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Things Agents Hide for Health Insurance | Reality of Health Insurance Policy - YouTube
Channel: Pushkar Raj Thakur: Business Coach
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Well, This video will open your eyes.
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The reason is that most of us take health
insurance, but they do not know how many things
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their advisors have hidden from them while
taking health insurance.
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Ultimately, when you go to make a claim, you
will not get the claim and on what small things
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you do not get the claim.
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I am going to cover all these points today
and along with this, I am also going to tell
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you that if you have not taken health insurance
till now.
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Health insurance is renewed every year.
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This means that in a way you are taking new
health insurance every year.
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So, if you are about to renew yours or if
you are going to take new health insurance,
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then you will take care of these points which
I am going to tell you, do ask all these points
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from your advisor and if you buy insurance
online, then you need to check all these points.
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I will proceed step by step and you will know
and check by yourself if you have health insurance,
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that all these things are covered inside it
or not.
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More and more people will come to know that
in today's date the health insurance they
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have taken is worthless.
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Now I start it, so I start with the first
point is the room rent capping.
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Now, what is this room rent capping?
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I will tell you exactly what happened, My
father had a minor accident.
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There was an injury on his shoulder and the
doctor suggested the operation.
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So when we went for the operation, I was very
young, at that time, I came to know at that
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time, then he said that you will not get the
room you want, you will get a normal room
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then I asked why that room would not be available
and why would we get this room, then they
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told at that time that your insurance which
you have taken here has a capping of room rent
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Now, what is this room rent capping?
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I'll explain this to you.
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Whatever your policy is and for example, you
have a policy of ₹ 300000?
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What happens in most companies is that they
give you a maximum assured amount is of 1% of the room rent.
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What does it mean that if you have a policy
of three lakhs then it becomes ₹ 3000 at
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one per cent, you can take a room only up
to ₹ 3000 for a day.
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You cannot take a room more expensive than
this and if you also say that if the room
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is of ₹ 5000 which you have liked and you
do not want to take that room of 3000, then
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you say that you adjust 3000 in my policy,
which you have to adjust the claim and I will
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give ₹ 2000 from my pocket.
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Even if this will not work, then your treatment
will be done only if you are living in a room
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of 3000 and this room is rent capping which
I came to know.
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That the advisor from whom my father had taken
the policy, why hadn't he told it earlier
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because they don't even tell?
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And when your hospital then you understand
that there is capping here and the treatment
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is also according to your capping, then all
the packages are made according to that and
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people do not know this thing and you also
check it now whether your policy has capping.
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Let's move on.
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The second point is when you talk about ICU.
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Look, in the ICU, the person is taken to the
emergency.
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At that point, it is known that it happens
inside most policies that there is a capping
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of 2% of the sum assured.
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2% of Whatever your sum assured is, you may
have 1 day ICU room rent.
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Meaning if you have a policy of 300000, then
₹ 6000 per day, then the company will not
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pay more than it.
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if you go to a big hospital on today's date,
forget that you will get an ICU bed for ₹ 6000
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per day or per night.
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You do not get it, then it is too much,
so you have to check that there is no capping.
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Now let me tell you the third thing that
comes is
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Automatic Restoration of Sum Assured now understands
this.
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suppose you have a policy of ₹ 300000, now
what happens if you have a claim of rs 200000,
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what will happen, Under most policies, you
will be told that now only ₹ 100000 is left.
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Now you have 12 months.
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If you took the policy money within January
and suppose your policy starts from January,
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then you took the claim within January.
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You took a claim of ₹ 200000 out of three
lakhs. You fell ill.
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Now you think there are 11 months in a whole
year.
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Now in these 11 months if I fall ill again,
what will happen.
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nothing will happen.
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In most policies, you will get only ₹ 100000
in this, then there is no restoration in it,
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then you have to check whether there is automatic
restoration?
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Now, what is the meaning of automatic restoration
that even if you fell ill and you took a claim
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of ₹ 200000, then the next time when you
fall ill, you had the policy for ₹ 300000,
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then you should get three lakhs sum assured
on it?
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Now it is not in most policies.
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Is it in your policy or not?
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You check it.
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Now this will blow the minds of 99% of the
people because most of the policyholders are
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not aware of this restoration benefit, that
if something like this happens.
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Let me give you an example of navy health
insurance.
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In this, you get automatic restoration of
sum assured in Navy Insurance, then it is a major point.
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Now let's move forward.
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Now let's see the Accidental injury benefit.
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Now, this is under very few policies.
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You have to understand that.
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You have taken a policy of ₹ 300000 means
you have a sum assured of ₹ 300000.
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We take insurance so if later there is an accident,
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If there is any mishap happen then, you don't have to
pay from your pocket.
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If there is a bill of ₹ 500000 or ₹ 600000,
where will the rest of the money come?
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In most of the policies, you have a sum assured
of 300000 then you will get the claim of only
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three lakhs and you will have to pay the rest
of the money from your pocket.
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At that time people did not understand how
to get money.
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Then it is a stress for people and in such
a short time people feel that now we should
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increase our policy, but it is not possible
practically.
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You will get the claim for the sum assured.
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But if there is a benefit in your policy that
your Sum Assured on Accidental Injury will
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be 2X, then if there is the claim of six lakhs
instead of three lakhs, that will be passed and money
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doesn't go out of your pocket.
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You have to check it.
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Now I said 99% in the last case, here in the
99.99% policies, there is no benefit of accidental
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injury benefit.
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Now you will ask where you get it, then you
will have to do a little research for it.
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In short, I have researched for you that even
if you will study navy health insurance and
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if you take your health insurance from the
navy, then you get accidental injury benefits.
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So you can check I am just recommending you,
the rest is your choice.
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Whatever you want to do, what you can do.
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Now move ahead, any single occupancy room
means If you are single then what happens
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if there is double occupancy inside the hospital
there are room lots in sharing too so if you
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think that privacy matters to me and I need
a room for me many policies do not
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have
coverage you should You have to check that
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if you are alone and you need treatment for
yourself, then you get a private room, then
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you should also check in your policy that
it should be there.
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Now let's move on.
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See this is the era of online.
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This era has changed.
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5 years ago people did not take online doctor
consultations.
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Earlier people didn't know that Online consultation
can also be taken, but today's date, people
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take online consultations with doctors.
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It should be covered in your policies, You
are taking online consultation, you pay for
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it, that should be covered.
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People do not have enough time to go to the
doctor and when their number comes, it is
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time waste that matters most on today's date.
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People do not have much time.
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So people can book online consultations according
to their convenience and people have to get
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medical checkups done.
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As you get your medical checkup done once a year,
then your medical checkup also costs money.
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That too should be covered in your policy,
If you have taken any health insurance for
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yourself, then whether it has this coverage
or not you check it.
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Alright, let's move ahead.
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you see here, you should find a claims relationship
manager here.
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I have seen many people.
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When they make the claim, they don't know
whom to talk to.
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Now if you don't know who to talk to, it gets
very hectic for you.
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If you are taking health insurance from whomever
and for example, If you are taking health
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insurance from the navy, then you need a dedicated
claims relationship manager who will help
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in getting your claim settled.
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Whatever your hospital's bills come, all the
money should reach the hospital and the patient
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who is there should get discharged.
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This is the job of the claims settlement manager,
so here you will get the claims relationship
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manager, he will help you.
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You check whether you get any dedicated person
from where you have taken the policy.
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Now, this is important.
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Now let's assume that today you got a diagnosis
of a disease and the doctor said that we will
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do the operation after 2 months, then the
doctor says that you come to get check every
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week, come weekly and along with this you
get all these tests done and now you tell
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me one thing, here, we understand that the
operation will take place after 2 months.
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We get the money for the operation in our
health insurance claim.
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We understand this, but I will go to the doctor
every week.
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These days the tests are too expensive to
get the doctor checked, so will they go out
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of my pocket?
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This is the coverage, we call this, pre-hospitalization
coverage and it is pre mean you are getting
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hospitalized, it is Before hospitalization
coverage.
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Now understand the post-hospitalization coverage,
understand that you had an operation, After
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that you have to take medicine.
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There is also a test.
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Again there is doctor consultation.
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That too should be covered.
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But in most policies, their timing is very
much less.
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Suppose you have an operation, then it will
be covered only for 30 days.
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You have to check for how long it is covered,
then I am telling you for example that pre-hospitalization
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coverage should be for at least 2 months and
post hospitalization coverage should be at
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least for 3 months because now If a disease
has been diagnosed, then, in reality, it is
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operated after 2 months, then you do not have
to pay out of pocket and after the operation
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or else you feel that you went to the hospital
and whatever treatment you got, then after
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two or three months, if your treatment goes
on till then, where will its cost come from?
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So that there will be no burden on your pocket,
you have to check that.
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If you have taken health insurance, then you
should check it in your policy and if you
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are going to take it next time, then check
it also, then go ahead.
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Here, you see that it is also needed to get
the daycare retreatment.
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Now let us understand what this daycare treatment
is, Now most of the policies in this you understood
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that it is necessary to stay at night.
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Meaning you have to spend 24 hours in the
hospital.
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But today medical science has become very
advanced.
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There are many operations such as hernia or
there are some laser operations in which the
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doctor says that you have come in the morning
and I will discharge you in the evening.
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But you should know that under most policies
if you do not stay at night in the hospital,
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Then you will not get that expense.
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So there the company also refuses to claim
that if you don't stay at night, otherwise
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you will not get the expenses, then people
get stuck here, so here you have to check
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that you are getting daycare treatment, then
check this out in your policy.
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Now let's go ahead and understand what this
thing is now.
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One is that I will go to the hospital and
get treatment and one is domiciliary.
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What is it, that I am at home in this or a
person has got paralysis?
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He can't go to the hospital.
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Whatever treatment will be given to him now,
it will be at home.
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Is this covered in your policy?
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You would not have thought about it.
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See, you are taking the policy.
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If you are giving money to a company every
year, then you have to check that you should
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get all these coverages, according to you.
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You should get it according to me.
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You check whether you need it or not because
these things are not as per the requirement.
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Look we are taking health insurance for the
emergency, if any issue comes inside the emergency,
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that should be covered.
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At that time, the bank balance we have inside
our savings account doesn't affect it, this
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is my opinion, so what do you think?
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You can tell in the comment below.
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Now you understand what organ donor coverage
means.
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Let's assume that there is a girl and there
is an issue in her kidney and the doctor suggests
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a kidney transplant.
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Now if there is a kidney transplant, then
Suppose her mother agrees to give her kidney
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to the girl who has taken the policy.
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That 20-year old girl has taken the policy.
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But she has taken the policy and if the mother gives her kidney now, then the mother will have to pay for her expenses.
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Mother will also go to the hospital, she has
an operation, she will also get medicine,
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she also has tests, then who will cover that
cost?
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Mother herself will cover that cost, the answer
is no.
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If you have taken medical insurance, then
you have to check that it is also necessary
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to have organ donor coverage in it.
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Are You Getting it?
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Finally, There are a lot of expenses that
you have to check like whether the ambulance
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coverage is there or not and there are many
things?
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If I talk about that, then I will tell you
more than 20 points.
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But I am telling the major things right now
that it is necessary to get all this coverage
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and here you can see one more thing that it
is very important to get the no claim bonus
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because it depends on the policy.
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Some have 10%, Some have 20% and some have
50%.
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Now, what is this?
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The first thing is that it is probably not
even in some policies and where you do not
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get any claim bonus, it is an issue.
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Now, What does it mean, let me explain to
you?
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Let's say you get no claim bonus of 50% in
any policy that means if you have taken any policy of ten lakhs.
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You paid this year's premium but you did not
claim this year's claim.
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What will happen next year is that you will
get a 50% bonus and this means that your policy
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will be 15 lakhs instead of 1000000.
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So every policy may not necessarily have 15%,
Whether 10% or 20% in a policy.
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And it will be assumed that the higher the
no claim bonus, the more the premium increases,
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then you will see it according to you.
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I have given the example to explain to you
that if there is a policy of 100000 and there
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is a no claim bonus of 10% then according
to 10% no claim bonus that if I have not taken
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the claim this year, so in the next year,
my sum assured here, It will increase from
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1000000 to 1100000 Now and next year it will
be of Rs 1200000, so now people will say that
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if it increases accordingly, no matter how
much it will increase, then the answer is
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no, that can only increase by one hundred
per cent basic.
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This means if you have taken the police of
ten lakhs, If it will increase every year,
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it will only go up to 20 lakhs.
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That won't be 5000000 anytime now here I have
told you the basic things.
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Now here if you feel that even these basic
things are not covered under your policy.
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I am repeating this au feel that even the
basic points that I have told you are not
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covered under your policy, then do not feel
bad but your policy is not that good either.
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It is worthless then, you have to check all
these points.
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Next time if you are taking the policy then
you need to understand that you are paying
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for the policy and the money which you are
paying now, you are giving it from your earnings
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and you are giving it because if there is
an emergency then no burden should not come
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on me and if there is a burden, then it is
of no use.
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Today I would like to tell you that like I
give you an example of Navy health insurance,
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then if you have trust in insurance, whatever
is the benefit I have told you here, All these
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points are covered.
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The beginning of Navy is, If you have heard
the name of Sachin Bansal Ji who is the co-founder
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of Flipkart and also the founder of Navy Health
Insurance, then here you are getting a very
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big name, you are getting trust here.
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If I talk about their hospital network, then
more than 10,000 hospitals come into their network
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They are serving over 12 lakh customers.
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Their claim settlement ratio is 97%.
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Let me also tell you that if you are taking
a policy from anywhere then you must also
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check the claim settlement ratio and if it
is less than 95% then it becomes a little concern.
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So 97% of the industries are considered good
within the industry so that is the claim settlement
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ratio of Navy Health Insurance.
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Along with this, you can buy health insurance
for just ₹ 241 per month and it is a hundred
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percent and you can avail yourself of cashless
claims in twenty minutes.
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I will put a link in the description and comment
box starting at 241 rupees, and you can buy
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health insurance.
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Well, In this video I have tried to cover
major points which you should check Before
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buying any Health Insurance.
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How did you like this video?
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You will let me know in the comment.
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Lastly, if you still have any questions then
you can ask in a comment.
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We will try to make the next videos on them.
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If you are watching this video on Facebook
then follow and if you are watching on YouTube
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then subscribe and click on the bell icon.
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I Will See You In The Next Video, Link To
Navy Health Insurance Is In The Description
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And Comment Box and go self-made
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