10 Expenses That Your Health Insurance Plan Doesn’t Cover

Nowadays where hospital bills are increasing rapidly, it is not a difficult task to understand the importance of health insurance plans. But if you understand that your health insurance plan will cover all the expenses of your illness. If you pick it up, it will also be wrong.

You should also be aware that your health insurance can leave you in some cases. Due to this, you will have to pay money from your own pocket.

That is why it is very important for you to know that you understand the coverage of your insurance plan so that you do not have trouble later.

Let us see when your health insurance plan will not cover all your hospital expenses.

# 1  Do you co-payment determined is ?

If so, then you will have to pay your share yourself, the company will not participate in it.

Let’s understand its logic, if you have opted for cop-payment of 20% then you will have to pay 20% of the hospital bill.

Let’s say your cover is Rs.10 lakhs and your bill is Rs.5 lakhs. Along with this, there is also a 20% co-payment in your plan. In such a case, the insurance company will pay only Rs 4 lakh. You will have to pay one lakh rupees from your pocket.

#2  Have you taken a deductible in your plan ?

Suppose you have bought a super top-up plan of 10 lakhs and its deductible for the year is Rs 2 lakhs, then you will have to pay the first 2 lakhs out of your pocket.

If your bill is 5 lakhs, then you will pay 2 lakhs and the insurance company will give 3 lakhs. If you are re-admitted in the same year and a bill of 3 lakh is generated, then the insurance company will bear all the expenses because you have already paid Rs 2 lakh.

# 3  any kind of excess, sub-limit of the above ?

Let me give a very simple example. Suppose your total cover is 10 lakhs and there is a sub-limit of 25000 for cataract treatment.

If you undergo a cataract operation and the bill becomes 60,000, then the insurance company will give only 25,000.

#4  Exceeding the fixed room rent (room-rent sublimit)

It is sometimes very confusing to understand this.

There are many types of rooms in the hospital and the rent for each is different. There is a limit on such daily room rent in your insurance policy. The amazing thing is that other expenses like surgery, doctor consultation, etc. all depend on the room rent. The more expensive the room, the more expensive the treatment.

Suppose this limit in your policy is Rs.5,000. But you choose a room in the hospital whose rent is Rs 10,000 per day. In such a case, the insurance company will pay only half the bill. This deduction will be applicable not only on the room rent but on the entire bill.

In this case, assuming a bill of Rs 5 lakh is made, then the insurance company will pay only Rs 2.5 lakh.

# 5 waiting period (waiting period) end of the first an existing illness (pre-existing illness) of treatment

You should be aware of this type of waiting period. This information is given in your policy contract. Cheaper plans may have a longer waiting period.

# 6 some years to for specific treatment of costs

Some common operations are not covered for a few years after purchasing your insurance plan. Such as kidney/gall bladder stones, hernia, cataracts,s, etc.

Otherwise, some people will take insurance only to save the cost of such treatment.

Keep in mind that this has nothing to do with your pre-existing illness.

#7 Healing in the first 30-90 days 

There is no planned treatment cover for the first 30-90 days in every policy.

Keep in mind that hospitalization and emergency due to an accident are also covered in these 30-90 days.

#8 Permanent exclusions

HIV/aids, dental or cosmetic treatment, etc. are not covered in your health insurance. There may be more such remedies. Read and understand your policy document properly.

Keep in mind that if the cosmetic surgery or dental treatment happened due to an accident, the company may cover it.

# 9 abroad for treatment

Most of the policies do not cover treatment abroad. All these plans cover the treatment in India only.

Plans that cover treatment abroad can be quite expensive.

# 10 consumables (consumables)

Your final hospital bill does not include the cost of operation, room rent, medicines, etc. And there are many other things. Such as food bills, diapers, baby food, TV charges, internet charges, etc. Your insurance company will not pay such expenses.

All these expenses can easily make up 8-10% of your bill. You have to pay it from your own pocket and you should be ready for it.

What you should do?

Provided you have taken health insurance, but you should keep in mind such expenses that your plan does not cover. And you should always save some money to pay for such expenses.

Also, understand the coverage of your insurance plan. Read your policy document thoroughly.

If some treatment or part of the bill is not covered by the policy, then the company will not pay it. Do not waste your time fighting the company in such a case.

Save your time and energy for cases where the insurance company has taken the wrong decision.

Also, keep some money deposited for medical emergencies and for such expenses which the insurance company does not cover.

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