8 Things To Keep In Mind While Buying Health Insurance

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There are 35 health insurance plans and further 52 variants available in Health Insurance.

Selecting a good health insurance plan from these wide range of options can be a daunting task. You'll have to decide how much coverage you need and what customisations to select. Then, there are various plans from different insurance companies that you’ll need to compare. You'll also have to check the exclusions, limitations, and long lists of terms and conditions.

While going through this arduous process, it is easy to lose track of some important aspects that can impact your policy as well as your claim in huge ways. Don’t want to miss out on any minor detail? We’re right here for you!

Here’s a checklist of 8 must-knows while buying a health insurance plan.

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Points Need To Consider While Purchasing Health Insurance Policy:

  • Adequate Cover For Old Age

    Given today’s rapid healthcare inflation, you have to remember that a sum insured that might seem sufficient now might not actually be sufficient in the future. Also, as you grow older, it might become difficult to upgrade your health insurance coverage due to age and health-related reasons. Hence, it is important to buy a large enough cover that will support you in your old age.

    For instance, if you think you need a health insurance cover of Rs. 5 Lakhs today, then 20 years from now you’ll need a cover of around Rs. 13-15 lakhs if you factor in inflation of around 5-8%.

  • No Room-Related Cap

    Most health insurance plans with a sum insured of less than Rs. 5 Lakhs come with room rent limits. These room rent limits can affect your entire hospital bill - not just the room’s cost. How?

    If you choose a hospital room with a rent that is more than what you’re eligible for, the insurer will -

    Deduct the difference in room charge.

    Proportionately deduct all associated medical costs.

    So, you might end up shelling out a large amount of money from your pocket because of room rent limits - despite buying adequate health insurance. Therefore, as far as possible, try to buy a policy that does not have such financial limitations.

  • No Cap On Specific Treatments/Procedures

    Some insurance companies may impose limits on specific diseases or treatments under your health insurance policy. Such limits will most likely be included in the fine print. And, if you buy a policy with such limits, you may have to pay a large amount of money from your pocket, despite having a sufficient sum insured.

    For instance, Sanjay buys a health insurance plan with a sum insured of Rs. 10 Lakhs. The policy specifies Rs. 2 Lakhs as the limit for appendicitis surgery. Now, say, Sanjay gets hospitalised and undergoes appendicitis surgery - and the expenses amount to Rs. 3.5 Lakhs. In this case, the insurer will only pay Rs. 2 Lakhs - because of the limit. Sanjay will have to pay the remaining Rs. 1.5 Lakhs from his pocket.

    So, make sure you go through the policy terms and conditions thoroughly and compare the fineprint across plans before zeroing down on one.

  • No Copayment Clause

    The copayment clause can impact your health insurance claim. If you buy a health plan that has a copay clause, you’ll have to bear a part of the claim before the insurer starts paying.

    For example, Khwahish buys a health insurance plan for her dad that has a co-pay clause of 10%. A few days later, her dad meets with an accident and is hospitalised. The total hospital bill is Rs. 1 Lakhs. In this case, Khwahish will have to pay Rs. 10,000 from her pocket. The insurer will then pay the remaining amount of Rs. 90,000.

    So, you should try to buy a policy without the copayment clause. In case you’re not able to, look for a policy with the lowest copay - so that there are no major out-of-pocket expenses.

  • All Day Care Procedures Covered

    A day care procedure is a medical procedure or surgery that, in the past, required a long stay at the hospital but can now be completed in less than 24 hours - thanks to developments in medical technology. Chemotherapy, radiotherapy, eye surgery, colonoscopy, etc. are some examples of day care procedures.

    Now, most insurance companies give a list of the number of daycare treatments that they will cover under the policy. This number, however, can be misleading. For instance, one insurer may include ‘eye surgeries’ in their list, while another insurer may segregate this further into several surgeries such as cataract, incision of the cornea, operation of tear ducts, etc. The insurer may do this just to increase the number of treatments in the list.

    So, to avoid any confusion, opt for a health insurance policy that covers all day care procedures. This will also ensure that any new additions to this list in the future will be covered too.

  • Organ donor costs covered

    The cost of transplanting an organ, like a kidney or a liver, etc. can be super expensive. Apart from harvesting and screening the organ, there are two surgeries required - one for the organ receiver and the other for the organ donor.

    Health insurance will cover your, i.e., the organ receiver’s hospitalisation expenses - if you ever require an organ donation in the future. But, it won’t cover the organ donor’s expenses - such as the organ screening costs, pre-hospitalisation tests, surgery costs, post-hospitalisation recovery expenses, costs arising out of any complications post surgery, etc. You may have to pay for all these expenses out of your pocket.

    However, if you opt for an organ donor cover with your health insurance that covers the expenses of the donor as well, these out-of-pocket expenses can be avoided.

  • Restoration Benefit

    With the escalating medical costs today, it is quite possible that you use your entire sum insured within a single major hospitalisation. If that happens, you’ll not have any health coverage for the rest of the year. And in case you’re covered under a family floater, other members in your family will be left without a cover for the remaining policy year.

    There’s a feature in health insurance policies called restoration benefit that can be helpful in such a situation. Just like the name suggests, the restoration benefit will restore or replenish your sum insured after it is exhausted in a policy year. In some policies, this feature is available by default, while in others, it is available as an optional benefit.

    The restoration benefit will ensure that you or your family members (in case of floater) are not left without a cover in case the base sum insured is exhausted. The terms of restoration of the sum insured may vary across insurers and products. So, ensure you understand how and when the restoration will trigger and its extent before you go ahead.

    Important Things To Note About The Restoration Benefit

    Buy a plan where this benefit is available as an inbuilt feature, and not an add-on - so that you won’t need to pay an additional premium for an ‘add-on cover’.

    Look for a plan that offers unlimited restoration, where your cover amount will get restored any number of times in a year.

    In some plans, restoration is triggered only for unrelated conditions. Meaning, say if you use your base sum insured for kidney surgery - the sum insured will be restored, but cannot be used for kidney surgery again. If you undergo a hospitalisation for the same disease/ illness again in the same year, restoration will not trigger. You can avoid this by buying a plan that allows restoration for both related and unrelated conditions.

    Restoration, in some plans, kicks in only when the entire sum insured is exhausted, while in others, it triggers even on partial exhaustion of the sum insured. To ensure you get a full cover for every hospitalisation, try to look for a plan that restores the sum insured even after partial exhaustion.

    In some policies, restoration benefit refills your sum insured up to the base policy cover. In others, the sum insured is refilled just up to the claim made by you. Try to buy a policy where the restoration is up to your base cover so that you get a larger cover for every hospitalisation.

  • Cover For Non-Medical Expenses

    Generally, health insurance does not cover non-medical expenses or the cost of consumables such as gloves, nebulization kits, oxygen masks, etc. You may have to pay for these expenses out of your pocket. However, if you opt for a consumables cover with your health insurance, these expenses will be covered too.

    During the pandemic, non-medical expenses related to gloves, masks, and PPE kits accounted for up to 25% of the total hospital bill. Keeping this in mind, buying non-medical expenses as a cover has become all the more important.


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Remember, when you or anyone in your family is hospitalised, the last thing you’d want is for the insurer to reject or pay only a part of your claim despite having adequate cover. So, ensure you keep the things we’ve mentioned above in mind while buying a health insurance policy.