Introduction

Health Insurance is one of the most crucial aspects of securing your financial budget against unforeseen medical expenses. With the rising cost of healthcare, a comprehensive health insurance plan can serve as a financial cushion during medical emergencies. Health Insurance is a financial product which needs to be thoroughly understood before buying. Health Insurance plans have features, benefits, terms and conditions that should by studied and understood by insured. Even in health insurance renewal, every year insured have to audit his health insurance policy that should be algin to his health needs. However, buying health insurance can be a cumbersome process for many people.

This article shall give you some pointers to look for while purchasing health insurance policy. It will help you to navigate health insurance plans with ease.

15 Thing to remember before buying Health Insurance

To make the process simpler, here’s a detailed explanation of the key factors to consider when choosing a health insurance policy:

1. Right Combination of Sum Insured and Coverage

Choosing the right sum insured amount is crucial. It should be sufficient to cover your medical needs, factoring in the rising costs of healthcare. A sum insured that is too low might leave you financially vulnerable during emergencies, while an unnecessarily high sum insured could lead to higher premiums. The premium of sum insured are today location based which means metropolitan cities will have higher premium for the same sum insured than for non-metro cities or rural areas.

It is advisable to have higher sum insured which can be algin your current and future healthcare need. Additionally, ensure the policy includes features like critical illness coverage, maternity benefits, or other specific requirements tailored to your needs.

2. Waiting Period for Preexisting Diseases

Many health policies have a waiting period, typically ranging from 2 to 4 years, before they start covering preexisting diseases. Insurance companies will not pay any claims for pre-existing diseases or any diseases related to pre-existing. Understanding this clause is essential to avoid unexpected expenses. If you or a family member has a preexisting disease, it’s advisable to choose a policy with a shorter waiting period or consider specialized plans catering to such diseases.

3. Room Rent Benefits

Room rent capping is a common feature in many health policies. These caps limit the reimbursement for room rent during hospitalization. If you opt for a room exceeding the limit, you might need to pay the difference amount out of pocket. It is beneficial to select a plan with adequate room rent limits or no capping at all to ensure a hassle-free health claim.

4. Pre and Post Hospitalization Coverage

Medical expenses are not limited to the hospitalization period. Costs incurred on diagnostic tests, consultations, and medications before and after hospitalization can add up significantly. Pre- hospitalization covers doctors fees, diagnostics bills, medicines; for a period of 30, 60, 90 days before hospitalization treatment. Post- hospitalization covers follow up doctor fees, medicines, diagnostics bills for period upto 60, 90, 180 days after hospitalization.

A good health policy should cover these pre and post-hospitalization expenses, providing comprehensive financial protection. This should a must check list for buying or renewing your health insurance policy.

5. Cashless Network Hospitals

The cashless treatment facility is a standout feature of health insurance policies. With this feature, policyholders can receive treatment at network hospitals without paying upfront medical bills. The insurer settles the bill directly with the hospital, making it a convenient and stress-free option during emergencies. Always check the insurer’s network of hospitals and ensure they include reputed facilities in your area.

6. Cumulative Bonus

Health insurance policies often reward policyholders who do not make any claims during a policy year. These rewards can come in the form of a Cumulative Bonus (CB), which increases the sum insured without an additional premium, or premium discounts during renewal. Cumulative bonus shall increase sum insured by fixed percentage of 10 or 20% every claim free year. Cumulative bonus percentage may varies from in very insurance companies. This benefits should be checked before buying new health insurance or renewing policy.

7. Restoration Benefits

Restoration benefits are another valuable feature, where the sum insured is replenished after it is exhausted, and ensuring uninterrupted coverage. This benefits is also know as refill which will come handy for multiple claims in policy year. This add-on cover is beneficial for people who has chronic diseases with high hospitalization treatment cost. This add-on covers best suited for family floater health insurance policies. Before buying health insurance policy keep in mind your budget and medical history while deciding restoring benefits.

8. Capping on Sum Insured for Common Ailments

Always check for capping on sum insured impose by insurance companies on common illness. These capping may vary from 10 to 25% on sum insured depending upon health insurance plans. The list of common illness is always mention in health insurance policies. It is important to know the sub limit your health insurance policy before buying or renewing, check health insurance with lower capping limit to avoid out of pocket expenses at time of claim settlement.

9. Daycare Procedure

Daycare procedure means medical treatment without requirement being hospitalized for 24 hours. Daycare treatment covers minor procedures, dialysis, chemotherapy, etc; list of daycare is mentioned in health insurance policies. The insured must read his health insurance policy thoroughly to understand daycare procedure coverages. Buy health insurance policy with maximum no of daycare procedure which can take care your current and future healthcare needs.

10. Modern Treatment

Innovation in medical treatment has made health recovery better, manageable and effective. Modern treatment in health insurance are covers robotics surgeries, deep brain stimulation, immunotherapy, intra vitreal injections, etc. Modern treatment may have sub limits in sum insured as per different health plans. It is necessary to check the list of modern treatment coverages mentioned before buying health plans.

11. AYUSH Treatment

AYUSH means Ayurveda, Yoga, Unani, Siddha, Homeopathy is alternative medical treatment in health insurance. AYUSH coverages upto sum insured or sub limit sum insured in health plan. AYUSH treatment is taken in government specified center or ayurvedic center. It is essential to know coverages and claim procedure in AYUSH treatment before buying health plans.

12. Preventive Health Check-ups

Regular health check-ups is essential for maintaining good health and detecting potential issues early. Many health insurance policies offer free or discounted preventive health check-ups as part of their benefits. These check-ups not only encourage a proactive approach to health but also provide added value to policyholders.

13. Co-Payment Clause

The co-payment clause in a health insurance policy requires the policyholder to pay a certain fixed percentage of the medical treatment cost, while the insurer covers the rest. While policies with co-payment options might have lower premiums, they could lead to higher out-of-pocket expenses during claims. Opt for policies with minimal or no co-payment obligations for greater affordability and convenience.

14. Exclusion

Some medical expenses are not covered by health insurance policies. Common exclusion in health insurance be non-medical expenses, cosmetic procedure, dental treatment, substance abuse, etc. Any health claim which excluded from health policy will lead to rejection. Waiting period, specific disease waiting period, pre-existing disease waiting which is also excluded from health policy. It is necessary to have proper understanding of exclusion in health policy before buying, as what insurer will cover and what is not covered. This will save you from disappointment and financial distress at time of health claims.

15. Efficient Claim Process

A seamless and transparent claims process is a hallmark of a reliable health insurance company. Quick claim settlements and a hassle-free process can make a significant difference during stressful times. When choosing an insurer, research their claim settlement ratio, customer reviews, and reputation for efficiency.

Conclusion

Health insurance is more than just a financial product; it is a necessity for ensuring peace of mind and protecting your family from unexpected medical expenses. By understanding the various factors outlined above, you can make an informed decision that aligns with your healthcare needs and budget.

Take the time to compare different policies, assess their features, and choose a plan that offers comprehensive coverage, flexibility, and value for money. Remember, the right health insurance policy is an investment in your health, financial stability, and future well-being.