The place was National Stock Exchange. The topic was investment, markets and wealth creation. But one session changed the course of the discussion. More emphasis was given on saving money than earning it. Because one medical emergency can wipe out years of earnings. Yet very few people still have health insurance in India. After all, what is wrong with India’s health insurance system? And can people forgo insurance and just rely on big savings?
The real problem: gap between expectations and reality
According to Chopra, the biggest problem is expectation mismatch. That means, the agent who sells the policy does not settle the claims. The seller makes big promises because his profit is in selling the policy. But at the time of claim, another department comes, whose objective is to save the company’s profit. For example, the lure of unlimited cover is offered, but at the time of claim, objections arise regarding room rent or other conditions. This increases frustration among customers.
network of nuances
Shilpa Arora said that most people do not understand what they are buying. Terms like room rent cap, sub-limit on treatment, deductible, co-payment reduce the claim amount. The one-page summary (CIS) of the policy is also in language difficult for the common man. TPAs (Third Party Administrators) in hospitals are also often limited to paper processes only. The claim may get stuck due to a small mistake.
Is just saving enough?
The clear answer from both the experts was no. Health cover of Rs 10 lakh is not the same as savings of Rs 10 lakh. The insurance resets every year. However, savings can be useful for minor illnesses and super top-up plan can be taken for big expenses. In metro cities, a base cover of at least Rs 10 lakh and a super top-up of Rs 2550 lakh was said to be necessary.
How to choose the right policy?
- View Room Rent Cap
- Is modern treatment covered or not?
- Check Hospital Network
- Check claim settlement speed and rejection rate
- It is not wise to skip health insurance, but complete information and caution while purchasing is very important.