5 common health policy issues buyers face

Nov 22, 2017

Health insurance is no longer an option but a dire necessity. Fortunately, a variety of health insurance options are available in the market that provide comprehensive deals that take care of all your needs.

Although, thorough research is the key to finding the best health policy, there are some factors that can make your best buy a troublesome affair to continue with: spike in renewal premiums, missing renewal reminders, last moment cash deposit in cashless treatments, and so on and so forth. Policybazaar lists a few common issues that can crop up as the holder of a health policy issue. Here's to being aware.

  • Sudden hike in renewal premiums

According to many experts, a sudden hike in health insurance premium is one of the biggest concerns for existing customers. Although, it’s understood that pricing of premiums increases with age and medical advancements, the sharp hike in renewal premiums can easily make renewing of premiums unaffordable for customers.

Recently, Mint received a letter from a 54-year old reader stating that his renewal premium increased from Rs 19,212 to Rs 26,524 for an insurance of Rs 6 lakhs. Unfortunately, ageing people don’t have any other option but to continue with the new premiums. Also, porting to a different insurer becomes quite a difficult task if you’ve already made claims on your policy or are suffering from an illness.

  • Missing renewal reminders

There are no regulations that make it mandatory for insurance companies to send regular reminders to the customers. However, due to technological intervention, service providers have taken it up as their added responsibility to send regular reminders for better customer service and experience. Hence, whenever you get a new policy, all the details will be shared with you on your registered email address as well as timely reminders will be sent to you (which can start from a week before the actual payment date).

These reminders prove to be of great help as health policies are long-term investments and you need to renew them every year.  In case, you miss it even for a single year, it will result in forfeiture of your existing health insurance and you’ll need to buy a new policy.

Also, if you have a health condition or issue, the new insurer is going to factor-in the condition before issuing the policy. As per experts, almost 20-30% of renewal reminders remain undelivered to the customers. This phenomenon occurs due to the fact that insurers haven’t got their database fully updated or might be their systems aren’t geared for systematic follow-ups. However, few cases also happen deliberately on the insurers’ part where customers who have made huge claims often don’t receive the reminder.

  • Not so-cashless option

It’s important to understand that the insured person can end up paying some portion of the medical bill from his/her own pocket. Health policies come with deductibles, under which the insurer would pay up to 90% of the bill and the patient will need to pay the remaining part on his/her own. While in some cases, hospitals may take up to 30 to 45 days to get the bill settled with the insurer.

Due to delays in cashless insurance approvals, the hospital might charge the patient in the form of a cash deposit. All this happens due to a mere fact that the insurance companies don’t maintain their database well i.e the database of insured customers is not updated, and hence the third-party administrators (hospitals/medical institutions) insist on cash deposit as they aren’t able to identify the insured’s details with the insurer.

  • Miscommunication

The lack of communication and transparency between insurance companies and the policy holders is a major issue that customers face while buying policies. For instance, if you are suffering from health conditions like high cholesterol and sugar, you might need to wait far longer to get the final decision from the insurance company. Also, in the procedure of reimbursement claims, the buyer often has to keep waiting for a longer period of time to get the dues cleared by the insurer.

Another problem is, excluded medical cases and clauses. For example, if the policyholder is suffering from knee pain and all kind of joint treatments are excluded from the policy, it will be an unfair scenario for him/her. Even grievance cells are not equipped with the right solutions and answers for these cases and there is an over-dependency on standard responses.

  • Renewal of contracts

Most often, insurers re-file their policies and the new product (policy) has many added features in it. However, with added features, there also comes a long list of added exclusions. Therefore, it’s always advisable to thoroughly read the list of exclusions before renewing health insurance policies. Or else, you might end up paying from your pocket in the end. Oral chemotherapy is one of such cases that are excluded from few of the insurer’s list. Medical advancements have opened doors for many day care and expensive treatments and insurers are excluding such expensive treatments by excluding day care medical procedures.

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