Insurance needs are dynamic and tend to change at different stages of life. Within the past few years, there has been quite a lot of innovation, particularly in the health insurance industry as a result of which mediclaim policies have evolved extensively based on the needs of the buyer. In order to expand their market-share and sales, health insurance providers have started experimenting by adding different new-age features to their conventional plans.
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People in today’s era have started focusing immensely on their health and try to lead a healthier lifestyle. However, this does not rule out the possibility of getting struck by illnesses or ailments. Therefore, it is vital to get the best health insurance plan in India with modern-day features that offer customized coverage based on individual needs.
Keeping the mentioned factors into consideration, let us take a quick look at some of the modern-day features and benefits of health insurance plans to consider in 2021.
A vital feature to consider when purchasing a health insurance plan is the claim of minimum hospitalization and OPD expenses incurred. Several health insurers in India offer claims against minimum hospitalization of 24 hours. However, with technological advancements in the field of medical science, there are a plethora of procedures that require less time such as dialysis, chemotherapy, vasectomy, tubectomy, etc.
Considering the time frame of these medical procedures, numerous health insurers in India have started offering coverage without any restrictions or capping. Some of the dental procedures fall under the category of day-care and hence are referred to as outpatient procedures commonly known as OPD procedures. When it comes to the coverage of OPD procedures, insurance seekers should be aware of the fact that only a few of the health insurers in India offer coverage that too with restrictions and capping.
In order to understand the primary reason behind the structure of coverage, it is important to decode the difference between OPD and day-care procedures. Typically, OPD procedures are the ones that require lesser time and include dental and minor surgical procedures. On the other hand, day-care procedures require a minimum of 24 hours and are a bit complex than the OPD procedures. Some of the common day-care procedures are chemotherapy, cataract surgery, radiotherapy, etc.
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From the provider’s perspective, it is crucial to assess the status of the applicant’s health in order to come up with a realistic risk assessment profile. The most common method of assessing the applicant’s health status is based on the disclosures made in the applicant along with medical examinations. Considering the current trend, most of the health insurers do not require applicants up to the age of 45 to undergo medical examinations unless they have a serious history of ailments or illnesses.
Moreover, with the grip of pandemic tightening across the globe, most of the insurers as well as buyers are reluctant to undergo medical examinations before purchasing health insurance plans in India. In order to ensure a smooth and hassle-free claim settlement, it is vital to disclose the right information in the application documents when purchasing mediclaim policies. Furthermore, the applicant always has the choice of undergoing medical examination voluntarily before the issuance of the health insurance plan in India.
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Another important modern-day feature that is a result of the evolution of health insurance plans in India is sub-limit. Almost every mediclaim policy offers total coverage, which is further broken down based on the doctor’s fee, surgical expenses, room rent, expenses of medications, other charges, etc. The feature of sub-limit refers to restricting the reimbursement under every category to a predefined limit.
Insurance seekers should thoroughly go through the fine print of the health insurance plan to understand the sub-limits and capping associated with each and every category. To under the concept of sub-limits let us consider an exemplary situation. Suppose your health insurance plan offers a cover of Rs 5,00,000 but at the same time the sub-limit for the room rent is one percent of the coverage. So, regardless of the total coverage, one needs to stick to individual sub-limits of different categories.
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As per the guidelines issued by the insurance regulatory authority i.e. IRDAI, it is mandatory for providers to issue health insurance plans in India to applicants up to the age of 65. Contrary to this most of the providers do not have such a limit in the mediclaim policies. Also, as per IRDAI guidelines, all health insurers in India are supposed to offer the feature of lifetime renewability to their customers. This is mainly due to the fact that if the policyholder is unable to renew their existing health insurance policy at the time of claim they will lose their pre-existing benefits. After the issuance of the policy, the policyholder has the option of renewing it till their lifetime. Health insurers in India cannot deny lifetime renewability on random grounds.
With progressing age and lifestyle, insurance needs, and requirements of the policyholder and the covered members tend to change dramatically. Therefore, it is vital to review and reassess your health insurance plan in India periodically. Furthermore, when purchasing a mediclaim policy it is crucial to compare, shortlist, and analyse different providers and plans to get the best one.
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