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Common Misconceptions about Health Insurance


With annual healthcare costs on the rise, a lack of proper health insurance can cause a huge financial loss in event of a serious illness or accident. However, health insurance as a financial product is widely misunderstood, and there is a general lack of understanding of the different terms and conditions of your health insurance policy in India. There are a number of misconceptions about the different policies which arise from the lack of understanding of your health insurance policy. In this article we try to demystify the common misconceptions about health insurance and debunk the myths that you might have.

List of Common Health Insurance Myths

#1: If you are covered under group health insurance scheme, you do not require additional health insurance cover

While a group health insurance policy does have its advantages, it is important to know the benefits that the employer’s group medical insurance provides. Apart from the total amount, check the policy coverage and whether it adequate for your family’s needs. It is best to buy additional health insurance in case you decide to change your employer for better opportunities or if your employer decides to cut down the benefits or restrict the coverage.

#2: If you have health insurance, all your medical expenses are covered

People believe that just because they have health insurance all their medical expenses are covered. What they fail to realize is that the coverage provided by medical insurance policies vary. For example, a health insurance policy may not cover maternity benefits or dental treatments. There are add-on policies or comprehensive health cover to cover these expenses. Of course, add-on covers or policies with more comprehensive coverage cost more. This is why it is important to check the coverages while taking a medical insurance for yourself and your family.

#3:  You need to be hospitalized for 24 hours to avail health insurance

A common health insurance myth is that you need to be hospitalized for 24 hours to avail a claim. However, not all procedures require 24 hours hospitalization. Day care procedures, such as chemotherapy and radiotherapy, do not require 24 hours hospitalization for availing claims.

#4:  It is always advisable to buy a policy through a trusted agent

It is a common misconception that when you buy a policy through a trusted agent you ensure peace of mind. This may not be true as the agent who sold you the policy may switch jobs or may not be there when you make claims. It is best to go through the terms and conditions before buying the policy instead of blindly believing what an insurance agent might tell you. Online quotes have made it easier to compare and then buy a health insurance policy.

#5: While buying a health insurance policy, you need to check the empanelled hospitals

If you are focused on buying a policy just because it has your preferred hospital in its network, then it might be important to keep in mind that even during the policy term, the network of empanelled hospitals can be changed. This can happen for many reasons. For example, a defaulting hospital can be blacklisted and be removed from the network. Similarly, certain hospitals may blacklist insurance companies or TPAs for delayed payments.

#6: Cashless is the answer to all your medical woes

Cashless is definitely a buzzword in health insurance. Under this mechanism, the Hospital agrees, under contract, to grant credit facility to the Insurance Company or the Third Party Administrator against authorized claims. However, it is important to note that cashless facility is available for only authorized claims and not all claims. The health insurance companies or TPA need to assess every claim received to authorize payment, only after the documents are submitted. This requires time which can range from a couple of hours to a day. The on-call emergency funds should be available with you.

#7: You must compare pre-existing waiting periods

People often fret about the waiting period of 4 years which is applicable in the case of pre-existing diseases. However, if you are perfectly healthy while taking a policy, then this clause does not apply to you. In case you do have a pre-existing disease, then most policies will cover it after four years of waiting period.

#8: There will be no changes in the terms of the health insurance policy you bought

A health insurance is a contract between the insurer and the insured which has to be renewed every year. It is important to check for changes in policy terms and conditions while renewing your policy.

It is important to dispel these myths about health insurance so as to choose a policy that suits your lifestyle, your financial and healthcare needs.

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Published on:14 Oct, 2014

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