- Date : 15/02/2018
- Read: 8 mins
With medical costs constantly increasing, would you be able to afford proper treatment if something happened to you right now?
The last three decades should stand out as the period in the past 100 years that witnessed the fastest transformation in lifestyle choices for the average Indian.
New investments that came in the wake of liberalisation in the early 1990s opened up newer jobs, which in turn spelt higher incomes, bigger spends, greater aspirations – in short, the period post-liberalisation was marked by a rush for a better lifestyle. Gone were the days when the average Indian would consider a residential phone a luxury; now, 88% of Indian households own cell phones.
Ironically, “better” lifestyles did not translate into a “more regulated lifestyle”, and soon, ailments related to one’s lifestyle began to spread.
As a result, the concept of 'lifestyle diseases' – unheard of 30 years ago – soon became the new normal as ailments such as diabetes, obesity, and hypertension began to shoot up in India.
Alongside, medical costs are rising phenomenally. As per a 2014 report of the National Sample Survey Office (NSSO), the average medical expenditure per hospitalisation for urban patients rose by about 176% over 2004 - 2014 (about 160% in rural India).
What is alarming is that the same NSSO report said as much as 82% of India’s urban population had no medical insurance.
Healthcare is expensive, and in the coming years, it could be more difficult to bear these expenses. Thus, perhaps, it is not out of place to ask yourself this question: “If I am to face a medical emergency today, can I cope with it?”
Fortunately, today there are steps that can be taken to ensure that you can indeed cope with a medical emergency, including accidents.
Remember: India is the chosen destination for many advanced medical treatments, and if spiralling healthcare costs are a reality, so is the availability of advanced medical treatments.
*The above data is the result of a poll taken by people who visited Tomorrowmakers.com.
However, it is advisable to have health insurance as it gives you the benefit of cashless treatment. Hence, you don't have to worry about not having enough money. More importantly, this can also ensure you get quality treatment without you having to worry about how your health will impact your savings.
If and when you are admitted to a network hospital, and get treated for an illness covered by your policy, you will not have to pay anything from your own pocket. Your health insurance provider will pay for your hospitalisation and treatment. This feature, however, applies only to those hospitals that are under insurers list of network hospitals. The list of network hospitals is generally provided in the policy document and on the insurer's website.
If you choose to get treatment at a non-network hospital, you will not receive this benefit from the insurance company. You will have to submit relevant documents and file for reimbursement, after which your insurer will decide whether it wants to reimburse the whole amount or just a part of it.
There is little need to belong to the 82% of the uninsured urban population that the NSSO talks of.
Various health insurance products are available in the market, all adhering to the guidelines of the insurance regulator, the IRDAI; as such, they are safe.
Significantly, multiple products mean options to select the one that suits a person the best; it is all about planning. For instance, based on your current stage of life- single, married, married with children - you can find a plan to suit exactly those needs. On the other hand, it would be more advisable to choose separate plans for family members above the age of 50 as they might require frequent claims; including them in the family floater may not leave any coverage for others.
It is also advisable to opt for policies that cover expenses that can be anticipated, such as pregnancy or hereditary health conditions.
“Can one cope with a medical emergency?” Of course, one can – just by being alive to the fact that there may be an emergency, and taking precautionary steps.
In India, nobody believes in regular health check-ups and that is because it is considered an extra expense, which delays detection of health problems till it gets critical, even deadly, and making treatment prohibitively costly.
But this can be avoided: health plans often include free health check-ups. It may be once every four years, but to avail of it, it is often mandatory to have the plan renewed on time, and zero-claims made during the time that the holder has had it.
On the other hand, the plan may offer a free health check-up once a year, even if a claim has been made – it all depends on the type of health plan.
The type of check-up allowed may or may not be specified by the insurer, and generally covers standard medical tests (for blood, urine, chest x-ray, general physical) and obesity tests (lipid profile).
If done at a diagnostic centre or lab that has a tie-up with the insurer, the costs are settled by the latter. If a non-empanelled centre is involved, the policyholder pays the amount and is reimbursed for the same.
But there may be limits on reimbursements; this needs to be clarified when buying the policy.
But it is not enough to merely buy a health policy and not understand how much – if at all – the requisite treatment will be entertained. What is the deal if you need a non-allopathy treatment or even an organ transplant?
Let us consider the first case: alternative therapies such as such as Ayurveda, Unani, sigdha, acupuncture or homeopathy are often successful where allopathy has failed.
The problem is that though the IRDA wants health coverage to include alternative treatments, many insurers are reluctant to play ball, given the grey areas that exist in the pricing structure of the non-allopathy sector.
There is no central governing body for it, leading to arbitrary rates and a lack of clarity about procedures. It gets messier when people combine alternative therapy with allopathy.
Some insurers such as New India, Chola, TATA AIG and HDFC Ergo have begun offering cover for alternative treatments if they are undertaken in government hospitals, but such places are few. And even then, reimbursements are capped at 25% of the expenses, depending on the type of health plan you avail.
When healthcare costs spiral, can that of organ transplants not follow suit? If anything, this area is frighteningly expensive: kidney transplants are hovering between Rs 4.3 lakhs and Rs 6 lakhs, while bone marrow transplant is upward of Rs 24 lakhs, and kidney transplant surgery can top Rs. 36 lakhs.
These charges are estimates and depend on the medical problem and condition of the patient; the final packages will include costs of treating post-surgical complications if any.
So the question is, if you are diagnosed with a medical condition necessitating an organ transplant, does health insurance in cover it, and if yes, how?
For the policyholder, there is no issue: health insurance covers all diagnosed conditions, tests, and treatments that require hospitalisation, including costs of those relating to organ transplants, up to the sum insured.
However, it is important to note that insurance companies do not cover all the costs related to the hospitalisation or surgery of the organ donor.
Donor-related expenses are incurred on “organ screening” (for compatibility), pre-hospitalisation processes; hospital room and nursing; transplantation surgery; post-surgery complications and recovery; post-hospitalisation processes. Of these, it should be noted, insurers do not cover pre- and post-hospitalisation costs of the donor and that incurred on post-surgery complications. Many have also categorically excluded costs of the actual surgery.
Moreover, hospitals offer lump sum “packages”, which makes it imperative for policyholders to break down the costs when considering insurance.
To come back to the original question, “If I am to face a medical emergency today, can I cope with it?” the answer should be: “Yes, I am... I have insurance.”
The problem is that people avoid buying health insurance as they find it difficult to understand clauses and are therefore unable to choose the best plan for themselves.
And if they do buy insurance, they tend to treat it like an expensive smartphone: they acquire one without understanding its features or trying to learn what all it provides.
Another thing to keep in mind is that most plans exclude pre-existing ailments for a specified period of time; hence, it is advisable to go with health insurance that has a shorter waiting period as this provides cover at the earliest.
Cases such as HIV/ AIDS, injury sustained due to alcohol, substance abuse, or during adventure sports such as paragliding, skiing, etc. may be excluded from the plan
Compare Features, not Premiums:
Additionally, it is important that you don't focus on lower premiums; instead, compare different plans to find one that suits your needs best.
Disclaimer: This article is intended for general information purposes only and should not be construed as investment or insurance or tax or legal advice. You should separately obtain independent advice when making decisions in these areas.