Obligations of an individual owning health insurance

By: Pranav V Sharma

Only buying health insurance and then being unworried about it is not an apt thing that one must do. There are few things that an insured person must look at or must have knowledge about. The obligations of an individual insured person include the following:

• Verify that the insurance agent or the one from whom you are buying the health insurance has appropriate certificates and rights to sell you the policy.

• Premium: The health insurance policy holder has to pay a fixed amount of money from time to time before any of his health care is covered by the health insurer. This amount is called the premium. The policy holder has the liberty to choose the time when they would pay the premium. The available options are:
• Every month
• Every three months
• Every 6 months
• Yearly

The policy holder has to pay a fixed premium regularly depending on the payment plan that he/she chooses.

• Upper limit of coverage: There usually is an upper limit to the amount of coverage that the insurer pays for the insured. For example, for any particular medical service the insurance company would pay 80% of the total cost of the service while the rest has to be paid by the policy owner. Depending on the cost of the service undertaken by the patient (policy holder) the insured may end up having to pay very little or a great deal. Also there could possibly be a fixed amount of coverage for specific medical procedures that the patient undergoes irrespective of the actual cost of that medical procedure. Hence, it is very important that the person owning the health insurance knows the upper limit of his coverage.

• Uncovered services: There are terms and conditions of every health insurance policy irrespective of its type. For health insurance policy there are some services that are not covered under the insurance. Therefore, the insurance company does not pay for such services. The health insurance policy holder thus does not get any privileges when he/she obtains any of the services that are uncovered by the policy. Thus the policy holder has to pay full amount for obtaining these uncovered services.

• Explanation: The owner of the health insurance has full right to ask for all the details about the benefits that will be covered and provided by the health insurance that the owner is buying.

• Proofs: As a health insurance policy owner, to claim coverage for any medical service that you obtain, you need to first acquire all the bills, reports and other related documents. Only when you submit all the required documents as a proof that he/she has undergone the procedure or has obtained medical services. The coverage can be denied if even a single document is missing or if the insurance company is not convinced that the policy owner has in real obtained the service for which he has filed a claim.

• Time: Timing is a very important factor. If you fail to inform about any medical procedure that you are planning to undergo and keep your agent (indirectly the insurance company) informed then your claim might not be so easy to be accepted.

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Pranav Sharma is an insurance agent based in Mumbai; Pranav assists individuals and corporates in purchasing the right health insurance & often shares his insights about the Mediclaim industry on internet.

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