There are several important points that you need to consider while buying a health insurance policy. It is not that you can claim for treatment of all kinds of medical conditions. There are many inclusions and exclusions in a medical insurance policy, defining what you can and cannot claim. Also, some medical conditions that are included in the policy may come with a waiting period. It is the time between buying the policy and being eligible to claim for a particular condition.
Health insurance coverage may be complete or partial, depending on your deductible and co-payment clauses. How you receive the claim settlement is another important aspect. Is your hospital part of the insurer’s network, will your claim be cashless or reimbursement-based, and how good is the claim settlement ratio of the insurer?
Today, we will look at eight important aspects that must be considered when buying a health insurance policy.
- Waiting period – The waiting period is the time frame during which you cannot raise a claim against the health insurance policy. It generally starts from the date of start of the policy. The shorter the waiting period, the sooner your health insurance risks are covered. Most insurers don’t have a waiting period for accident-related hospitalisation. The Corona Kavach policy has a 15-day waiting period, while the waiting period for general hospitalisation could be around a month. It is the specific waiting periods that you need to pay attention to. There could be different waiting periods for pre-existing diseases, maternity benefits and other specific ailments.
- Pre-existing diseases – Insurance companies have a list of medical conditions which fall under the category of pre-existing diseases. If you have been diagnosed with one or more of these diseases in the last few years, generally within the past 48 months, you have to declare that you have such and such pre-existing disease. Accordingly, there will be a waiting period of 24 to 48 months before you can raise a claim against such diseases. While buying health insurance you must check the list of pre-existing diseases and their applicability.
- Co-payment – The co-payment reduces the cost of your health insurance premium. However, you need to pay a percentage of the hospital bill out of your pocket. So, if you have a 20% co-payment clause, your insurer will pay 80% of the hospital bill and you will have to take care of the remaining 20%.
- Pre and post-hospitalisation – Your total medical expenses may comprise expenses incurred before, during and after the hospitalisation. While buying a health insurance policy, ensure that pre and post-hospitalisation expenses are also covered. Insurers generally define a time frame for which these expenses are covered. For example, coverage of pre-hospitalisation expenses within one month of hospitalisation and two months post-hospitalisation. This will help you meet expenses such as diagnostic tests, investigative procedures, continuing treatments etc.
- Room rent limits – If you have a health insurance policy, you will also have to keep your room-rent cap in mind. Insurers fix a limit on the room rent; for example, 1% of the sum assured or Rs 10,000 whichever is higher. If you choose to stay in a more expensive room, you will have to pay the incremental cost yourself. There may be room rent caps in the case of ICU rooms as well. If the quality of your hospital stay matters to you, then make sure you choose a plan that has a sufficient width in its room rent limit or has a limitless room rent option.
- Inclusions and Exclusions – You must gain an understanding of the inclusions and exclusions in the policy coverage. Your policy document will have all the details of various medical conditions that are included and excluded in the policy. Claims made against excluded medical conditions can lead to rejection. Permanent exclusions may include any treatment done without a doctor’s consultation and expenses such as cosmetic surgery, pre-existing diseases within the waiting period, dental procedures, and more.
- Deductible – Similar to a co-payment, a deductible is an expense for the policyholder. However, unlike co-payment, it is a fixed amount that you need to pay and not a percentage. Like co-payment, a high amount of deductible can reduce your premium amount. Some policies have a compulsory deductible portion, while you can also voluntarily choose an additional deductible amount. When you check online health insurance, also assess how much deductible you are willing to take and how it will affect your premium cost.
- Network of hospitals – The size of an insurer’s hospital network has a direct impact on the claim settlement and customer satisfaction. The more hospitals there are in an insurer’s network, the better are your chances of getting a cashless treatment. Also, there will be a greater possibility that your preferred hospital is on the list. While selecting a policy, check that major hospitals are a part of their network.
Hopefully, this article simplifies the world of medical insurance for you and demystifies some of the commonly used jargon in the industry. Apart from these aspects, the reputation and customer perception of the insurer are important aspects of your decision-making process. When you choose a trusted insurer, you place your faith in a company that has the infrastructure to meet your healthcare and customer satisfaction needs. If you don’t have health insurance, the pandemic is a stark reminder that you need to get one now. So, go ahead and make the smart choice today.