Health insurance is quite complicated and choosing the right policy can be difficult with so many different policies with different features out there. The number of options is bound to leave you confused. Don’t worry. Here is a list of things you need to consider before choosing your health insurance policy:
Room rental limits
Your health insurance coverage should have no room rental limits and no room type limits. This will help ensure that the bulk of your insurance policy is paid off.
For example, if you purchase health insurance coverage with a room rental limit of 5,000 a day and you end up staying in a room that costs 12,000/day (due to, say, unavailability of 5,000 rooms or because of the minimum room rent in the hospital be 12,000), the entire hospital bill will be paid pro rata. Let’s say your bill amount for 10 days is 12 lakh rupees, you may think you just need to pay the 7000 differential for 10 days ie 70,000.
But this is not true, the insurance company will deduct the proportionate charges and hence the bill passed by the insurance company will be 5 lakh (12 X 5/12) and not 12 lakh. You will be left with a hole in your pocket and disappointed that health insurance is useless. In reality, you were unaware of how health insurance works and the health insurance you chose was a poor policy. Health insurance policies without room rental and room type limit will be a little more expensive, but this feature is a must in health insurance.
Pre and post hospitalization coverage
Pre- and post-hospitalization costs are also covered by health insurance. Pre-hospitalization expenses are incurred prior to admission and include expenses related to diagnostic tests, investigative procedures, medications, etc. Post-hospital expenses are incurred after the person is discharged from hospital and include follow-up tests, ongoing treatments, etc.
An average policy provides 30 days and 60 days of coverage respectively. It is advisable to look for policies with maximum coverage of 60 days and 180 days.
Don’t overlook the sublimits
Sub-limits are additional limits to the coverage of a health insurance policy applied to predefined medical expenses. Sub-limits are like the upper limit of the claim amount for certain coverages. These sublimits are expressed as a fixed value for a particular disease/disease/treatment (e.g 50,000 for cataract surgery o 5,000 for Ambulance) or expressed as a percentage of the total sum insured (for example, room rent can be equal to 1% of the sum insured). There are policies with higher or no sub-limits, slightly expensive but worth it.
Waiting periods
All diseases and procedures are not covered as soon as you have health insurance. It has a waiting period for illnesses that you already have when you buy the policy. Pre-existing diseases generally have a waiting period of 2 to 4 years. It is important to understand waiting periods and exclusions. You can opt for a policy with a shorter waiting period. There are some conditions like diabetes and high blood pressure that can be covered with a higher premium from day one.
Hospital network and claims settlement process
Make sure your preferred hospital network is covered by the policy you are purchasing. All insurers today provide you with a cashless claims settlement process as long as the hospital is mandated by the insurer. If you are treated at an out-of-network hospital, you will need to pay the bill and submit a claim. Please note that the refund request is not as smooth as the cashless request.
Day structure
Many treatments that used to require hospitalization can now be done in less than a day. Such treatments are called day procedures. Some examples of daytime procedures are dialysis, radiation therapy, chemotherapy, among others. Make sure you have an extensive list of treatments covered as part of your policy. It is best to follow a policy that mentions All day treatments are covered.
Co-pay function
A co-pay feature means that only a percentage of the total bill will be paid by you. For example, if the payment participation amount is 20%, 20% of the invoice must be paid by you. This reduces your initial premium, but will certainly pinch your pockets during your hospitalization. It is always advisable to opt for a policy with zero co-payment.
Nishant Batra CWM is Chief Goal Planner of Holistic primary wealth.
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