Issues with health insurance policy

Health insurance policyholders are faced with many issues when it comes to getting their claims settled to making renewals. This makes health insurance a hassle for the insured which needs be addressed by the insurance companies. We take a look at the kind of issues faced by the insured and how these can be resolved by the insurers.

Hike in premium: Insurance companies at times hike the renewal premium sharply, which comes as a shocker to the insured. The increase in premium may be as high as 50%, which can make payment of premium unaffordable for some policyholders. Of course, health insurance premiums do go up with age and advances in medical treatments, but these hikes are gradual and within reasonable limits. If the hike is sudden and too steep, then it becomes an issue which insurance companies can and should best avoid raking up. Alternatively, the Insurance Regulatory and Development Authority of India (IRDAI) can impose a cap on how much the insurers can hike premiums every year.

Upfront cash payment for cashless claim: The cashless claim policy attracts prospective customers because they are given to understand that they will not be required to pay any money upfront while getting hospitalised. But this is not always the case. If the insurer delays in settling the bills of the hospital, the hospital may demand a deposit from the insured. The deposit is reimbursed to the insured after the bill is fully settled by the insurer. Here, the onus is on the insurer to settle the hospital bills as quickly as possible, and if it fails to do so, the insured has to shell out the deposit from his/her own pocket, thereby defeating the purpose of ‘cashless’ policy. Also, if the database of the insured customers provided by the insurer to the third party administrator (TPA) is not updated, the TPA may take time to identify the insured or the insurer may take a long time to respond to a pre-authorisation request from the TPA. In such cases too, the hospital may insist on a cash deposit from the insured, making the ‘cashlessness’ of the policy redundant.
 
Change in features and exclusions of the policy: At times, the insurer re-files the policy with new nomenclature, features and exclusions. This may make the policy a new product altogether, which may put some of the existing customers at a disadvantage if they get excluded from insurance cover due to the new exclusions. This is because such exclusions may significantly add to the out-of-pocket expenses of the insured.