Mediclaim health insurance: Does it vary from city to city?

Mediclaim health insurance Does it vary from city to city

Are you moving to another city in India? Well, then you have got one more thing to plan about – your health insurance! Not many people know that medical insurance policies vary from place to place. It is not uniform throughout the country. Failure to inform the insurance providers about your change in location might result in confusion later if you need to make a claim against your policy. So, read this article and understand how the dynamics change when you move base.

1. Network Hospitals 

Insurane providers usually have thousands of hospitals across the nation in their network. In order to avail reimbursement for your claim, you will need to take medical treatment from one of these “network hospitals”. If you take treatment at a hospital that is not part of the network of your insurance provider, your request for bill payment/ reimbursement will surely be rejected. 

Almost all of us would have 2-3 hospitals we would prefer to visit. The reasons might be because the hospital is well-reputed, or that we know the doctors working there or are familiar with their processes and costs. 

Ensure that claims for hospitalisation in your preferred hospital chain (or individual hospital) at the new city are covered under the network of the insurance provider. It would indeed be an unpleasant shock if you realise later that the hospital in the new city is not part of the coverage network, and that your reimbursement claim is being rejected. If the hospital(s) you plan on visiting in the new city is not in the network, then you might have to plan on changing to a new insurance company that meets your needs. 

A tip here would be to choose an insurance provider which has a large number of network hospitals. An example would be Chola Health Insurance with a network of 9,500+ hospitals across India!

2. Potential change in Premiums

The premium you pay is one of the most important factors when it comes to choosing the medical insurance of your choice. This premium, as mentioned earlier in this blog, is subject to change if you change your locality. In India, cities are currently classified into three zones – namely zone 1, zone 2, and zone 3. Each insurance company might have a different way of classifying cities into zones. Metropolitan cities usually come under zone 1, with other Tier 1 cities coming under zone 2. The remaining cities that are not covered under Tier 1 are classified as zone 3.

The premium rate will decrease as you move down the zones (i.e. from a zone 1 city to a zone 2 city), and vice versa. This is because the cost of treatment is generally lower in zone 2 and 3 cities when compared to zone 1 cities.

3. Rules and Restrictions

In case you move from a lower zone city into a higher one and request treatment, a few restrictions might be placed by the insurance provider. This is especially applicable when the treatment is advanced in nature. The insurance company might demand co-payment, where a part of the hospitalisation is undertaken by the policyholder. Another mandate might be an increase in premium rates. Make sure you have a conversation with your insurance provider on change of premium cost, support for advanced treatment before you move to a new city. This is to ensure that you are well-informed about the rules and restrictions.

Hope this article was informative for you. Stay healthy and stay safe!

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