Understanding Policy Clauses In Health Insurance

The clauses that are related to limitations and exclusions may seem complicated at first but it is crucial to understand these before signing up. There could be some exclusions and limitations that may not affect you or your family at all while some may be important depending on your health history and hereditary family history. So while what is excluded for one person may not make a difference, it might make a huge impact for another. That is why it is important to understand what these are and how they impact and relate to you as an individual and to your family in general.

Exclusions are those conditions or expenses that are not covered by the insurance company. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it should ever arise. Some insurance companies will also impose a sub limit that is within the sum insured overall. Exclusions are those expenses that the insurance company need not pay for. The IRDA has standardized this with a list of expenses. There are also different waiting periods for different conditions.

One of the common exclusions for health insurance are pre-existing diseases. This is because the entire premise of insurance is based on uncertainty so if there is a disease that you are already suffering from, it will not come under the insurance. Usually, you can get insurance companies to cover you for a pre-existing disease after a specified waiting period is over.

Another thing that is excluded is pregnancy and expenses related to childbirth and later vaccinations. There could be a waiting period for pregnancy as well, after which there are some benefits that could be availed. Other things that are excluded from a health insurance policy are cosmetic surgeries, dental surgeries, alternative treatments such as Ayurveda and homeopathy, etc.

Sub-limits are another factor which should be carefully looked into at the outset before investing in an insurance policy. A sub-limit is related to exclusions that are associated with doctors’ fees, ambulance costs, rent for hospital rooms, etc. Knowing your sub limits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay for out of your own pocket.

There are policies which seem to have a whole list of exclusions and sub-limits and there are those that have a moderate amount of them. So knowing what is excluded and what is not will help you make a better decision regarding which health insurance to choose. This can be done easily by doing a systematic and meticulous comparison of health insurance policies taken from different websites or from the agents directly. Knowledge is power and knowing this beforehand helps you in better planning your future and that of your family.

How Smoking Impacts Your Health Insurance Policy

It’s a well-known fact that smoking causes an adverse effect on your health. You must have seen the warning message on all cigarette boxes – ‘Smoking is injurious to health’. Smoking tobacco is a root cause of 30% of all cancer deaths and causes 16 times higher risk of heart attack.

There are almost 120 million smokers in India. As per World Health Organization, India accommodates around 12% of the world’s smoking population. The number of men smoking tobacco has increased from 78 million in year 1998 to 108 million in the year 2015. Tobacco consumption is accountable for the death of 6 million people each year. Direct tobacco consumption accounts for over 5 million deaths and 0.6 million deaths are due to exposure to second-hand smoke. Considering serious public health risks, the Government has banned smoking in public places from 2nd October, 2008.

Not only your health, it also causes you to pay higher premiums for a health insurance policy, due to increased health risks and shorter life expectancy. A nonsmoker however, gets premium discounts as a reward to lead a healthy lifestyle. Being a smoker, it is advisable not to hide your smoking habit from your health insurance company, as it helps you to cover the smoking-related health issues.

There is a wide curiosity among people, how smoking impacts the health insurance and its cost. Let’s educate yourself about smoking and its impact on health insurance policy.

Smoking – What It Includes

Smoking includes inhalation of of the smoke of burning tobacco in the form of cigarettes, cigars and beedi. Whether you are an occasional smoker or frequent smoker, you will be considered as a smoker under the health insurance policy.

Smokers can buy health insurance, however an insurance company may charge extra premium or reject your application for insurance, depending on the number of cigarettes you smoke on a regular basis. A smoker may also have to go through additional health check-ups that can help an insurance company to ascertain the risk factor and then charge the premium amount accordingly.

How Smoking Affects Your Health and Insurance Premium

Smoking makes the serious impact on your health, some of them are detailed below.

Circulatory System: Smoking results in increased risk in the heartache and blood pressure. Building up of fatty acids could resulting to atherosclerosis.

Immune System: Smoking results in severe and long lasting illnesses. Smokers are more prone to develop ulcers, cancer, pneumonia, high blood pressure, bronchitis, and other viral/bacterial/fungal infections.

Respiratory System: Smoking may damage lung functions and breathlessness. It may cause damage to the air sacs of the lungs, increased chance of developing chronic bronchitis.

Oral Health: Smoking can lead to tooth loss, tooth staining, gum disease which may increase the risk of tooth decay.

Cancer: Smoking for a long time also causes cancer to various body organs.

When it comes to a health insurance policy, an insurance company considers the magnitude of illnesses and deaths caused due to smoking and that’s why, smokers need to pay higher premiums to avail health insurance cover. Typically, the insurance companies charge around 15 to 20 percent higher from a smoker policyholder. Those who smoke would need to undergo additional medical checks, before the insurer issues you the policy.

Let’s understand the difference of premium between a smoker and non-smoker individual.

Ritesh (non-smoker) at 30 years of age buys an individual health plan with Rs 5 Lacs coverage, for 1 year policy term, the chargeable annual premium amount is Rs 4,656. However, Raj (smoker) is buying an individual health plan, he is charged with an annual premium amount of Rs 7,552. An increase in premium amount is only due to the fact that Ansh lies in the smoker category of premium. We can see Raj is paying Rs 2896 extra on account of smoking.

Smoker with Existing Health Problems

If you are a frequent smoker that has caused the symptoms of the declining health condition and getting puzzled whether you can get a health insurance. The answer is yes, the only thing required is to make honest and proper disclosures.

The insurance company will then assess the risk associated with your profile and then decide on terms & conditions and the premium to be charged for providing you a health cover. The premiums charged will be higher and a waiting period will be applied for covering your pre-existing diseases. Moreover, if you are seeking an immediate coverage on your deteriorating health condition, you may go for a critical illness policy.

Conclusion:

Smoking makes an adverse impact on your health and your health insurance policy as well. An insurance company will charge you a higher premium in proportion to the risk associated in providing a health cover. An important point to note that you should disclose all relevant information regarding your health and smoking habits. In case, you are found hiding or providing fake information, the insurance company may decline in settling the claims.