In a rapidly evolving healthcare landscape, while India has one of the most advanced healthcare systems in the world, availing that healthcare comes at a significant cost. While relatively lower in healthcare prices compared to other nearby countries, India is also subject to a high medical inflation problem. Despite being a signatory to Universal Health Care, the multi-payer model’s inherent limitations result in increased prices.
One thing to note is that along with these prices, the scope and number of individuals with health conditions are also increasing. According to the Indian Heart Association, 50% of all heart attacks in Indians occur under 50 years, and 25% of all heart attacks in Indians occur under the age of 40. Besides heart ailments, there is also a growing concern for genetic malformities impacting several comorbidities arising from a sedentary lifestyle in the Country.
To address all these and more, health insurance plays a crucial role in providing financial protection during medical emergencies. Despite increasing awareness, a significant number of Indians still hold on to outdated beliefs and half-truths about health insurance plans, which often lead to poor financial decisions and unnecessary expenses.
Misunderstanding the terms, benefits, and processes associated with medical health insurance plans can prevent individuals from maximising their policy’s benefits or, worse, leaving them unprotected during a medical crisis.
Here are the top 10 misconceptions about health insurance that can end up costing you both peace of mind and money.
1. Health insurance is only needed for hospitalisation
Many believe that a health insurance policy only comes into play when someone is admitted to a hospital. While hospitalisation is a core part of coverage, most health insurance plans now offer benefits such as daycare procedures, outpatient department (OPD) consultations, diagnostic tests, and even mental health care. Failing to consider these aspects may result in paying out-of-pocket for services that are already included in your plan.
Additionally, note that most health insurance policies include waiting periods for certain conditions, including critical illnesses and pre-existing conditions. Thus, having your coverage be active before needing it during hospitalisation is preferred.
2. Young and healthy individuals don’t need health insurance
A common misconception is that young and healthy individuals do not need health insurance. However, medical emergencies can happen to anyone, and buying insurance early means lower premiums and the ability to complete waiting periods as mentioned above before serious health issues arise. It also helps in long-term health insurance planning and tax planning, ensuring you’re covered before problems begin while also reducing your tax liability.
3. Employer-provided health insurance is sufficient
Many salaried employees rely entirely on the health insurance provided by their employer. While group insurance offers basic coverage lacking several key aspects, such as dental coverage, it often has limited sums insured and fewer personalisation options, depending on the policy.
Moreover, this policy terminates upon your departure from the job. Unless you have another job with health insurance lined up, having a personal or family health insurance plan ensures continuous protection, regardless of your employment status, while also helping with the waiting period and potentially lower premiums or an increased sum insured due to no-claim bonuses.
4. All medical expenses are covered
Not all expenses are reimbursed, and this misconception can lead to surprise bills. Most health insurance plans have exclusions, such as cosmetic surgeries, dental procedures, and pre-existing conditions, during the waiting period. Understanding what your policy does not cover is just as important as knowing what it does.
5. One policy is enough for the entire family
While health insurance plans for family offer collective coverage, one policy may not always be adequate. For larger families or those with elderly members, individual policies or top-up plans can offer better financial protection. Assuming a single-family floater policy is sufficient may result in inadequate coverage when multiple claims arise in a year.
Consider this: the healthcare needs of senior citizens differ significantly, as many of them have pre-existing conditions such as high blood pressure, diabetes, and heart conditions, among others. Thus, they require more comprehensive coverage, but this also results in a higher risk of claims. This means that, due to the increased risk, senior citizens would face higher premium prices, which can result in a significant annual premium increase as part of a family floater plan.
To counter this, senior citizens can be protected with a specialised plan offering a lower premium and a shorter waiting period for better coverage.
6. Maternity cover starts immediately
Maternity coverage is often one of the most misunderstood coverages offered under medical health insurance plans. Most individuals believe that maternity coverage begins on the policy start date; however, most plans have a waiting period of 9 months to 4 years before maternity expenses are covered, resulting in non-coverage until the waiting period is completed. Buying insurance with maternity benefits only when you’re planning a family soon may result in out-of-pocket costs due to policy restrictions.
7. Claim settlement means cashless always
Cashless treatment is subject to hospital network agreements and prior approvals. Many policyholders assume that every hospital visit can be handled cashlessly, which isn’t the case. If you receive treatment from a non-network hospital or do not follow the correct claim process, you may be required to pay upfront and then receive reimbursement later.
8. Buying online means no human assistance
Some avoid buying health insurance online, thinking it lacks personal support. However, most reputable insurers provide robust customer service through chat, phone, or app support, including claim assistance and guidance on policy selection. Digital platforms make buying and managing health insurance easier and more transparent.
9. Cheaper premiums equal better plans
The cheapest health insurance plan is not always the best. Lower premiums may come with high deductibles, limited benefits, or sub-limits on room rent and surgery costs. Evaluating the plan’s coverage, hospital network, claim process, and add-ons is critical for long-term value, not just the price tag.
10. Once purchased, you don’t need to revisit your policy
Health insurance needs change over time, particularly after marriage, the birth of children, or the development of a health condition. Sticking with the same policy year after year without reviewing it can result in being underinsured. It’s essential to review and update your plan annually to reflect your current needs.
Conclusion
Believing in these common myths around health insurance can result in costly mistakes that defeat the purpose of having a policy in the first place. The key to securing the best protection lies in understanding your coverage, choosing the right insurer, and staying informed. Evaluate your policy periodically, understand the terms, and never hesitate to seek help in selecting the right plan.
Whether you are buying insurance for the first time or reviewing your current plan, debunking these misconceptions can empower you to make smarter and more cost-effective decisions, especially with reliable insurers like Bajaj Allianz supporting you at every step.
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