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Health Insurance Myths


Health insurance is among the most misunderstood financial products in India. These myths lead to low penetration and inadequate coverage. Let us bust the most persistent myths here:

Employee group insurance is all I need

The coverage provided by employee group insurance schemes is typically rationalized to keep the costs under control. These rationalizations could include:

  1. Excluding coverage for non-dependent parents
  2. Co-payments
  3. Limits set on certain expenses

The sum assured offered through a group insurance policy may not always be sufficient either. Make an estimate of your projected healthcare costs and look for top-up insurance in case you need further coverage.

Further, the cover is only valid as long as you are an employee and this could leave you without a cover if you are between jobs. The cover would also not be available post-retirement and getting a new health insurance policy may prove costly that late in life.

I am a smoker, and therefore will be denied a health cover

Most insurers are willing to provide health insurance cover even if you smoke tobacco or consume alcohol. That said, as smokers have a high risk associated and are prone to health hazards, they are charged a higher premium and have to undergo a stringent health examination before coverage is offered. Remember to disclose if you were a smoker in the past and have quit smoking now, as this information can have a material impact on your health risks.

I am fit, I don’t need health insurance

You may be fit and taking good care of your health, but that does not mean that no illness or accidents may hit you unannounced. Illnesses like dengue and malaria, for example, can lead to hospitalization despite you being in peak health otherwise. The hospital bill can run up to over ₹60,000 within a couple of days, depending on the severity of the condition. A health insurance policy allows you to be prepared for such unforeseen situations. 

Health insurance only pays when I am hospitalized

This is no longer true. With the advent of technology, many healthcare procedures that needed hospitalization earlier can now be completed as daycare procedures. For example, a cataract operation does not require hospitalization anymore. Health insurance policies have also evolved to allow access to such healthcare procedures. Further, many policies also provide cover for a doctor consultation, dental treatment and alternative therapies that do not require hospitalization.

I can get health insurance when I need a major surgery

Insurance cover comes with a waiting period that limits the claims to accidental hospitalization for the first 30 days. Even after that, treatment to a few ailments may have a waiting period of up to 4 years associated with them. Typically, pre-existing diseases also have a waiting period of 2 to 3 years associated with them. Non-disclosure of pre-existing diseases can lead to denial of coverage and a longer waiting period for the disease. Therefore, make sure that you do not hide any pertinent information from your insurer.

More network hospitals the better

The total number of network hospitals hardly makes a difference for an individual policyholder. What should matter to you is whether you have a sufficient number of network hospitals around your place of residence. You wouldn't want to be rushed across the city in an emergency just to be admitted to a network hospital.

Similarly, do not simply look at the number of daycare procedures covered, but the extent of coverage provided. A huge list of restricted daycare procedures may leave you with only a partial coverage when you actually need the policy to pay up. For example, a cover for "incision of the cornea" is not the same as a cover for cataract surgery.



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