Questions You Should Ask Before Signing Up For Health Insurance

A health insurance plan will financially protect you against expenses you may incur if you’re hospitalised. It is a significant purchase and hence, it is crucial that you don’t go wrong while purchasing it. One small mistake on your part when purchasing the plan could impact your claim in the future.

To ensure you don’t make any mistakes, and invest in a plan that suits your needs, we’ve prepared a list of ten questions you must ask before signing up for health insurance.

So, let’s begin!
 

10 Questions To Ask Before Signing Up For Health Insurance

• What Is Health Insurance? What Is The Scope Of Coverage?

  You should be aware about health insurance and the extent of its coverage before you purchase a policy. Health insurance is a contract between you and the insurance company under which, in exchange for the premium you pay, the insurance company will cover the hospitalisation expenses you incur for any injury or illness.

  Here’s a list of some common expenses that are covered under health insurance.

1. In-patient care expenses: Inpatient care is the healthcare that you get when you are admitted to a hospital to undergo a particular treatment or surgery due to an illness or injury. The expenses related to inpatient care will be covered by health insurance only if you undergo a continuous hospitalisation of 24 hours or more.

2. Room-rent and boarding charges: Room rent is the per-day bed or room charges charged by the hospital, whereas room-boarding charges include the additional expenses incurred while using a hospital room, like the cost of food, cleaning, etc.

3. Day care treatment costs: Day care treatment is performed in a hospital or a day care centre under general or local anaesthesia and takes less than 24 hours to complete. The costs of day care treatments will be covered by health insurance.

4. Pre and post-hospitalisation expenses: Pre-hospitalisation expenses are those that are incurred prior to a hospitalisation and post-hospitalisation expenses are those that are incurred after you get discharged from the hospital.

5. Organ donor expenses: The organ donor benefit in health insurance will cover the hospitalisation and surgery expenses of the organ donor in case of an organ transplantation.

6. Modern treatment costs: Modern treatment costs: Health insurance will also cover expenses of modern treatments that use advanced technologies such as robotic surgery, stem cell therapy, oral chemotherapy, and so on.

7. Domiciliary expenses: These include expenses incurred while taking medical treatment at home because -

• No beds are available at the hospital, or
• You suffer from a serious illness or injury that prevents you from being moved to the hospital.

• How Much Cover Is Adequate? Should I buy For Today’s Hospital Expenses Or For The Long Term?

  You purchase health insurance for the future, not just the present. Health insurance is a lifetime cover - so, the sum insured you choose must be sufficient for your entire life. A cover that you believe is adequate today may not be relevant 10 to 15 years from now. Hospitalisation costs will rise in tandem with the cost of healthcare, making the coverage you choose today insufficient in the long run.

  So, when deciding how much sum insured to choose, make sure to account for current inflation in addition to the amount of coverage you believe is adequate for today. For example, if you think that a Rs. 5 Lakhs cover will suffice for you now, you must factor in 8% to 10% inflation. So, the coverage you will require in the future will be between 13 to 15 Lakhs.

• Are There Any Financial Limitations In The Policy I Am Buying?

  Many insurance companies impose certain financial limitations under health insurance plans, and then there are plans without any financial limitations. So, check if the policy you are looking to buy has financial limits that will restrict you from using the entire sum insured available. You should also check if there are any core benefits that have separate financial limitations.

  Here are some financial limits you should look out for -

1. Room rent limit: It is the limit up to which the health insurance will cover the per-day hospital room charges. A room rent limit will affect not only the cost of the room, but also your entire hospital bill.

   Learn about room rent limits in detail here:

2. Limits on core benefits: If you choose core benefits, like Modern Treatment Cover, Organ Donor Cover, Domiciliary Hospitalisation Cover, etc., the insurer will not cover the expenses incurred under such core benefits up to the sum insured. They may set limits or put a cap on how much they will cover under these core benefits. If you incur any expenses that exceed the limit set by the insurer, you must pay them out of your own pocket.

3. Limits on treatments: There could be specific limits on how much you can spend on certain treatments. The most common financial limit in the policy is for diseases like cataract etc.

4. Co-payment: If the policy has a co-pay clause, you will have to pay a certain percentage of the approved claim amount out of your pocket. The insurance company will then pay the remaining claim amount.

   Learn in detail about co-payment in health insurance in this article.

Before signing up for the policy, make sure you are aware of all such financial limitations and if possible, buy a policy with no or fewer limits.

• What Will The Policy Not Cover?

  There will be certain conditions or treatments that will not be covered by a health insurance policy. These are known as exclusions. IRDAI has set certain standard exclusions that health insurance plans will not cover at all. In addition to these, the insurance company may also exclude certain diseases or treatments from the policy.

  So, before you buy a health insurance policy, make sure you are aware of all the things the policy will not cover - to avoid any surprises after the policy is issued or at the time of claim.

• Can I Have A Comparison Of The Top Plans In The Market?

  Suppose you want to buy a smartwatch - and search for the best smartwatches on the internet. Now, will you buy the very first smartwatch that appears on your screen? No, right? You will check 3 to 4 smartwatches of different brands, examine the features, battery life, available functions, etc. before making the purchase.

  Similarly, when purchasing health insurance, it is important to conduct a thorough comparison of a few top insurance plans currently available in the market. You should compare the benefits, limitations, exclusions, and other provisions of these policies. You should look for a policy that meets your needs and has a premium that is within your budget. Comparing the top plans on the market will help you understand the benefits of different plans and make an informed decision.

• Which Hospitals Around Me Provide Cashless Facilities Today?

  You purchase a health insurance policy thinking it will cover any future hospitalisation expenses and you won't have to run from pillar to post to arrange the money for the expenses.

  Now, for a claim to be covered as cashless, you must be treated in a hospital that is on the insurance company's network hospital list. So, while buying the policy, check with your insurer to see which hospitals in your area are on their network list and whether they will provide you with a cashless facility.

  It is important to check this because you may not be able to apply for a cashless claim if the hospitals in your area are not on the insurer's list of network providers.

• What Is The Track Record Of The Insurance Company With Respect To Claims?

  Next, it is also important to check the insurance company’s claim track record. Because it will give you an idea of what to expect if you apply for a claim in the future.

  Basically, you should -

1. Check how many claims the insurance company has settled out of the total claims received in a given year.
2. Check how many complaints they have received for claims.
3. Check how soon does a insurance company settle claims. Insurance companies report claims they have settled in 30 days of receipt.

You can get these details from the public disclosure section on the insurer’s website, your financial advisor, or the IRDAI's website.

• Who Will Be Accountable o Take Care Of My Claims In Your Organisation? Is There A Fixed Relationship Manager?

  Most companies employ call centres for customer service and claims. This may not be the most ideal channel for communication, especially when there is a dispute or something has gone wrong. It is always advisable to buy insurance from a place, where the organization is taking claims seriously, probably even deploying a relationship manager who can help you personally at the time of claims.

• What Is The Experience Of The Advisor Who Is Suggesting Health Insurance? Does He Have Any Experience Managing Claims?

  The advisor who is recommending the health insurance products to you, must be experienced and have in-depth knowledge of the products.

  So, ask the advisor about his experience - this will allow you to better understand their knowledge of the product they are pitching to you. Next, inquire whether they have any experience handling claims or have handled any claims in the past. If they have, ask them what problems you might encounter during the claims process and what steps you can take to avoid them.

• Who Will Help In Case Of A Dispute With The Insurance Company?

  Another question you must ask your financial advisor is whether they will help you out in case there is a dispute with the insurance company regarding your policy or a claim not being paid. In case you are buying the policy on your own, you can check the procedure for raising a dispute against the insurance company and the things that you must keep in mind while doing so.

  Generally, any disputes or complaints against the insurance company are handled by the Ombudsman. But, before you approach the Ombudsman, you will have to raise the complaint with your insurer. You can turn to the Ombudsman only if -

1. The insurer rejects your complaint.

   OR

2. You are not satisfied with the insurer’s response.

   OR

3. The insurer fails to respond within 30 days of receiving your complaint.

So, these are the questions you must ask before you go ahead and purchase a health insurance policy. Keeping the above things in mind will ensure you don’t face any difficulties in your health insurance journey.