Health Insurance lene se pehle 5 Chije - Jo har kisi ko check karni chahiye
Aaj ke daur mein ek purani kahawat hai Jaan hai toh jahan hai. Lekin aaj kal jaan bachane ka kharcha itna badh gaya hai ki bina Health Insurance ke hospital jana kisi sapne se kam nahi hai. Ek middle-class family ki puri zindagi ki savings ek haftay ke hospital bill mein saf ho sakti hai.
Isi dar se hum sab jaldi mein koi bhi sasta sa insurance plan le lete hain. Lekin kya aapne kabhi socha hai ki claim ke waqt insurance company aapke bill ka sirf aadha paisa hi kyun deti hai.Wo hote hain Hidden Clauses.
Agar aap 25 se 40 saal ki umar mein hain, toh ye sahi waqt hai ek majboot health policy lene ka. Aaj The Gyaan Matrix par hum bat karenge un 5 hidden baaton ki jo agent aapko kabhi nahi batayega.
| Checklist Item | Kyun Zaroori Hai? | Expert Tip |
|---|---|---|
| Waiting Period | Purani bimariyon ke liye kitna intezar karna hoga? | Kam se kam waiting period wali policy lein. |
| Co-Payment | Kya aapko bill ka kuch hissa khud bharna padega? | Hamesha 'Zero Co-payment' wali policy best hai. |
| Room Rent Limit | Hospital room ke kharche par koi pabandi toh nahi? | 'No Room Rent Capping' wali policy chunein. |
| Network Hospitals | Kya aapke ghar ke paas Cashless suvidha hai? | Hospital list check karein jahan cashless ho sake. |
| Restoration Benefit | Paisa khatam hone par kya policy refill hogi? | Check karein ki ye facility free hai ya nahi. |
1. Room Rent Capping: Sabse Bada Dhoka
Jyadatar log sirf Sum Insured (total cover) dekhte hai, jaise ki 5 lakh ya 10 lakh. Lekin policy ke andar ek chota sa clause hota hai- Room Rent Limit.
Ye Kyun Khatarnak Hai.
Kayi purani policies mein limit hoti hai ki aapke sum insured ka sirf 1% hi room rent milega. Agar aapki policy 5 lakh ki hai, toh per day sirf ₹5,000 kamre ke liye milenge.
Lekin asal khel yahan shuru hota hai jise "Proportionate Deduction" kehte hain. Agar aapne ₹10,000 wala room le liya, toh insurance company sirf room rent hi nahi, balki doctors ki fees aur surgery ka kharcha bhi usi proportion mein kaat legi. Yaani ₹10 lakh ka bill hone par bhi aapko sirf ₹5 lakh hi milenge.
Solution: Hamesha aisi policy lein jisme No Room Rent Cap ho ya phir Single Private AC Room allowed ho.
2. Waiting Period (PED): Sabar ka Phal Meetha.
Insurance lete hi sari bimariyan cover nahi ho jati. Har policy mein ek Waiting Period hota hai.
Initial Waiting Period: Shuruat ke 30 din (accident ke ilawa kuch cover nahi hota).
Pre-Existing Disease (PED): Agar aapko pehle se sugar, BP ya koi aur bimari hai, toh wo 2 se 4 saal baad hi cover hogi.
Specific Diseases: Pathri (Stone), Hernia, aur Joint Replacement jaisi chijo par aksar 2 saal ka lock-in hota hai.
Pro-Tip: Policy lete waqt apni purani bimariyan kabhi na chupayein. Agar baad mein pata chala, toh company ek rupaya bhi nahi degi. Kam se kam waiting period wali policy chune.
3. Co-payment Clause: Aapki Pocket par Bojh
Co-payment sunne mein toh partnership jaisa lagta hai, lekin ye nuksan ka sauda hai. Iska matlab hai ki bill ka ek nishchit percentage (jaise 10% ya 20%) aapko apni jeb se dena hoga.
Aksar log kam premium ke chakkar mein Co-pay wali policy le lete hain. Sochiye, agar 20 lakh ka bill aaya aur 20% Co-pay hai, toh aapko ₹4 lakh khud dene honge. Phir insurance lene ka fayda hi kya hua.
Smart Choice: 25-40 saal ki umar mein hamesha 0% Co-payment wali policy hi leni chahiye.
4. Restoration/Refill Benefit: Backup ka Backup
Man lijiye aapne 5 lakh ki policy li aur badkismati se sal ke shuruat mein hi koi bada operation ho gaya jisme 5 lakh kharch ho gaye. Ab agar usi saa family ka koi aur sadasya admit ho jaye to kya hoga.
Yahan kaam aata hai Restoration Benefit. Jaise hi aapka basic cover khatam hota hai, company automatically use phir se refill kar deti hai.
Kya Check Kare: Dekhiye ki restoration Same Illness par mil raha hai ya nahi. Kuch companies ek hi bimari ke liye dubara refill nahi deti, jo ki galat hai.
5. Modern Treatments aur Day Care Coverage
Medical science bahut tarakki kar chuka hai. Aaj kal kayi bade operations 2-3 ghante mein ho jate hain aur aapko 24 ghante hospital mein rukne ki jarurat nahi padti (jaise Cataract ya Dialysis). Isse Day Care Treatment kehte hain.
Purani policies kehti thin ki jab tak 24 ghante admit nahi hoge, claim nahi milega. Aaj ke jamane me aisi policy bekar hai. Sath hi, Robotic Surgeries aur Stem Cell therapy jaise Modern Treatments ka cover hona bhi jaruri hai.
Bonus Point: Cashless Hospital Network
Sabse bada stress tab hota hai jab hospital wale admission ke time deposit maangte hain. Agar aapke bank mein paise nahi hain, toh mushkil ho jayegi.
Isliye policy lene se pehle dekhe ki aapke shehar ke bade hospitals us company ke Cashless Network mein hain ya nahi. Agar cashless hai toh aapko bas apna card dikhana hai aur insurance company direct hospital ko payment karegi.
Conclusion:
Health insurance sirf ek paper nahi balki aapki family ka suraksha kavach hai. Sirf sasta premium mat dekhiye balki upar bataye gaye 5 points (Room rent, Co-pay, Waiting period, Restoration, aur Network) ko dhyan se padhiye.
Ek achhi policy wo hai jo musibat ke waqt aapke sath khadi ho, na ki technical words mein aapko fasaye.
The Gyaan Matrix ka sujhav hai: Policy lene se pehle uske Policy Wordings ko 15 minute jarur padhe.
Frequently Asked Questions (FAQs)
Q1. Kya hum purani policy ko kisi dusri company mein badal sakte hain?
Ji ha ise Insurance Portability kehte hain. Aapka waiting period ka credit bhi nayi company mein transfer ho jata hai.
Q2. NCB (No Claim Bonus) kya hota hai?
Agar aap kisi sal claim nahi lete toh company aapka sum insured free mein badha deti hai. Kuch companies toh ise 100% se 500% tak badha deti hain.
Q3. Kya ayurvedic ilaj (AYUSH) insurance me cover hota hai?
Aaj kal lagbhag har nayi policy AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, Homeopathy) ko cover karti hai lekin iski ek limit ho sakti hai.
Tags:
Insurance & Banking