Tips for Choosing the Right Insurance Policy

The old saying “Health is Wealth” denotes having good health is a lot more important that having plenty of wealth. Good health can help you earn efficiently and ensure you enjoy a quality life. A person with a bad health on the other hand, spends most of his money on treatment and doctor visits. The popular Arabic proverb says, “He, who has health, has hope; and he, who has hope, has everything”.

Thus, it is our responsibility to stay protected. Despite all the precautions, it is not always possible to avoid accidents and illness and thus one need to be eventually prepared for such tragic incidents. In extreme cases, we are also forced to borrow money from outside to continue our treatment.

Safeguarding your health with insurance policy will ensure you are prepared for all sorts of eventualities. With thorough research and comparison you can identify the best product that suits your requirements. Research can be time consuming and confusing with so many available options in the market. There are a few vital pointers that you must keep in mind while looking for the best insurance covers and they are as follows:

• Basic Hospitalization Cover: In case your pocket does not allow you to buy a comprehensive health insurance cover, you can look for basic health care plan that pays for the expenses incurred from any sorts of illness or accident.

• Coverage and Premium: Expensive insurance policies need not be good always. You must review the Coverage of Critical Illness, Hospitalization Cash Benefit, OPD and other such benefits, if the premiums are identical. You must identify and assess the business needs you require.

• Family Floater Policy: It is better to buy a family floater health insurance policy instead of the individual policy. Every member can utilize the sum assured in a family floater policy. This can help you save premiums.

• Sum Assured: The sum assured can be determined based on the city you live and the size of your family. Health insurance costs in big cities are more than that of the small cities. Thus, you need to determine the sum accordingly.

• Separate Policy for Parents: Premium amount in family floater policy is calculated based on the age of the eldest member. Thus, you must keep a separate policy for parents and save on the premium.

• Day Care Procedures: You must take a look at the list of diseases covered under Day Care Procedures, before buying the insurance policies.

• Exclusions: Policy buyers must go through the policy document very carefully before signing it. You must ask for the details of the terms and conditions of the policy. The exclusion part is highly important and you need to enquire about the scenarios and diseases that are not covered under the policy.

• Top-Ups: If your employer offers you a health insurance policy and you are looking for a policy of higher sum insured, you need not buy a separate policy. You can simply top up your existing policy with the required benefits and sum assured. This is a good way to save on the premium.

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The Health Insurance Process – When the Patient Gets Stuck

Studies show that ER costs make up the biggest portion of amounts owed from insured and uninsured patients struggling to pay medical bills!

In Network or Not?

Did you know that about 66% of emergency room doctors are independent contractors who may or may not be in your insurance plan? And in a practice called balance billing, any out-of-network provider or lab can bill you for whatever your insurance does not cover. You might receive bills from several entities, some of which you never even met!

What is an out-of-network provider mean? This is a healthcare professional that does not have a contract with an insurance plan. Therefore, the provider does not have to accept the insurance’s allowable amount as payment in full.

The Ambulance

Think about the ambulance too. If the ambulance company that takes you to the ER does not hold a contract with your insurance, you could be on the hook for more than $2,000.00 depending on where you live in relation to the ER and what level of care your receive prior to arriving at the hospital. Plus, if your insurance company concludes that an ER visit wasn’t warranted, you might owe even more money.

To avoid these nasty surprises, consider the following strategies:

Insurance Policy

It might sound rudimentary because it is. Ask your insurer what the plan does and does not cover in the event of emergency care. This includes the ER copay, coinsurance, and deductible – in and out-of-network. Many patients are surprised to learn there are different values for out-of-network care. Some plans even have a tiered payment system. Find out which area hospitals are in network with your insurance. Check with the hospital to see which ER doctors are in network in your insurance plan.

Find out how your plan defines a medically necessary ambulance ride and what is required to appeal a non-payment decision.

EMTs decide which hospital they will take you too but you can request a particular one. Request an in-network doctor when the admission forms are completed. Be aware, however, your insurance may deny the charge if you request a hospital further away and could have been treated at a location nearest you.

Out-of-Network Bills

If you get a bill for out-of-network charges that you could not prevent because of the emergency, then it’s time to get to work. Ask your insurer if they’ll cover the costs at the in-network rate. Contact the providers and ask what the insurance has already paid and ask them to settle for that or negotiate for a lower amount.

About a quarter of US states have consumer protection laws that restrict providers from balance billing in certain care situations like emergencies. Some laws apply only to certain health plans or certain providers. Contact your state’s insurance department for specifics.

If all this fails, contact your insurance to determine what must be submitted to file an appeal and time limits for filing. Generally, documentation from the provider(s) will be required. In the case of an out-of-network situation, ask the doctor to provide a letter attesting to a good faith effort was made to utilize a contracted provider and no equitable access to such provider existed.

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Important Points to Ponder Before Buying a Health Insurance Plan

A health insurance plan is an essential part of financial planning in this era of skyrocketing medical costs. Medical inflation has been aggravating at its full spree which makes it all the more important to buy a Health Insurance plan which could sponsor the hospitalization and medical treatment bills or expenses.

It is important to evaluate and look for the following parameters to get a best health plan for you and your family.

1. Check for the Waiting Period Clause

You must be feeling care free after taking an insurance, but your health insurance comes with a waiting period clause for specific conditions. There is an initial period clause which says that any hospitalization claim will not be admissible in first 30 days of the policy commencement apart from accidental hospitalization.The pre-existing diseases or conditions are also not covered immediately after you purchase a policy.There is a waiting period ranging from 2 years to 4 years as per the plan conditions in the industry. Also, there are certain surgeries and treatments like hernia, cataract, joint replacement, etc. which can be treated after a specific waiting period of 1 or 2 years.

So,it is important to check the waiting period clause before you finalize the health plan.

2. Check for Sublimits

There are certain capping or sublimits in your health plan which says that the specific kind of expenses are paid by the insurance company upto a specific limit and beyond that the insured or customer has to bear them at his own. For example: Room rent charges are capped on per day basis for different health plans. Some health plans also come with a mandatory co-pay where the portion of the admissible claim is to be borne by the insured and the remaining is paid by the insurance company.

Check for the sublimits in your health plan to avoid any last minute surprises at the time of claim.

3. Check for Network Hospitals

The insurance companies offering health plans have certain empaneled network hospitals with whom they have a tie up. Any hospitalization or treatment taken in the mentioned or specified network hospital list is done on the cashless basis subject to policy conditions.

Check for the list of network hospitals of insurance company and ensure you have network hospitals of the insurer near your place of residence in case of any emergency hospitalization. Also, a treatment in non-network hospital may not offer cashless treatment and some insurers have a co-pay clause if you take a treatment in non-network hospital.

4. Check for the Claim Process

Different insurance companies have different claim procedures. Some settle or administer claims through Third Party Administrators (TPA’s) and some have their own in house claim settlement unit to foster quick and hassle free claim processing. Also, check the claim settlement ratio of the insurer you intend to buy a health plan from to have a clear picture on the number of claims settled by the insurer.

It is important to have a handy information on claims procedure to have a smooth and hassle free treatment in the times of hospitalization.

5. Compare & Buy Online

It is important to take a right buying decision which can be done by comparing the available health insurance plans online. You can compare the price, key features, policy benefits, value added benefits, eligibility, exclusions,etc. of multiple health insurance plans to make a right informed choice of your own without any interference of the agents. Buying online health insurance plan is a hassle free process which required least documentation and quick policy processing. There are certain online portals which will enable you to make an easy comparison and will assist you in choosing the right Health insurance plan.

Online buying of the health plan is economical as companies offer discounts on premium for buying a policy online. The reason for an insurance policy to be cost effective if bought online is because the intermediary cost of the premium component is removed. When there is no intermediary in between, Co.’s save on the commission and policy issuance cost, which the Co. transfers it to the customers.

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