What to look for in a health insurance plan

Deccan Chronicle.  | Adhil Shetty

Business, In Other News

If you’re unsure of what to look for in a health insurance plan, here are some tips.

As healthcare gets increasingly expensive with each passing year, it’s imperative for us to cover our family against sudden hospitalisation and critical illness.

Come January, and the hunt for the right insurance product intensifies. Buying health insurance is also a necessity. As healthcare gets increasingly expensive with each passing year, it’s imperative for us to cover our family against sudden hospitalisation and critical illness. If you’re unsure of what to look for in a health insurance plan, here are some tips. 

INDIVIDUAL vs FAMILY FLOATER
You can choose between an individual cover and one that covers multiple members of your family, including your wife, kids, and parents. Ideally, to keep premium costs manageable, you should buy a separate plan for your parents.

ROOM RENT LIMIT
Check the room rent allowances on your policy. For example, a policy may offer you a rent limit of Rs 3,000 which allows you to comfortably receive treatment in a single private room at a hospital in your area. The higher the limit, the better for you.  

PRE & POST HOSPITALISATION EXPENSES
Health covers not only cover your hospitalisation expenses, but they can also cover related expenses incurred before and after hospitalisation. For example, lab tests conducted before a diagnosis can also be added to your claim. This pre- and post-period may typically range from one to six months. Long periods mean more savings for you in case of a hospitalisation.

CO-PAY
It is the percentage of your claim amount that you will pay out of your pocket. The rest will be covered by insurance. Ideally, the plan should have no co-pay. However, some plans may mandatorily have co-pay. For example, there may be a mandatory 10 per cent co-pay for senior citizens on some policies.

EXCLUSIONS
Exclusions are one of the most important parts of your policy document and you should read them carefully to avoid surprises. A policy may exclude claims arising in pre-defined situations. For example, a typical health cover will not settle any claim for 30 days since the policy commencement. One policy may exclude pre-defined diseases in the first two years, or pre-existing conditions for four years. Another policy may exclude hospitalisation required by an act of war. Each policy will have its unique approach towards exclusion.

CRITICAL ILLNESS COVERAGE
Some critical illnesses such as cancer are costly. While critical illness covers can also be bought as stand-alone policies, they may also be part of a health cover. The claimant may be paid a lump sum benefit in addition to the health coverage. The lump sum can be useful in managing non-medical expenses such as loss of income, family’s boarding during the hospitalisation, and travel. Compare your policy options online before settling on the policy that you want. After buying, examine policy document to make sure you got what you need. If not, use the free look period to return the policy and get your refund.

RESTORATION BENEFITS
Your health policy has a sum assured up to which you will be covered. In a situation where you exhaust your cover during one hospitalisation, a policy with cover restoration may restore your benefits in case you have further hospitalisations in the same year. This restoration may be a standing feature of your policy or be availed by paying an additional premium. 

(The writer is CEO, BankBazaar.com)

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