Health Insurance Guide

Guide to Buy the Right Health Insurance Policy

Take a look at the following health insurance checklist that can guide you to buy the right mediclaim policy:

1. Go for Lower Waiting Periods

   Before you buy health insurance, check the waiting periods applicable to pre-existing diseases (PED), critical illness cover and other treatments/procedures. Waiting period is the time period you have to wait to file a claim with your insurer. While the PED waiting period ranges for up to 3 years, the critical illness cover comes with a waiting period of up to 90 days, depending on the plan.

   Hence, you must prefer buying a health insurance policy with a low waiting period, especially for pre-existing diseases.

2. Say No to Co-payment

   Avoid buying a medical insurance policy with a co-payment clause. Co-payments increase your out-of-pocket expenses as you are required to pay a fixed percentage of the claim amount every time a claim is raised. Even though co-payments lower your premiums, it is better to avoid them altogether to keep your expenses to a minimum during medical emergencies.

3. Buy a Policy with No Room Rent Limit

   Before you buy a mediclaim policy, check if it has any restrictions on the hospital room category or room rent. Most health insurance plans come with a room rent limit or a fixed room category for your hospital stay. If you opt for a higher room category during hospitalization, you will have to proportionately pay more for every service availed during hospitalization, which increases your out-of-pocket expenses substantially. Hence, prefer plans with no room rent limit.

4. Check for Disease-wise Sub-limits

   Check if the health policy you want to buy comes with any sub-limits on certain treatments and medical procedures. Usually, insurance companies levy a sub-limit or a maximum coverage limit for a specific disease or medical procedure to keep the premiums low. This restricts the amount your insurer pays for that treatment/procedure and increases your out-of-pocket expenses. Hence, you must avoid plans that come with any sub-limits.

5. Opt for a Wider Coverage for Pre-Hospitalization and Post-Hospitalization Expenses

   While buying medical insurance, check the number of days up to which the insurer covers pre and post-hospitalization expenses, as it varies from plan to plan. Pre-hospitalization costs cover the expenses incurred before hospitalization on diagnostics, medicines and doctor consultations. On the other hand, post-hospitalization expenses cover the cost of medicines, follow-up consultations, physiotherapy, etc., availed after hospital discharge. To make the most of this coverage, you should prefer plans that cover at least 90 days of pre-hospitalization expenses and 180 days of post-hospitalization expenses.

6. Choose Restoration Benefit

   Prefer choosing a health insurance policy that comes with an unlimited restoration benefit. With this benefit, the sum insured of your policy will be restored unlimited times a year if it gets exhausted before renewal. The restore benefit ensures increased coverage during the policy year without paying additional premium. However, make sure the restoration benefit is applicable to the same and unrelated illnesses.

7. Get Coverage for Domiciliary Hospitalization

   Make sure to buy a mediclaim policy that covers domiciliary treatment. With domiciliary hospitalization cover, your insurer will pay for the medical treatment at home in case you cannot be transferred to a hospital or no hospital bed is available. However, you need to get a doctor's recommendation, and the home treatment should be obtained for at least 3 days to activate this cover.

8. Go for Annual Health Check-ups

   Choose a health insurance plan that comes with annual health check-ups. Regular health check-ups are essential to diagnose a disease or medical condition at an early age. To promote wellness, many insurers offer a preventive health check-up benefit every year or after every few claim-free years at their network providers.

9. Opt for Consumables Cover

   Go for a policy that covers the cost of consumables during hospitalization. Consumables refer to non-medical expenses incurred on items, such as gloves, cotton, syringes, bandages, etc., which are usually not covered by insurance companies. But in recent years, several plans offer consumables cover as an in-built or optional benefit.

10. Get Coverage for AYUSH Treatments

    Opt for a mediclaim policy that covers AYUSH treatments or treatments availed through Ayurveda, Unani, Siddha, Homeopathy and Yoga. Such alternative treatments have become quite advanced and are preferred by many people today. However, most plans offer AYUSH cover only for in-patient hospitalization and day care treatments availed through the AYUSH system of medicines.

11. Opt for Maternity Benefit

    If you are newly married or planning to start a family soon, you must buy a policy with maternity benefit. Doing so will cover the maternity expenses incurred during pregnancy and childbirth, including delivery charges and pre & post-natal expenses. It also covers the treatment and vaccination expenses of the newborn baby.

    However, most maternity insurance plans come with a waiting period of 3 months to 6 years. If you want to start your family soon, opt for a shorter waiting period. But if you plan to get pregnant after a few years, you can go for a longer maternity waiting period.

12. Prefer Plans with OPD Cover

    If you have young kids or elderly people in your family who need to visit a doctor regularly, you must opt for OPD cover in your mediclaim policy. With the OPD benefit, your insurer will pay for the cost of doctor consultations, diagnostic tests, medicines, and treatments availed on an outpatient department basis. While some plans may offer OPD as an in-built cover, others may offer it on the payment of an additional premium.

13. Get No Claim Bonus for Every Claim-free Year

    Before you buy medical insurance, check the No Claim Bonus or cumulative bonus applicable to the policy. Such bonus provides a renewal premium discount or increases your sum insured amount for no increase in premiums if no claims are filed in the previous policy year. Hence, opt for a policy that offers a high no claim bonus or cumulative bonus for every claim-free year.

14. Choose Plans Covering Less Than 24 Hours of Hospitalization

    Usually, health insurance companies cover hospitalization expenses if you are admitted to the hospital for more than 24 hours. Any claim for less than 24 hours of hospitalization, except for day care treatments, is rejected by the insurer. However, multiple plans today cover hospitalization for more than 2 hours. Thus, you must prefer plans that offer coverage for a minimum of 2 hours of hospitalization.

15. Check the Policy Exclusions

    Always check the exclusions in health insurance before purchasing a policy. Doing so helps you understand which diseases, procedures and situations are not covered by your mediclaim policy. This prevents future rejections of claims arising out of exclusions in your policy. Hence, you must prefer a policy that comes with minimal policy exclusions.