Points to be considered before buying health insurance.
All the medical insurance policies are approved by IRDAI and are good but before buying the medical insurance some of the basic points to be checked
To decide which health insurance plan is good to consider the following factors
- Room Rent capping: the limit on room rent per day means the maximum limit of hospital room charges payable per day. For example, if you have a Mediclaim insurance policy having a sum insured Rs.300000/- and room rant capping is 1% of the sum insured then you are entitled to get the room charges Rs.3000/ per day only. There are subsequent results also if you admit in a hospital and take a room with higher room rent then all other expenses like doctor charges, nursing charges, operation charges etc. Would also be higher and the difference amount will be recovered from you only.
- Waiting Period: there are various waiting periods applicable under a health insurance plan, like
- 30 days waiting period: First 30 days of newly purchased health insurance does not cover any ailments. Only accidental hospitalization is covered from day one.
- Two Years waiting period: some of the ailments are not covered during the first two years and got covered after two completion of a successful year of the policy. Please note the policy must continue with the same company without any gap. Please see exclusions under the policy. It may differ from company to company. However, we are providing a list of this ailment. Some of the companies are providing coverage of all the ailments after successful completion of two years and there is no ailment having a waiting period of more than two years.
- Three and four-year waiting period: Preexisting disease is not covered under any health insurance policy and it is covered only after continuous completion of two years of the health insurance. Please note, these preexisting diseases are covered by some of the insurance companies after completion of two years, some are provided coverage after three or four years.
- Pre Existing Disease: Pre-existing disease is defined as a condition, ailment or injury for which the insured had symptoms and/or was diagnosed and/or received medical treatment before buying the policy. Usually, insurers cover pre-existing ailments only after completion of two/ three/ four years of the health insurance policy.
- Network Hospitals: If your health insurance company has a high number of network hospitals in each and every city all across India, it is the best thing to go for other than the other factors, I mentioned above. More the number of network hospitals would give you better facilities nearer to your home.
- Reward or Bonus: most health insurance plans reward you in the form of bonus for every claim free year. As a bonus, insurance companies either provide an increase in the sum assured or Offer a discount in renewal premium.
- ICU charges: Normally ICU charges are double of the room rent so while purchasing the health insurance, you must check the limit of ICU charges however if there is no room rent capping then no capping on ICU Charges.
- Co-pay and Deductibles: Co-Pay and deductibles are those deductibles which have to be paid by insured so it is very important to check these conditions before buying the health insurance policy.
- Daily cash benefits: this is again added on benefit and very limited insurance policies have this cover. This cover provides daily cash to the patient during the hospitalization for their routine expenses.
- Ambulance cover: This benefits to carrying the patient to hospital cover is also provided by all the insurance policies.
- Day care Ailments: As discussed earlier, the health insurance policy provides the coverage only for a minimum of 24 hours hospitalization. However, there are some ailments which are covered under day care procedure and these are defined under the insurance policy.
- Automatic Restoration: it is a very good option and all the policy doesn’t have these cover. This cover provides the automatic restoration of your sum insured which you have consumed during the first hospitalization.
- Pre-acceptance health checkup requirement: Most of the policies having entry age to buy the insurance policy after a certain age, they ask for a health checkup before providing the health insurance plan. However, some of the insurance companies are providing insurance without any health checkup up the 60 year age.
- Claim Settlement Ratio: Claim settlement ratio or CSR is the ratio of the total number of claim settled by your health insurance company divided by the total number of claims received in the same duration of time or year. So if a company has high CSR, it means it is more likely or hassle-free to settle a claim for you.
- Free-look Period: The Policy allows you a period of 15 days from the date of receipt, to review the term and conditions, and to return the same if not acceptable.
- Convalescence Benefit: In the event of insured hospitalized for a disease/ illness/ injury for a continuous period exceeding 10 days, some Insurance companies will pay a benefit amount of Rs. 5,000 or 10000 per policy year. This benefit will be triggered provided that the hospitalization claim is accepted under the In-Patient Hospitalization Treatment Cover.
This benefit will be applied annually for policies with a term of more than 1 year.
- Medical Second Opinion: The Insured Person can obtain a Medical Second Opinion from a Doctor in the Company’s network of Medical Practitioners. All medical records thatwere provided by the insuredare submitted to the Doctor chosen by him/her online and also the medical opinion is directly available to the Insured person by the Doctor.
- Incurred Claim Ratio: Incurred Claim Ratio is the total amount of all claims received by the health insurance company divided by the total amount of premium collected in the same duration of time. High incurred claim ratio of a company indicates that they are more likely to accept new customers. Also, it also results in the lesser waiting period for the pre-existing illnesses and other such diseases, in your health insurance plans.
- Premium Amount: within a single health insurance plan, you can have multiple variants wherein your premium cost would be different depending on the sum assured and age. Therefore, you need to know what are the benefits that you are eligible to receive for the amount of premium you have paid.
- Sum insured: is the maximum value for a year that your Insurance Company can pay in case you are hospitalized. Any amount above the sum insured will be bear by you.
- Online purchase: most people can buy a health insurance policy online these days. You can compare policy online and select the best and save time. So insurers should ensure the website remains easy to navigate and use so that policy purchase remains simple.
The Procedure for Filing a Health Insurance Claim