Page 65 - Ebook health insurance IC27

Sashi Publications

The hospitalization products differ in exclusions, waiting periods and cost
sharing provisions. Some of the exclusions like HIV/AIDS , fertility or assisted
conceptions, cosmetic or aesthetic procedures, intentional self injury, influence
of intoxicating drugs or alcohol, injury due to adventure sports, personal
comfort and convenience items etc are quite common to all.

Some exclusions like maternity, dental treatment or non allopathic treatments,
however, vary from product to product. The waiting periods provided by policies
also vary for specific disease conditions or procedures. Increasingly various cost
sharing mechanisms like sub-limits on room, ICU charges, on payments made for
specific surgeries like cataract or hysterectomy, co-payment for using non-network
hospitals or even for network hospitals, are being provided in insurance policies,
as mechanisms to contain costs for the insurer and to provide for higher spending
being shared with the insured.

(b) Personal Accident -Personal Accident policies are offered on a standalone basis
and also as a package policy. They provide for features like a lump sum benefit
payout in the event of death or permanent disablement, and a weekly compensation
for temporary disablement.

They have optional medical coverage, which even covers some outpatient coverage
for accidents in addition to inpatient coverage. Newer personal accident policies
also come with a whole range of innovative components, like cost of modification
of house or vehicle to meet the needs after an accident.

(c) Critical Illness - Dreaded diseases like cancer, heart attack, coma or major
organ failure may be quite infrequent, but are associated with extremely high costs
of healthcare, and such costs include a substantial component, which may not be

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