Essential Things that Should be Included in your Health Insurance or Policy

Things to Consider While Purchasing a Health Insurance Plan

The pointers below will help you select a health insurance plan that resonates with the healthcare needs of both you and your loved ones. Some of the crucial factors that you should consider before finalising a health insurance plan are listed as follows:

Pre and Post Hospitalization Cover

Many times, even a short stay at the hospital can run into more than what an average person can afford. Therefore, a critical point to check before purchasing a policy is to ensure that pre and post-hospitalisation cover is provided.

Pre-hospitalisation charges include all the tests and reports done by the hospital 30 to 60 days before hospital admission. On the other hand, post-hospitalisation costs like ambulance expenses, medical tests, medicines, etc., are covered for up to 45 to 90 days after you have been discharged from the hospital.
New Age Treatment Cover

Advanced treatments like stem cell therapy, immunotherapy, deep brain stimulation, and robotic surgeries can be expensive. When purchasing a medical plan, it is essential to check for the inclusion of such new-age treatments. You can include them as an add-on cover to avoid out-of-pocket expenses if they are not included.

For illustration, take Nirmal's case. He has been diagnosed with stage 1 lung cancer, and the doctor has prescribed immunotherapy for three years. The cost of one immunotherapy season is Rs. 1-1.5 lakh. He would need ten sessions every year for three years. The total cost would be more than Rs. 30 lakh. Nirmal's health insurance doesn't cover new-age treatments, and he has to shell out the entire cost from his pocket. To avoid such a condition, selecting a health plan that provides modern treatment cover in your basic health plan or as an add-on cover is recommended.
Add-on Covers

Some of the most common add-ons in health insurance are maternity cover, room rent waiver, global health cover, or hospital cash cover. As per the regulations set by IRDAI, the composite premium of all the add-ons included with the primary insurance should not exceed 30% of the original premium amount. Therefore, you can enhance your medical plan with add-on covers at a minimal premium.
Shorter Waiting-period Clause

Once you have purchased a medical plan for yourself or your family, there is a clause known as the waiting period. During this period, the insurer does not accept any claims concerning any specific illnesses or pre-existing diseases. The waiting period can range from 24 months (2 years)to 48 months (4 years) as per the insurer and the plan you have chosen.

Diseases like blood pressure, diabetes, and thyroid, among many others, are applicable under the waiting period clause. Some other diseases and treatments, like cataracts, varicose veins and others, may also be included within the waiting period clause. Therefore, it is in your best interest to compare and choose a medical plan with the lowest waiting period possible and thus help request claim benefits in an emergency.
Maximum Daycare Procedures

You can also check the number of daycare procedures covered under your health insurance plan. These procedures only require paying hospitalisation expenses for 24 hours. Some of the treatments included in daycare procedures are radiotherapy for cancer, cataract surgery, dialysis, etc. depending on your current health conditions, you may go for a health plan that covers maximum daycare treatments.
Limited Co-Payment Clause

Co-payment in health insurance policy works in two ways. The premium cost is higher if the policyholder chooses a lower co-pay. However, it reduces the claim amount that needs to be paid.

On the other hand, a higher co-payment reduces the total premium but increases the claim amount. A few insurance providers make co-payments necessary, while others make it optional.

For example, if Rahul has a health plan with a co-payment of 10% and his hospital bill comes out to be Rs. 5 lakh, then he would need to pay an amount of 50,000 and the remaining amount of Rs. 4.5 the insurer would bear lakh. Therefore, choosing health insurance with a co-payment is advisable only if you can pay off the remaining claim amount on your own.
Room Rent Capping

Hospital room rent capping can change as per the type of room selected. Many insurance providers set an upper limit on the room rent according to the policyholder's health insurance. You can opt for a plan with no room rent capping, which helps you pay off the room rent charges, including ICU, single room, etc.
No Claims Bonus

A no-claims bonus included in your medical insurance is a discount the insurer offers in return for the years without a medical plan claim. Specifically, the basic coverage amount is increased during policy renewal.

For example, you have a policy of Rs. 6 lakh, and there were no claims for two years. And the insurer provides around 10% of the no-claim bonus every year. Therefore, at the end of 2-years of policy tenure, you get 20% of NCB, which will keep increasing for subsequent years. The higher the percentage of NCB, the more you can benefit.
Policy Coverage and Limitations

When purchasing medical insurance, you must go through the policy coverage, limitations, and the sum insured. It will be helpful in determining the type of surgeries and illnesses you can claim for. Hence, a suitable health plan should cover most of the hospitalisation expenses and provide daily cash benefits, maternity charges, ambulance charges, and home treatment expenses, among many others.

On the other hand, it is also essential that you go through policy limitations. To give you an overview, most of the insurers do not cover the following:
1. Terminal illnesses
2. Injuries caused by war or terrorism
3. Claims filed due to adventure sports injuries
4. Cosmetic surgeries
5. Common illnesses and many more
A brief understanding of what you can claim for and what is limited would ensure clarity at the time of claim settlement.
Cashless Health Insurance

You may look for cashless health insurance coverage since the insurance provider would settle the claim directly with the hospital on your behalf. However, in reimbursement, the policyholder needs to run from pillar to post to settle hospital bills and then claim to the health insurance company. After a few days, the insurer reimburses the claim amount.
Quick Claim Settlement Turn-around-time (TAT)

While choosing a health insurance plan, you may need to research the insurer's claim settlement history comprehensively. The best way to do so is to check the claim settlement ratio and the reviews provided by previous customers online.

Takeaway

All the above points are some of the most important things an individual should check while purchasing a health insurance policy. The best way to do so is by comparing different health plans from top insurers and then selecting the one that matches your healthcare needs.