Decide On The Right Type
As discussed above, there are several types of health insurance plans available in the market. So, you can choose a plan depending on your and your family’s requirements. For instance, in case no one in the family suffers from a medical condition, hospitalisation claims are less likely to happen. In such a case, you can choose a family floater policy. If your parents or anyone in your family has a medical condition, you can consider buying individual health insurance for them and a family floater policy to cover the rest of the family members.
Choose The Right Sum Insured
You are already aware that investing in health insurance is a long-term commitment. So, when choosing a sum insured, you need to make sure that it is sufficient enough to satisfy your needs today and in the future. While doing so, it is also important to account for inflation for adequate protection.
You might think it makes sense to purchase a plan with a lower sum insured today and upgrade later. But upgrading is not as simple as it sounds. When one becomes older and develops a lifestyle disease or medical condition, upgrading health insurance becomes increasingly difficult. The insurance company may either reject an upgrade request or increase premiums. There may be additional waiting periods from the year of the upgrade as well. Why face all this, when you can purchase enough health insurance coverage now?
Look For A Plan With Lifetime Renewability
You need to verify the validity of your policy - check whether it offers limited or lifetime renewal. As you get older, the need for health insurance increases. So, make sure you choose a health plan that provides lifetime renewals.
For instance, say your health insurance plan offers renewal until 50 years of age. After you reach this age, you will need to purchase another one - which can be an expensive affair. A pan with lifetime renewability will enable you to use the plan hassle-free for as long as you like - all you need to do is keep on renewing the plan on time.
Look For Comprehensive Coverage
In order to be covered for all possible medical expenses, you need comprehensive coverage. In addition, you should ensure that the coverage benefits you choose are suitable for your needs.
For example, consumables such as gloves, masks, etc. are usually not covered by a health insurance policy. If you want to cover them, you need to buy health insurance that comes with a consumables cover.
Check The Financial Limitations And Restrictions
There are some financial limitations and restrictions associated with health insurance plans.
You should be aware of the following financial limitations:
Room Rent Limit- A room rent limit is a maximum amount up to which the insurer will cover the per-day hospital room charges. If you choose a higher rent than you are entitled to, your insurer will not only deduct the difference in room charges but will also proportionally deduct all hospitalisation expenses. This is why it is recommended that you choose a policy that has no such cap.
Limitations On Treatment - Certain treatments and surgeries, such as cataract surgery and knee surgery, are subject to financial restrictions. So, your health plan will cover these treatments only up to the stated limit - even if the cost falls within your sum insured.
Limitations On Benefits- Similarly, financial limits may apply to benefits such as coverage for home hospitalisation, alternative treatment, and modern treatment. Insurance companies may limit the amount of coverage they offer under these benefits. You may have to foot the bill if your expenses exceed the insurer's limit.
Copay- A co-pay clause requires you to pay a specific percentage of the approved claim amount from your own pocket before the insurer steps in to cover the rest.
Make sure there are no such financial restrictions in the policy you are planning to buy.
Look For Value-Added Benefits
Whenever you compare health insurance plans, look for value-added features and benefits that are provided along with a policy's coverage features. The following are some of the most common benefits -
- Sum insured restoration
- Cumulative or No claim bonus
- Free health check-ups
- Second medical opinion
The best way to maximise your investment is to find a policy that offers a wide range of value-added benefits.
Opt For Riders
You can enhance the scope of your policy coverage by adding additional riders or add-ons by paying an additional premium. These add-ons kick in under certain circumstances.
For instance, the critical illness rider pays out if you get diagnosed with any of the critical illnesses listed in the policy. Or if you want to cover maternity expenses, you can choose a maternity add-on.
You can check for such add-ons, and pick the one that best suits your needs.
Check The Exclusions
The health insurance policy for your family does not cover specific treatments and medical conditions. These are called exclusions. The IRDAI has a standard list of exclusions that are not included in health insurance, while the insurer may have its own exclusion list of treatments and illnesses. Thus, it would be best to check with your insurer when buying the policy about these exclusions - so that you don’t run into any unpleasant surprises in the future
Beware of Waiting Periods
A waiting period is a period during which the insurer will not cover certain treatments or surgeries.
Types Of Waiting Periods:
Initial Waiting Period: You can’t claim for any health conditions during the initial 30 days except for accidents.
Pre-Existing Disease Waiting Period: The IRDAI defines a pre-existing disease as any medical condition that was diagnosed or treated in the 48 months prior to the purchase of the policy. For such pre-existing conditions, all health insurance plans impose a waiting period of 2-4 years.
Specified Disease/ Procedure Waiting Period: Insurers may impose a waiting period of 2-4 years for a specific list of medical conditions such as hernia, spinal disorders, chronic kidney disease, haemorrhoids, etc.
Compare The Premiums
The purpose of a health insurance policy is to cover your hospitalisation and medical treatment expenses. In exchange, you must make regular premium payments in order to continue receiving coverage. There are many factors that determine your premiums, including your chosen sum insured, your age, your medical history, your lifestyle habits, etc. Once you have decided on the sum insured, you will need to compare the premiums of different health insurance policies offered by various insurers and pick the one that fits your budget.
Check the Network Hospital List
Network hospitals are a list of hospitals that have a tie-up with the insurance company for providing cashless treatments. If you are getting hospitalised in a network hospital, you do not have to pay for your treatment from your pockets. The insurer will directly settle the medical bill with the hospital. Therefore, it is important to check whether your insurer covers the prime hospitals in your area. Additionally, make sure that these hospitals provide cashless claims.
Check The Track Record Of The Insurance Company
It is essential to review the insurance company's claims history. You should consider the following aspects before choosing an insurer:
How many claims are settled by the insurer in a given year?
Does the insurer settle claims quickly and efficiently?
How many complaints and issues are raised by other customers?
All this information is available on the IRDAI's or insurer's public disclosure page.