After seeing the various financial hardships faced by his friend during his dad’s hospitalization, Shyam decided to buy a family health insurance / mediclaim policy to avert this situation. On seeing a galore of options of various policies available he was confused and decided to approach a health insurance agent.

His father suggested him to approach their family friend Mr. Patil for help. Mr. Patil is a Life Insurance Agent. He suggested a mediclaim policy for which Shyam promptly issued a cheque without raising any questions and renewed it year after year.

Years later, while things were moving smoothly Shyam returned home from office to find his mother had fallen in the bathroom and was taken to the nearby hospital by their neighbors. After performing various tests and X-rays, the doctor advised that she will need to undergo a major spine surgery. Shyam was told that the total bill for the treatment would amount to Rs.2.50 Lakhs.

Shyam happily informed the desk regarding his policy and submitted his cashless mediclaim card and papers. On completing the Cashless formalities, the Hospital informed that the TPA has approved an amount of Rs.1.2 Lakhs of the claim, informing about a sub-limit in the policy. Shyam was shocked that he had to pay the remaining Rs.1.30 Lakhs from his own pocket. He tried calling Mr. Patil to understand more about the health insurance policy that he had purchased but he was not reachable. Shyam then found on his own that he had coverage of only Rs.2 lakh with a capping on major treatments at Rs.1.20 Lakhs.

This is the scenario in most Indian homes. Most Indians buy their health insurance policy from friends or relatives or friend’s relatives or from their recommendations without understanding, whether the health insurance agent is equipped to recommend and service Health Insurance. They have very little knowledge or interest of what the policy offers, about the waiting period for various ailments, network hospitals, cashless facilities, etc. till a claim arises.

This was not the end of Shyam’s struggle. On suggestion with his friends, he tried discussing the claiming for the Post Hospitalization bills amounting to Rs. 12000/- with Mr Patil. He being an expert in Life Insurance, was not able to offer any expertise, and asked Shyam to contact the TPA directly. Shyam had to run from pillar to post, send various emails, escalate and further escalate to get his bills reimbursed.

To add salt to injury, Shyam, later realized that he was paying for an expensive Health Insurance policy which had a higher premium for a smaller restrictive coverage.

So here’s the learning:

2 Most Common Mistakes people make when buying Insurance.

- Buying Health Insurance from a non-specialist.

Shyam realized later that Mr Patil was an agent of a life insurance company. He helped people buy health insurance products but did not have full exposure to various health insurance products that are available and did not have much expertise in servicing or solving claims. Would you go to a dentist, if you have a problem with your vision?

- Deciding on an agent blindly

: It has been noticed that people spend more time shopping for their personal accessories then short listing and finalizing a Health Insurance Advisor. They follow the advice of friends and relatives without actually evaluating whether the agent is qualified and experienced enough in Health Insurance to service him in the long term.

Before buying a health insurance policy it is important to evaluate various agents and brokers and then finalize one of them. 70% of your problems related to Health Insurance would be based on the capabilities of your intermediary/agent/advisor.

To understand the nuances of different types of policies and its price, feel free to seek the help of InsuranceMall to select the right products based on your need. Or you can directly call them on +91-22-30503050

InsuranceMall is the leading and first online insurance broker in India. With the motto to make our customer delighted and proud about their decisions, we’re always there to help them with best possible policy