When it’s a question of simply pooling the money for one who would actually incur a loss, then why there are so many terms & conditions? Why it can’t be as simple as, in case of hospitalization total bill amount up to the sum insured is payable. All I want to say is, 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 an improvement is possible in the terms & conditions of the health insurance policy.
1: 30 Days 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 expect a hospitalization.
Scope of relaxation: Because of this clause, the insured is actually being covered for only 11 months unless its accident. The insurer can provide an option to start the inception date after 1 month of receipt of premium and let the insured decide if he is ok to bear the risk of accidental hospitalization till then.
Insured can forego this accidental cover for 1 month by holding a Personal Accident cover separately.
3) Restandardization of coverage list:
It has been seen that the same coverage is provided by insurers either in ascending or descending manner.
Like, few put co-pay as for an inbuilt item, an insured has to pay extra to avoid co-pay. Others put co-pay as for an additional item, for which you would get a discount in premium if you opt.
This can be standardized that only one flow should continue.
There should be a standard list in which any negatives can’t be made a part of it, only additions can be done to stand ahead in the market.
4) Look back on the ways policies are designed:
There are certain policies in the market which give one picture while buying the policy and a very different picture in case of occurrence of the 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, instead of 15 to 4, the policy should reflect 4 to 15 to gain positivity among buyers.