The pandemic has shown many consequences. One of them is not having enough funds to handle your medical emergencies, especially without health insurance plans. Sooner or later people realized the importance of health insurance in their life. However, purchasing a new policy creates a stir in the mind with so many options available. Comparison is essential, but what should the parameters be? Here is a comprehensive guide to help you focus on a few specific points that should be considered when purchasing a health insurance plan.
Health insurance – Insurers and type of plans
It is one of the most important decisions when making health insurance plans. Various companies provide insurance services in India. Again, all companies have their own plans with different functionality and coverage. Therefore, you should analyze your own needs, pre-existing health conditions, budget, number of members, etc., before selecting the company and plan. If you want coverage for your whole family, a floating family health insurance plan may be more useful than individual health insurance. The family float covers all members under one policy.
Age becomes the main factor in calculating premiums for health insurance plans. Lower the age, lower the premium. This is because the chances of developing fatal or chronic diseases are lower at a younger age. This reduces the risk for insurance companies. Additionally, different companies have different protocols for charging premiums. Some charge premiums based on the age of each individual policy member, while others charge premiums based on the age of the oldest family member.
Premiums and top-ups
Premiums vary between policies and insurance companies. This is because the coverage provided by different policies is different. Therefore, find a suitable policy with a premium that fits your budget. However, it is of the utmost importance not to compromise with risk coverage instead of lower premiums. Ultimately, the goal is protection against uncertainty. The policies also offer an option for endorsements and supplements, where you can cover certain additional illnesses or increase the sum insured by paying an additional premium. If you feel that your base sum does not adequately cover all of your health risks, you can opt for a supplemental health insurance policy according to your needs.
Usually, insurance companies settle claims in two ways, namely reimbursement and cashless. Under reimbursement, you will have to pay the medical bills out of pocket first. Later, after filing the claim, the insurer will reimburse you according to the terms and conditions of the policy. The other method is cashless. Here you pay directly at the hospital and you don’t have to shell out money out of pocket. However, a cashless service is only available in hospitals with which the insurer has links. Therefore, it is necessary to see the hospitals of an insurer’s network before purchasing policies.
The waiting period is the period during which no claims can be made for hospitalizations for pre-existing medical conditions. It ranges from one year to three years for different companies. Choose a policy with as short a waiting period as possible. If hospitalization occurs during the waiting period due to an already existing health problem, the entire medical cost will fall on your shoulders.
Pre and post hospitalization coverage
Normally, insurance companies cover the costs for a certain period before hospitalization and after the patient is discharged. This is called pre- and post-hospitalization coverage. When purchasing health insurance plans, make sure that the number of days covered by the pre- and post-hospitalization clause is greater.
Typically, if you change insurance companies, there is a waiting period for existing health issues to be addressed. However, some companies offer a portability option that allows you to switch insurers without complying with new wait time requirements and other limitations, thus keeping the benefits of continuity intact. Portability is readily available at a younger age, whereas, for older people, many insurance companies may refrain from providing this feature because the risk is high.
No claim bonus
Each year, when no claim is made to the insurance company, the latter pays a premium for the absence of claims. Usually this is an increase in the sum insured for the same amount of premium. The percentage increase may differ for different policies, but this is generally a standard practice followed by all companies. Therefore, select a company with the highest percentage increase.
Claim and quota clause
Learn about the process for filing a claim, reimbursement period, etc., before purchasing health insurance plans. For seniors aged 60 and over, some companies include a co-payment clause in the contract. The co-payment clause means that part of each claim will be your responsibility. The company will take care of the rest. Usually the co-pay ratio is around 10%, where you will bear 10%, and the company will settle the remaining 90% of the claim. The lower the ratio, the better.
Maternity leave, emergency hospitalizations, surgeries and operations coverage for new policies
These are exceptional cases and you should be clear about whether your policy covers these cases or not. New policies may not cover surgery and operations for an initial one or two years. Many policies also do not cover maternity cases. Besides the above, ambulance costs, intensive care costs and transplants are a few clauses that you should be aware of. These cases usually involve a high amount of expense when the insured event is triggered.
The above points are a guide for selecting the best policy. Always read the policy document or brochure containing all the terms and conditions and policy coverage before choosing one. You don’t want claims settling shocks because you overlooked certain conditions when purchasing your policy.