I am Bharti Senior Citizen 75yr Old from Gujarat. I am having Care Health Insurance CARE Policy. Kindly let me Guide:

Accident Hospitalisation case Under Health/Mediclaim Policy covers Physiotherapy Charges in Post Hospitalisation Recommended by Doctors? 

GOD Bless You.

Ans: Many insurance companies offer both features either in a single plan or under separate plans. Amongst the two features, the most preferred and essential feature is the one covering hospitalisation expenses.

The non-hospitalisation or out-patient expense cover usually comes at a high premium with a lower limit. However, the hospitalisation plan usually covers non-hospitalisation bills related to pre-hospitalisation & post-hospitalisation period.

There are multiple advanced health insurance plans available offering limit up to 1 crore that cover hospitalisation and pre/post hospitalisation expenses and bundled with other prominent features such as ‘Daily  cash allowance’ to count on in case of hospitalisation – to cover expenses that are not usually covered in hospitalisation only linked plans.

Under section 80D of the Income Tax Act, 1961, the premium paid is eligible for tax deduction up to an amount of Rs. 50,000 for senior citizens.

Ans: Hi, the coverage amount should be an estimate of the treatment you may be expecting in the near future in case you have any pre existing diseases. Else, due to the age being on higher end, you may have to pay higher premiums. Do not delay and purchase as soon as possible.

Ans: Your understanding of pre- and post-hospitalization coverage is mostly correct, but there can be nuances based on the insurer's policy and specific terms and conditions. Here’s a breakdown:

General Coverage for Pre and Post-Hospitalization:
Pre-Hospitalization: Typically, medical expenses incurred up to a certain number of days (e.g., 30 days, 60 days) before the hospitalization are covered. These include consultations, diagnostic tests, and medications directly related to the condition for which the patient is hospitalized.
Post-Hospitalization: Medical expenses incurred up to a certain number of days (e.g., 60 days, 90 days) after discharge are covered. These generally include follow-up consultations, diagnostic tests, and medications needed for recovery.
Specific Coverage Details:
Directly Related Tests: Diagnostic tests and consultations that are directly related to the treatment or procedure for which hospitalization is required are typically covered. For example, tests specifically to diagnose or assess the kidney stone would be covered.
Mandatory Tests: Some mandatory tests, like an HIV test before surgery, may be required by the hospital or medical guidelines but might not be covered if they are not deemed directly related to the specific condition being treated. Insurers often scrutinize these and may exclude them from coverage.
General Health Tests: General tests such as Liver Function Test (LFT) or Complete Blood Count (CBC) that are part of routine pre-surgery assessments might not be covered if they are not directly linked to the treatment of the condition for which hospitalization is required.
Steps to Clarify Coverage:
Review Policy Document: Carefully read your health insurance policy It will outline what is covered and any exclusions.
Consult Insurer: Speak directly with your insurance provider or a representative to get clarity on what specific tests and consultations are covered under pre- and post-hospitalization.
Get Written Confirmation: If there is any ambiguity, request written confirmation from the insurer regarding the coverage of specific tests or procedures to avoid surprises later.
Example Scenario:
For a kidney stone procedure, if your doctor advises an HIV test as part of the pre-surgery requirements:

Insurer's Perspective: The insurer may argue that the HIV test is a general mandatory requirement for surgery and not specifically related to the treatment of the kidney stone.
Your Argument: You could argue that the HIV test is part of the necessary pre-surgical protocol required for the safe conduct of the kidney stone procedure, thus should be covered.
In conclusion, while pre- and post-hospitalization coverage aims to cover necessary medical expenses related to a condition, the specifics can vary. It's crucial to have clear communication with your insurer and understand the terms of your policy to ensure appropriate coverage.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Health insurance policies typically cover various medical procedures, including surgeries. Hip replacement surgery is a significant medical procedure, and understanding its coverage under your health insurance is crucial. Let’s break it down.

Coverage for Hip Replacement Surgery
Inclusion in Policies

Major Surgeries: Most comprehensive health insurance plans cover major surgeries, including hip replacement.

Hospitalisation Costs: Covers hospitalisation expenses, including room rent, doctor fees, and nursing charges.

Pre- and Post-Hospitalisation

Medical Tests: Pre-hospitalisation expenses, like diagnostic tests, are often covered.

Follow-Up: Post-hospitalisation expenses, such as follow-up visits and medications, are typically included.

Checking Your Policy
Policy Document

Terms and Conditions: Review your health insurance policy document for specific coverage details.

Exclusions: Look for any exclusions related to hip replacement surgery.

Customer Support

Insurance Provider: Contact your insurance provider’s customer support for clarification.

Detailed Information: Ask for detailed information about coverage limits and conditions.

Additional Considerations
Waiting Periods

Initial Waiting Period: Check if there is an initial waiting period before you can claim for surgeries.

Specific Waiting Period: Some policies may have a specific waiting period for certain surgeries.

Co-Payment Clause

Shared Costs: Some policies have a co-payment clause, where you pay a part of the expenses.

Percentage: Understand the percentage you need to co-pay.

Disadvantages of Index Funds
Lack of Flexibility

Fixed Portfolio: Index funds have a fixed portfolio, limiting flexibility.

Underperformance: They may underperform compared to actively managed funds.

Benefits of Regular Funds
Professional Management

Expertise: Managed by professional fund managers.

Higher Returns: Potential for higher returns compared to direct funds.

Importance of a Certified Financial Planner
Expert Guidance

Personalised Advice: Provides tailored advice based on your specific needs.

Continuous Support: Offers ongoing support and adjustments to your financial plan.

Final Insights
Review Your Policy: Always review your health insurance policy for specific coverage details.

Seek Professional Help: Consider consulting with a certified financial planner for expert guidance.

Stay Informed: Stay informed about your policy terms and conditions to avoid surprises.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

Ans: Health insurance covers medical expenses. It includes hospital stays, surgeries, and treatments. You need to check the policy details.

Coverage for Pre-existing Conditions
Pre-existing conditions are medical issues you had before getting insurance. These conditions often have a waiting period before coverage starts.

Your Specific Case
You mentioned a leg fracture. Since it's now two years old, check if the policy covers it. Most policies cover pre-existing conditions after a specific waiting period. Since your policy is now in its fourth year, it's likely the surgery will be covered.

Action Steps
Review Your Policy: Check the terms for pre-existing conditions and waiting periods.

Contact Your Insurer: Confirm coverage for your surgery.

Plan for Surgery: Ensure all paperwork and approvals are in order.

Future Considerations
Stay Informed: Keep updated on your policy's terms and conditions.

Regular Health Check-ups: This helps in early detection of health issues.

Emergency Fund: Always have some savings for medical emergencies.

Final Insights
Your health insurance is crucial. Ensure you understand its terms and use it wisely. Stay proactive about your health and insurance details.

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner,

www.holisticinvestment.in