Key Factors to Consider Before Buying a Health Insurance Plan

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There are a few factors that you should consider to make the right decision while buying a health insurance plan:

Scope of Coverage – The policy coverage will decide the type of illnesses and surgeries that you can claim during the policy term. Closely look at the benefits offered like hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, maternity cover, etc., while choosing a health plan.
Sum Insured – The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation, it is advisable to buy a health insurance plan with a minimum sum insured of ₹10 lakh. You can also choose to buy ₹1 crore health plan to get wider coverage as they have become affordable nowadays. If it’s a family floater policy or senior citizen insurance, the higher the sum insured, the better the coverage will be.
Policy Type – There are different types of medical insurance policies available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy Top Up and Super Top Up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment. You can choose this option at the time of policy purchase and renewal.
Waiting Period Clause – Your health insurance policy only comes into action once the initial waiting period is over. If any claim is filed during the initial waiting period except for accidental hospitalization claims, the insurer will reject it. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc. It is also applicable to specific illnesses, treatments, and maternity cover. Just make sure to choose a plan with a minimal waiting period.
Co-payment Clause – Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (policyholder). The co-payment option does not have any effect on the sum insured. However, it allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Thus, opt for this clause only if you can afford to pay off a portion of your hospitalization bills, that can be 10% and above, without a financial burden.
Room Rent Sub-limits – A health insurance plan may have various sub-limits and the most common one is the room rent sub-limit. For instance, if your medical insurance policy comes with a sum insured of ₹3 lakh with a sub-limit of 1% on daily room rent, then your room cost will be covered up to ₹3,000 per day. Any additional amount on room rent will have to be paid from your own pocket. So, choosing a health plan with no or minimal sub-limits is advisable.
Network of Cashless Hospitals – Check the list of network hospitals for an insurance company where cashless claims can be filed. The higher is the number of network hospitals in your vicinity, the better are the chances of availing cashless hospitalization benefits.
Lifelong Renewability Option – Medical insurance policies are usually renewed every year. When the policy term is about to end, the policyholder has to pay the insurance premium at the time of renewal in order to continue the insurance coverage. Thus, when buying a health insurance plan, choosing a plan with a lifetime renewability option is beneficial in the long run.
Premium Loading Factor – Premium loading is the additional amount that is charged to a risk-prone customer in the premium, especially in senior citizen health insurance plans. Choosing a medical insurance plan with no loading will save you from paying a higher premium. Some insurers also charge a claim loading. This aspect, though ignored in the beginning, usually increases your out-of-pocket expenses at the time of claim.
Check the Claim Settlement Ratio – Claim Settlement Ratio is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. A claim settlement ratio above 80% can be an ideal choice.

Health Insurance Riders

Riders in health insurance are the additional coverage that you can purchase to avail extra benefits and make your health policy more comprehensive. The cost of the health insurance rider depends on your age, sum insured, type of coverage, etc. Take a look at the five most common riders that you can consider buying with your health insurance policy:

Maternity Cover Rider – The maternity cover rider can help you to get your maternity expenses covered, including childbirth, pre and post-natal expenses, etc. Some insurers may offer coverage for newborn baby expenses until the end of the policy tenure. However, this rider comes with a waiting period that may range from 9 months to 6 years, depending on the health insurer.
Consumables Cover Rider – The consumables cover rider pays for non-medical expenses incurred by the insured during hospitalization, such as cotton, bandages, prescriptions, thermometers, syringes, registration charges, gloves, masks, etc. These expenses account for approximately 10-20% of the total hospital bill but are usually not covered by insurers. With consumable cover, policyholders can significantly reduce out-of-pocket expenses while obtaining the best quality treatment.
Critical Illness Rider – The critical illness rider will ensure that your health insurance policy covers critical illnesses, such as heart diseases, cancer, etc., diagnosed for the first time during the policy tenure. It will provide you with a lump sum benefit amount irrespective of the actual medical expenses incurred during the treatment. It comes with a waiting period of 90 days & a survival period of 30 days. Most plans cover about 10 to 40 critical diseases, depending on the insurer.
Personal Accident Rider – The personal accident rider can help you get compensation from your insurer in case an accidental injury leads to your disability or death. It will pay you the entire sum insured in case of permanent total disability but only a part of the sum insured, depending on the nature of the injury in case of partial disability. It is also known as the double indemnity rider, as your family will get a death benefit in case of accidental death.
Hospital Cash Rider – The hospital cash rider enables you to get a fixed daily cash allowance from your insurer to cover incidental expenses that you may incur during hospitalization for an injury or illness. It offers twice the coverage amount for a specific number of days in case you are admitted to the ICU. The daily cash amount may vary as per the policy terms and opted coverage. However, you need to be hospitalized for at least 24 hours to activate this rider.
Room Rent Waiver – The room rent waiver ensures that your health insurance policy covers the rent for the hospital room of your choice during hospitalization. It ensures that no cap on room rent applies to you and, thus, allows you to opt for a room with higher sub-limits or no sub-limits without paying extra money from your pockets.

Does Your Health Insurance Policy Cover Coronavirus (COVID-19) Treatment?

Yes, your existing health insurance policy covers the cost of COVID-19 treatment. Several health insurers and general insurers have already launched health insurance plans for coronavirus that cover medical expenses incurred on the treatment of coronavirus. After the IRDAI guidelines, two special standard health insurance products, namely the Corona Kavach policy and the Corona Rakshak policy, were launched and purchased by a lot of people. Let’s check out these two COVID insurance products and how they are different from basic health plans.

Corona Kavach PolicyIt is an indemnity-based health insurance plan that covers COVID hospitalization expenses, home treatment, and AYUSH treatment costs. The cost of masks, gloves, ventilators, oxygen cylinders, and PPE kit is also covered in the Corona Kavach policy.
Corona Rakshak PolicyCorona Rakshak policy is a benefit-based product that provides a lump sum payment for hospitalization (minimum 72 hours) expenses upon the diagnosis of coronavirus during the policy term. The minimum policy term is 3.5 months and the maximum is 9.5 months.

Courtsey To : Policybazaar