. You might pay lower Bajaj Allianz health insurance premiums if you live in a city in Zones 2 or 3. ##
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The Cost Of Health Insurance Generally Rises Over Time
Your online health insurance policy’s monthly premium changes over time. You move from one bracket to the next as you get older. The premium rises as a result. In addition, many insurers also tack on higher premiums based on the frequency of your claims.
Reality: Choose a plan to get higher coverage without exclusions as soon as possible. Your chances of getting an underwritten health insurance policy may significantly decrease if you develop any illness, such as diabetes or hypertension.
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Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.