Life has this amazing knack of playing
roulette with you!
I had planned to write about my experiences
with medical insurance on the first Sunday of this month, and a medical
emergency on that Saturday itself took the entire weekend. And this Sunday was
dominated by work.
Anyway, here goes. 6 points based on my
experience of what to do – and what not to do – while buying medical insurance.
Buy what you need – not what saves you
tax: We have this amazing thing in India of
Rs.15,000 tax saving under section 80D (we all seem to remember this section,
as we save the entire amount on tax). Hence, we all end up investing only this
amount on Mediclaim. I did the same. But maybe it is not enough for some families.
What if there are 3 children and aged parents to take care of? What if there is
a medical history in the family that necessitates preparation through proper
medical insurance planning? There are many possibilities. Always take into
account all these factors while deciding how much to invest. Rs.15,000 should
be the minimum, and not the only number. My own experience – my old policies
had lapsed and I had to take a new policy in 2007. I realised that I would have
to shell out a huge premium for my parent’s insurance, as they are both above
60, hence in consultation with them, we decided not to take insurance for them.
Over the next two years, both of them required treatment, and we had to shell
out of our own pockets!
Do not let your policies lapse: The second lesson I learnt. I had mediclaim till 2004, which we
allowed to lapse when I went abroad. It would have cost next to nothing to keep
it alive, but I allowed it to lapse. Result – when I came back and invested
once again, I had to pay higher premia as we had moved into different age brackets,
and we also lost all no-claim benefits.
Buy a floating cover, it is worth the
extra premium: The harshest lesson I learnt over
the past one year. I have insurance for myself, my wife and both the children.
On seeing the difference in premium, I decided to go in for separate policy amounts
for each individual, insuring myself for the highest sum, followed by my wife,
and then smaller amounts for the children. My daughter and I both needed
hospitalisation this year. And while the amount for me was well within my insurance
limits, the amount spent on my daughter’s treatment extended well beyond. This
naturally took a huge chunk out of my savings. The funny part is – the total
amount for both our treatments combined is less than 2/3rds of the total insured
value for both of us. In other words, had I taken a floating cover, I would not
have spent a rupee (apart from the minor amounts that insurance companies or
their TPAs love to deduct).
Find out what insurance companies have
tie-ups with good hospitals near your home: And go
with only those companies which do. It is a simple but oft overlooked fact, but
think about it. Where do we rush to in an emergency? The best hospital nearest
to our house. And if at that time we have to also run around for money? It can
get extremely harrowing. Believe me; we have been through it in the past year!
Remember, it is not only for ourselves but also for our family members, who
spend the best part of their day near home itself.
Find out who offers cashless treatment
at a good hospital near your home: It follows from
the previous point. You may get insurance, and everything may be in order, but
if the hospital and the insurance agency do not have an agreement for cashless
treatment, you could run around like a dog chasing its tail!
I had my accident on Sunday afternoon. Unfortunately, the hospital and my
insurance company did not have a tie-up for cashless, and the hospital rules wanted
us to pay Rs.1.4 lakhs for me to be operated upon immediately. And with my left
hand broken (for those unaware, I am left-handed), I could not even sign a
cheque. Even if I could, what use would it have been on a Sunday? It was only
the emergency and possibly our family friend’s (who is a doctor known to the
surgeon) discussion that made the hospital accept that they would do the
surgery and we could make the payment the next day.
Everyone would not be as lucky!
Also, for me, claiming the money from the TPA was like getting money from a Jew!
Have you heard of the saying “A fool can ask more questions than the wisest man
can answer”. I am sure the person who coined this saying must have had to
answer a doctor in an insurance company!
And the number of times they made me run around, I could qualify for the
Olympics! They are expected to complete one process in 45 days, but you ask
them about the claim on the 46th day, and then they will start
sending queries. The way the lady at the TPA counter acted aghast when I asked
her how come their letters don’t reach our house when every other letter does,
had to be seen to be believed. I get a strong feeling they do this only to
delay payments.
I nearly gave up on one claim because I realised that I may end up spending
more than 20% on taxi fare going back and forth, in addition to the huge waste
of time! And when I stopped responding, they sent the cheque home – one year
later!
I learnt the advantage of cashless a while earlier when my brother had to be
rushed to hospital at midnight, and everything was taken care of like
clockwork.
Do
not trust your insurance agent: Sound a bit harsh, but it is true. Remember, he
is doing a job, which is to sell you a medical policy. He may end up saying yes
to everything you say, with just the right pauses and intonations to drive you
towards where he gets more commission.
Decide your requirements, read the fine print and make your own decision.
After all, it’s your life – and your family’s.
