With rising healthcare costs, hospitalization can be an expensive affair. Having health insurance can provide peace of mind, but it’s important to understand what your policy covers and what it doesn’t.

Here are 10 essential facts about hospitalization and health insurance:.

1. What is covered under health insurance?

Most health insurance policies cover hospitalization due to illness or accidents. This usually includes room charges, nursing expenses, intensive care unit charges, medical practitioner fees, and surgical charges.

Your policy may also cover pre-hospitalization charges and post-hospitalization expenses such as follow-up appointments and medication costs.

2. What is not covered under health insurance?

Most policies have certain exclusions such as cosmetic surgery, non-medical expenses, experimental treatment, and self-inflicted injuries. It’s important to read your policy documents carefully to understand what expenses will not be covered.

3. How much coverage do you need?

The amount of coverage you need depends on your age, health condition, and family history. In general, it’s recommended to have a minimum coverage of Rs. 5 lakh for individuals and Rs. 10 lakh for families.

However, if you have a history of illnesses in your family or are prone to certain diseases, you may need higher coverage.

4. What is a cashless hospitalization?

With a cashless hospitalization, your health insurance policy provider settles the medical bills directly with the hospital. This means you don’t have to pay for the hospitalization charges upfront.

However, the hospital needs to be listed under your policy’s network for cashless hospitalization to be applicable.

5. What is a reimbursement claim?

If you get hospitalized at a non-network hospital or if cashless hospitalization is not available, you will have to pay for the medical bills upfront.

You can then submit a reimbursement claim to your health insurance provider to get the expenses reimbursed. However, the company will only reimburse the expenses that are covered under your policy.

6. How do you file a claim?

To file a claim, you need to inform your health insurance provider as soon as possible about the hospitalization.

You will need to fill out a claim form and provide all relevant documents such as hospital bills, discharge summary, and prescription receipts. The company will then review your claim and settle the expenses accordingly.

7. What is a waiting period?

Most health insurance policies have a waiting period before they come into effect. This is usually 30 days from the policy start date, during which the policyholder cannot make any claims.

However, some policies may have a longer waiting period for certain illnesses such as diabetes or hypertension.

8. What is a pre-existing medical condition?

A pre-existing medical condition is any illness or medical condition that a person has before applying for a health insurance policy.

Some policies may not cover pre-existing medical conditions or may have a waiting period before providing coverage for such conditions.

9. What is a co-pay?

A co-pay is a cost-sharing arrangement between the policyholder and the insurance company. In some policies, the policyholder has to pay a certain percentage of the hospitalization expenses while the insurance company covers the rest.

For example, if your policy has a 10% co-pay, and your hospitalization bill is Rs. 1 lakh, you will have to pay Rs. 10,000 while the insurance company will pay the remaining Rs. 90,000.

10. What is the grace period?

If you miss paying your health insurance premium on time, the policy will lapse. However, most policies have a grace period during which you can pay the premium without any penalty or interest. The grace period is usually 30 days from the due date.