2/ Health Insurance cos won't pay based on fixed package charges, unless they are part of a pre-agreed contract.
Insurers will demand a detailed breakup of the package charges and then evaluate the claim against the insurance policy.
3/ Here's how Insurers will look at the breakup from Max
#1 Room Rent, #2 RMO Visits, #3 Nursing, are considered part of Room Chg. If these are billed separately, only Room Rent will be paid.
Consumables under # 7a & # 7b are not covered
Rest of the items are payable separately
4/
- Any ad hoc miscellaneous charge in the breakup are not payable.
- Any charge that is not reasonable (disproportionately high) will be paid only at reasonable rates.
Unfortunately, you pay what is not payable.
5/ Of course, if you have a health insurance policy with a room rent limit, you are up for proportionate deductions.
Which means that if your ICU room limit is 10K per day & you are charged say 20K per day - your entire bill may have a proportionate deduction of around 40-50%
6/ How can you prepare for long term, instead of panic?
a) Have a policy that covers each family member for 10-15L. Ideally 20L.
b) Ensure your policy has no room rent cap.
c) Get a fixed cash benefit policy for the deductions. Read about it here:
Agent vs Online - whom do you buy health insurance from?
A debate more complex than Android vs iPhone
I found a reasonable answer to this question through countless interactions with customers over 15+ years of working in insurance distribution.
Here's what I realized.
Online platforms are great for transactional products.
Products where the cognitive load to make decisions is low - where stakes are low, where decisions are reversible.
Simple UX and an efficient call centre do the trick.
But this same thing is not true for complex insurance products like health insurance.
These products have serious nuances that cannot be understood easily.
Personalization, right declarations when buying the policy
Paperwork, follow-up, and dispute management when making claims
4 myths regarding parents' health insurance through an employer you must know.
On the face of it, employer parent's health insurance looks like a no-brainer
✅ No medical tests
✅ No waiting periods
✅ Cover all diseases
✅ Faster claims
To problem kya hain? Read on 😅
𝗠𝘆𝘁𝗵 𝟭: I will remain employed for a good time. So I will always have parents cover
Not really
Note, parents' coverage with those lovely benefits causes major losses to insurers The policy is hence prone to:
a) price hikes
b) reductions in benefits
I have witnessed companies that start with fancy benefits for parents, free.
Then renewal comes
When they realize there is a huge premium hike, the CFO walks in, and rest is history
Just check the pricing history of parents insurance in your company for last 5 years.