- Make sure to know exactly what the policy covers and what is excluded
- Read all the jargon which is essential to understand how the policy will work at the time of a claim
- Be on top of the policy with full knowledge of what you are getting into than being taken by surprises at the time of raising claims
Health is of paramount at every stage in life. Poor health has its impact on your physical, mental and financial condition. These days there are several health insurance policies to sift through to arrive at the one that suits you best. Make sure you understand what the policy offers, what it covers and what is excluded to know how best it will work for you in your hour of need. There are standard health insurance policies, group health policies, top-ups, health insurance riders to attach with your life insurance policies like critical illness riders.
One of the challenges faced by you at the time of buying a health policy is the terminology used in the policy which could be rather confusing if you are unaware. These are known as policy wordings in insurance parlance. For instance the total risk that your policy covers or the sum assured on the policy is one of the first word that come into play. This factor is important, but it is not the only parameter that should drive the choice of insurance policy. Here are 10 other things that you should be well-versed with at the time of taking adequate health insurance cover.
1. Pre- and Post-hospitalisation: Typically, medical expenses are not just about hospitalisation, they also include medical expenses incurred before and after the hospitalisation procedure, which should be paid for by the policy as part of the pre- and post-hospitalisation expenses. For instance, follow-up visits to the doctor, medicines to be taken or follow-up investigations required after hospitalisation should be covered. Likewise, any diagnostics or tests, which were relevant to the ailment leading to the hospitalisation is considered under this aspect of the insurance.
2. Network hospitals: Check the list of network hospitals and see if it includes the hospital or nursing home that you often visit or is in the vicinity of your home. If you are the sort who travels frequently, be sure to know the hospitals that are part of the network hospitals under the policy which you could visit when travelling outside your city. The importance of network hospitals is to ensure that at the time of the need, the policy automatically works on the cashless feature offered by the insurance policy which can be availed only in the network hospitals.
3. Claims efficiency: The proof of the policy is the claim settlement it offers. Claim settlement time and claim settlement ratio should be one of the most important factors that must be considered. Higher the settlement ratio and faster the settlement time generally means that the insurance provider is doing a good job with genuine claims.
4. Day-care procedures: Day-care procedures are not covered in most health insurance plans. Moreover, to make a medical claim, hospitalisation for at least 24 hours is mandatory. However, there are several procedures that do not require hospitalisation for the mandatory period, make sure that your policy includes insuring such procedures too. These could include cataract, fractures, neurological problems or septoplasty, which is a surgical process to correct displacement of nasal septum. Opt for a policy that covers maximum number of day-care procedures.
“Don’t let your wealth be a casualty to your ill-health, know the kind of health insurance cover that you need”
5. Co-payment: The concept of co-payment means that the policyholder will bear a pre-defined percentage of the claim amount and the rest will be settled by the insurance company; a general clause with most group health insurance policies. While you may find an insurance plan to be cheap, it may not offer you complete coverage if it comes with a co-payment clause. Some policies mention select procedures in which the co-pay clause comes into play.
6. Maternity Benefits: The complications and cost of pregnancy are going up and in order to manage these costs associated with pregnancy, it is important to check whether the policy offers maternity coverage. Before buying a health insurance policy, ascertain these points — look for the waiting period applicable for claiming maternity expenses, consider the sub-limits, see if the policy covers outpatient expenses related to maternity and check for specific exclusions related to the cover.
7. Free medical check-up: Look for a health insurance policy that entitles you to a free medical check-up at least once a year so that the tests or check-up has no bearing on the premium when policies come up for renewal. Do not confuse this with the OPD expenses that some health insurance policies pay for.
8. Lifetime Renewal: Ideally, you should opt for a health insurance policy that can be renewed throughout your life and has no upper age limit at the time of renewal. This clause is useful when you are taking a policy for elderly parents to ensure their age-related health risks are taken into account.
9. No claim bonus: Many insurance companies offer a no-claim bonus, which is a discount on the next year premium you pay if you have not lodged any claim in a particular policy year. In such a case, either the sum insured is increased or the premium payment decreases or both. With policies available for multi-year renewal these days, do evaluate how the no-claim bonus will work if you renew a policy in blocks of few years.
10. Survival Period: This factorcomes intoplay with critical illness covers, where the survival period is the span of time for which the policyholder has to survive once the covered condition is detected in order to be eligible for the claim payout. Typically, the survival period in case of heart related conditions is 28 days from the date of diagnosis, while in case of cancer-related condition; there is no survival period applicable.