8 Things To Keep In Mind While Buying Health Insurance

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.

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.