Is my cashless health insurance policy vulnerable to hidden hospital costs?

My health insurance policy covers cashless hospitalisation. However, during a recent episode of hospitalisation of my friend’s father, he had to pay an amount to the hospital despite his cashless being approved. Now I am worried. Do I have the correct plan? 

Name withheld 

Reply by Nitin Deo, Chief–Underwriting, Claims and Reinsurance, Zuno  

Anomalies between the expected and actual coverage under cashless hospitalisation reveal the importance of understanding the terms and conditions of your health insurance policy. Evaluating whether your plan leaves you vulnerable to supplementary costs that the hospitals may charge is crucial.

A health insurance policy is a contract between yourself and the insurer. You can make no deductions unless they are specified in the contract. You should contact the insurance company and they will explain the deductions to your satisfaction. In the case of health insurance policies, deductions at the time of claims depend on the features and exclusions mentioned in the policies. There are two major types of deductions:

Deductions due to items not covered as per the terms and conditions of the policy – these usually include non-medical charges or are not directly associated with the treatment for which the insurance company has covered one. Usually, these are common across most health insurance policies.

You can opt for a voluntary deduction at the time of purchasing the policy. Some policies have optional features like co-payment, room rent restriction, etc., which you can opt for at the time of purchase. Effectively, if opted for, these features would reduce your premium outgo but increase out-of-pocket expense at the time of claim. It is essential to choose these features wisely to optimise the value of the premium you are paying.

 Some policies cover even non-medical expenses by charging a higher premium upfront. You can check with your insurance company regarding availability of such plans. It is therefore highly recommended that you understand and choose your health insurance plan well. 

(Views expressed by the investment expert are his/her own. E-mail us your investment queries at askmoneytoday@intoday.com. We will get your queries answered by our panel of experts.)