How To Choose The Best Mediclaim Policy For A Family?

by SMCIB on Thursday, 01 December 2022

How To Choose The Best Mediclaim Policy For A Family?

Family is the solid support you will never have to pay for because come rain or shine, they will always be there to cheer you every step of the way. And, you would want to do the same for them – making sure they get everything they deserve. And when it comes to their health, there can be no compromises. You would want them to have the best medical care possible at times of need. What else can do that better than Health Insurance?

But how do you pick the best mediclaim policy for your family from all the options available?

There is no such thing as the 'best' policy on the market. You need to choose the right cover, and customise it according to your needs - select a plan that offers the features you need, and buy it from the right insurance company - if you want your health plan to be the 'best'.

This article will help you find the right health insurance plan for your family -

  1. Decide The Right Coverage

    When purchasing health insurance for your family, it's important to keep in mind that it is a long-term commitment and it is an investment for the future. Hence, you must choose a sum insured that is sufficient not only for today but also for years to come. Additionally, you need to account for inflation of 6 to 8% - to ensure your family is always protected.

    Why should you get a cover that will be sufficient for tomorrow as well?

    You might think upgrading is an option. The process of upgrading a health insurance policy is not easy. It can be difficult to upgrade health insurance coverage as one gets older and develops a lifestyle disease or medical condition. The insurance company may either reject the application for a higher upgrade right away or charge higher premiums. Furthermore, your family may have to serve additional waiting periods starting from the year of the upgrade. If you buy enough insurance coverage today, your family need not go through all of these troubles.

  2. Learn About The Coverage Offered

    The next step is to understand its scope of coverage so you know what to expect in the future. Here is a list of a few expenses that will be covered under health insurance -

    ?In-Patient Hospitalisation Costs
    Expenses incurred during hospital stays are covered by health insurance policies. In-patient hospitalisation costs include medical treatment expenses, room rent, ICU charges etc. To qualify for coverage, your family must undergo a continuous hospital stay of 24 hours or more.

    ?Pre & Post-Hospitalization Costs
    - Pre-hospitalization costs are the expenses incurred before undergoing treatment or getting admitted to the hospital. These include blood tests, X-rays etc
    - Post-hospitalization costs are the expenses you incur after you are discharged from the hospital and are covered by health insurance. These costs include follow-up visits to your doctor, diagnostic tests, rehabilitation, etc.

    ?Daycare Treatment Expenses
    Daycare treatments are surgeries or treatments, such as angiography, cataract, dialysis, etc., that are completed in less than 24 hours at a hospital or a daycare centre under general or local anaesthesia. The expenses associated with daycare treatments will be covered by a health insurance policy.

    ?Organ Donor Hospitalisation Costs
    In an organ transplant, both the organ recipient and the organ donor undergo surgery. The hospitalisation expenses of an organ recipient are covered by a standard health insurance plan. In contrast, it does not cover expenses the organ donor incurs, such as pre-hospitalization tests, surgery costs, and organ screening costs. All of these costs may need to be borne by the organ donor.

    You can buy an organ donor cover with health insurance plans to cover the expenses of the donor.

    ?Domiciliary Hospitalisation Expenses
    You can choose to receive treatment at home in cases where you cannot move to a hospital due to bed unavailability or an injury/illness that makes moving impossible. This is called domiciliary hospitalisation.

  3. Take Note Of The Exclusions

    An exclusion is a situation that is not covered by a health insurance policy. IRDAI has defined specific exclusions that insurance plans will not cover at any cost. Likewise, insurance companies may exclude specific illnesses or treatments from coverage. So, be aware of what the health insurance policy doesn't cover so that you won't be caught off guard when the policy is issued or when a claim is filed.

    The most important thing to remember is that if you buy a health insurance plan, you won't be able to make a claim from day one. Certain medical conditions and treatments are not covered by health insurance plans for a certain period of time. This period is known as the ‘waiting period’. Those medical conditions and treatments will only be covered after the waiting period has passed.

    Let's take a look at the types of waiting periods in health insurance.

    ➔ Initial Waiting Period
    During the first 30 days, you are not eligible to make a claim for any health conditions other than accidents.

    ➔ Pre-Existing Diseases Waiting Period
    IRDAI defines pre-existing diseases as medical conditions or illnesses diagnosed or treated 48 months prior to the purchase of the policy. Insurers impose 2-4 years of waiting periods for pre-existing conditions.

    ➔ Specific Disease/ Procedure Waiting Period
    In addition to the above two waiting periods, the insurer may also apply a 2-4 year waiting period for specific medical conditions and treatments such as hernia, spinal disorders, chronic kidney disease, haemorrhoids, etc.

  4. Be Aware Of The Financial Limits​​​​​​​

    Certain health insurance plans come with financial restrictions and limitations, and then there are plans with no such restrictions. If you plan to buy an insurance policy, verify that the total sum insured you choose is not restricted by financial limits.

    Listed below are some financial limitations to be aware of:

    ?Room Rent Limit
    A room rent limit is the maximum limit up to which health insurance will cover the per-day hospital room charges. If you choose a room with a higher rent than what you are eligible for, your insurer will not only deduct the difference in room charges but will also proportionally deduct all hospitalisation expenses from the coverage. It is therefore recommended that you purchase a policy without such a limit for your family.

    ?Limitations On Treatment
    Some treatments and surgeries may be subject to financial restrictions. Financial limits are usually imposed on conditions like cataract surgery and knee surgery.

    ?Limitations On Benefits
    There may be financial limits on benefits such as domiciliary hospitalisation coverage, organ donor coverage, etc as well. Insurers may cap or limit the amount of coverage they will provide under these benefits. Expenses that exceed the insurer's limit may have to be borne by you.

    A copay is a percentage of your approved claim amount that you must share with the insurance company. Generally, if a policy has a co-pay clause, you will have to pay a set percentage of the approved claim amount out of pocket. The insurance company will then pay the rest of the claim amount.

  5. Find Out What Features And Benefits It Offers

    Several features and benefits are available with health insurance policies. These features or benefits may be inbuilt or optional. Make sure the health insurance you choose for your family offers the following features/benefits:

    ?Restoration Benefit
    Restoration benefit, also known as restore, reinstatement, refill or reset, restores your health insurance sum insured after it has been exhausted within a policy year. You can regard this as an emergency backup in dire circumstances as it comes with a long list of terms and conditions.

    ?No Claim Bonus​​​​​​​
    No Claim Bonus (NCB) is a reward your family will receive if they don't submit a claim in a particular policy year.
    NCB will be given either by –

    ➔ Increasing the sum insured or
    ➔ Decreasing the premium amount.

    Despite NCB's apparent advantages, there are some downsides -

    ➔ When you make a claim under your policy, your no-claim bonus will start reducing at the same rate as it increased.
    ➔ The no-claim bonus does not boost other benefits such as the room rent limit.

    Besides these, there can be other drawbacks as well. Please go through the brochure or policy wording carefully before opting for such benefits.

  6. Compare The Best Plans Available

    The market is flooded with options, making the task of selecting the right one for your family even more challenging. So, it is important to conduct extensive research and analysis before investing your money. Once you understand the features, benefits, exclusions, etc., you can compare the top insurance plans available on the market. In order to make an informed decision, it is essential to compare the benefits, restrictions, exclusions, prices, and other provisions we discussed above. This way you can find a mediclaim policy that is appropriate for your family.

  7. Find Out Which Hospitals Are Part Of The Cashless Network

    The primary purpose of getting health insurance is to prevent the need to make arrangements for future hospitalisation expenses. However, cashless claims are only available at hospitals listed on the insurance company's network list.

    When choosing a health insurance plan, you should determine which hospitals in your area are on the insurer's network list. Ensure that those network hospitals have a cashless facility as well. If your area's hospitals aren't on the insurer's network provider list, you may not be able to file a cashless claim at those hospitals and needless to say, this can be a major problem for your family at times of need.

  8. Review The Insurance Company's Claim History​​​​​​​

    There have been numerous stories about families running from pillar to post to raise money for hospitalisation after last-minute claim rejections. Therefore, it is common to wonder whether your family's insurance claim will be honoured when the time comes.

    What is the best way to check whether the insurer is reliable and will settle claims?

    Take a closer look at the company's claims history. In essence, make sure you have answers to these questions -

    1. How many claims are settled by the insurance company out of the total number of claims received in a particular year?
    2. How long does it typically take for an insurer to settle a claim?
    3. How many complaints have been received by the insurance company so far?

    As a result, you will have a clearer picture of how future claims will turn out. These details can be found on the insurer's website or the website of the IRDAI.

​​​​​Wrapping up!

When it comes to choosing health insurance, it is essential to do thorough research - as it should be worth your money and time. Ensure your family's needs and requirements align with the policy’s features and benefits. In the end, that's what makes it the 'best'.

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