Terms & conditions in Health Insurance Policy Should not be used for Marketing Tactics



When it’s a question of simply pooling the money for one who would actually incur a loss, then why are there so many terms and conditions? Why can’t it be as simple as that? In the case of hospitalization, the total bill amount up to the sum insured is payable?

All I want to say is, that wherever there is a need for the insured to take the burden of expenses, it should be grouped under minimum heads, making it easy to understand while buying and easy to settle the claim.

Now let’s see where all the improvement is possible in the terms & conditions of the health insurance policy.

1: 30-day waiting period:

What is it: Any insurance policy does not pay for the first 30 days of inception unless it’s an accidental hospitalization.

Why it is needed: This is necessary because every person would then buy an insurance policy when he is already sick and expects a hospitalization.

Scope of relaxation: Because of this clause, the insured is actually being covered for only 11 months unless there’s an accident. The insurer can provide an option to start the inception date after 1 month of receipt of the premium and let the insured decide if he is ok to bear the risk of accidental hospitalization till then.
The insured can forego this accidental cover for 1 month by holding a Personal Accident cover separately.

2) Restandardization of coverage lists:

It has been seen that the same coverage is provided by insurers either in an ascending or descending manner.

Like, few people put co-pay as an inbuilt item, an insured has to pay extra to avoid co-pay. Others refer to a co-pay as an additional item, for which you would get a discount on the premium if you opted.

This can be standardized so that only one flow should continue.

There should be a standard list in which any negatives can’t be made part of it, only additions can be done to stay ahead in the market.

3) Look back on the ways policies are designed:

There are certain policies in the market that give one picture while buying the policy and a very different picture in the event of a claim.

There is a product in the market that shows 15 Lakhs of health insurance cover while we buy, but when we look at the sub-limits, not more than 4 lakhs is payable in case of occurrence of even critical illness. 15 lakhs is applicable only in case of accidental hospitalization, or it can be considered as the total sum insured available throughout the policy year.

This policy should be represented as a 4 lakhs sum insured policy only, whereas the benefits like 15 lakhs on accidental hospitalization or overall limit throughout the policy year can be stated as additional benefits only.

All I want to convey is, that instead of 15 to 4, the policy should reflect 4 to 15 to gain positivity among buyers.

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Susheel Agarwal

Susheel is the CEO of Ethika Insurance Broking P Ltd. This company, which has a current value of 10 million dollars, was bootstrapped by him and two of his friends. He attributes his success to his ability to inspire others to seek happiness at work.