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Health insurance: Ashish Mehrotra

Business Standard 

I have a family-floater health insurance and have been paying premium for two years. This year, the sum assured has gone up due to the no-claim bonus but so has my premium, though I have not made any claims. Even if I include service tax , the amount looks high. Why is this?
Health insurance premium is calculated on the basis of the age of the customer. Hence, you might see difference in the premium for a 35-year-old male versus a 36-year-old male. Service tax was increased from 12.36 per cent to 14.5 per cent in the Union Budget 2016, which also includes a 0.5 per cent Swachh Bharat cess. With rising health care costs and increase in medical inflation, health premia are also likely to go up.

However, you must bear in mind the advantages of buying a comprehensive health insurance cover for your family and yourself. Health insurance premia will always be a fraction of the cost that you will need to pay from your pocket, in case of an unforeseen medical exigency. Also, if you buy a policy in your early 30s, you can serve your waiting periods earlier and utilise your policy to make a claim when you actually need it. There are other benefits as well. Many health insurers offer no-claim bonus up to 20 per cent of the base sum insured for every claim-free year. You can double your policy cover in five years and have adequate coverage when you need it the most. This is an important benefit, given the year-on-year increase in medical costs.

If I am applying for cashless hospitalisation at a network hospital, how long will it take for the approval? Will the entire amount be approved or will I have to pay some of it ?
Point of claim is the moment of truth for any health insurer and the importance of responding quickly to a pre-authorisation request cannot be overstated. Most health insurers process cashless admission requests within two to four hours.

Some health insurers process cashless hospitalisation requests within 30 minutes of receiving all the documents. Keep in mind that a part of the bill will have to be borne by the insured if it consists of inadmissible/non-payable items under health insurance. You must read the terms and conditions of your policy thoroughly to understand what is covered and what is not.

The views expressed are expert's own. Send your queries to

First Published: Sun, May 08 2016. 23:00 IST