4 Things your Health Insurance Agent won’t tell you!

You realize you are in a soup when after undergoing kidney stones surgery, you are told the medical expenses for this surgery aren’t payable in your health insurance policy. When you get your claim rejected stating that kidney stones are only covered after 2 years from Buying the Health Insurance Policy, you want to find that rogue health insurance agent of yours! When you were buying the policy, he kept repeating that all your hospitalization charges would be covered. And it was now after your claim was rejected that you discovered the whole concept of exclusions!

We give you 4 points that your health insurance agent may not tell you, so that you don’t suffer a similar fate again.

Your Agent may not tell you that:

No. 1: He represents one Company and can only sell you a product of that Company

This particular nature of his job, he may not quite share with his customers. Customers should know that a Health insurance agent is actually a representative of the health insurance company that hires him to sell their policies.

Thus you find that your agent may be

Biased: He may push you to buy only his company’s products by positioning his company as better than other health insurance companies.
Not Customer-centric: Even though he may visit your home and even collect the cheque and home deliver the policy, your agent may not think of your best interests. Since an agent can only sell product of one company, he may not tell you that there are better products available for your needs.

Unaware about Health Care: Your agent will not generally have expertise in health care and thus not be the best person to advise you on which Health insurance policy to buy. He will also not be the best person to handle your health care claims as he lacks the knowledge to discuss with the health insurance company in case of complicated claims.
What you can do about it?

Rather than buying health insurance from an Agent, Buy health insurance from a Health Insurance broker who is authorised to sell products from different companies and can compare their pros and cons. A Broker will also be in a better position to handle your claims as he has a better know-how of health care.

If you have already bought a policy from an agent, ask him for the policy documents and read it carefully to know all the terms and conditions in it. There are some brokers who would help you understand better the policy you had bought even if you had not bought the policy through them.

Now, you can also Change your Agent if you are not happy with him

No.2 All Hospitalizations are not covered in the Policy

Health insurance in India is hospitalization insurance that covers the hospitalization costs incurred in India but there are conditions and exceptions. This is a fact, your Agent may not mention. He will go on harping about the benefits of the policies and assuring you that all hospitalization costs will be covered which will only be half the story. The other half, customers will come to know only after their claims are rejected.

There are numerous exclusions (things not covered) in the policy (OPD, dental, cosmetic, alternative (non-allopathic) treatments, etc.) and a number of waiting periods (Pre-existing -4 years, Surgeries for Cataract, Hernia- 2 years) which you need to know before you buy health insurance policy.

Not showing the Policy Wordings

The best way of understanding if a product is good or bad would be by reading its policy wordings and here is where your agent may not be helpful. Most Agents will show you the brochure of the policy which will contain all the positives of the policy and its features. Since an average customer will not ask about the policy wordings, they miss out on knowing what exactly they are getting. It is only after you pay the premium that you get the policy wordings!

What you can do about it?

You need to ask your Agent upfront about the exclusions in the policy and before you decide to buy health insurance policy ask him to show you the policy wordings and only after going through the wordings and satisfying yourself that the terms are OK with you should you buy that product.

No. 3 The Premium amount will change

When buying a product, one of the important parameters in comparing policies is the premium amount. Ideally, the product you buy is the one which gives you maximum benefits at a reasonable price. But one thing that the Agent forgets to tell you when you are selecting a product is that your premium amount will change and most likely increase. The two reasons for the increase are- Age and Claims you have made.

The logic is as you grow old, you are at an increased risk to suffer from ailments and thus more likely to claim and thus at a greater risk calling for a higher premium. On the other hand, in some policies, after every year you get a claim paid, you will be loaded a percentage depending on the percentage of cover amount you claimed.

For ex. If you have a policy of Rs. 3 lakh rupees and you claim Rs. 60,000 which is 20% of the cover amount, you will have to shell out 25% more on your premium.

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