Explained: co-pay clause in health insurance policies

This article explains how the co-payment (co-pay) clause works for health insurance policies. It originates from an email exchange with a reader about base policy co-pay limits and super top-up applicability. This article would not have been possible but for the expert guidance of¬† Ajay Pruthi, a fee-only SEBI registered investment advisor. He can be…

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Cashless versus Reimbursable Hospitalization: Which is better?

There is a belief among some that hospitals may misuse the cashless hospitalization facility offered by medical insurance policies. As a result, they suggest paying out of pocket and then seeking reimbursement through the policy. This raises the question: is it more prudent to utilize the cashless hospitalization facility or pay upfront and seek reimbursement…

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Health insurer said hospitalization was unnecessary, but paid after Ombudsman complaint!

This article is based on a real-life experience of my client, Rajesh.¬† He had a 21-month-old health insurance policy from an Insurer for the Sum Insured of ‚āĻ 10 lakhs with good comprehensive features. About the author: Shashi Singh is a fee-only SEBI-registered investment advisor. He can be contacted via his website¬†finmyn.com. Shashi is part…

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Claim rejection data for standalone health insurers for FY 2021-2022

Based on the IRDA annual report, we discuss the claim rejection data for standalone health insurers for FY 2021-22. We can only answer how many claims health insurers reject yearly for standalone health insurers. IRDA does not provide break up details for the total claims processed by general insurers. For general insurers (including PSUs), we…

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Don’t forget these steps after buying a health insurance policy!

Here is a list of things to do after you buy a health insurance policy. ¬†These simple steps would aid premium payment, claim application and hospitalization. This post is a companion piece: Do¬†not forget these steps after buying a term insurance policy! 1. ¬†Understand claim procedures Whether cashless or reimbursement, insurers must be immediately intimated…

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Why we purchased United India Super Top Up Policy with 95 lakhs sum insured

United has recently made significant changes to its Family Medicare Policy and Super Top-Up Medicare Policy. I discuss why we purchased the revised top-up cover with Rs. 95 lakhs sum insured in this article. If you are looking to buy base or super top-up health insurance, this may be useful: Select the right health insurance…

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Select the right health insurance policy with these free resources

Here are five free resources (two ebooks, two webinars and a policy comparison spreadsheet) to help you choose a suitable health insurance policy. 1. Ebook on Health Insurance by Venkatesh Jayaraman. Author Bio: I was brought up in Chennai and moved around Bengaluru, Chennai, Mysuru and Pune to cater for my career requirements. But primarily…

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