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8 Things to Look for Before Buying Your Next Health Insurance Policy

by janeausten
Health Insurance Policy

Suppose you have purchased a health insurance policy or are about to do so. In that case, you may be confused by all the technical phrases and jargon you encounter online and in your policy documentation.

However, we can provide you with some of the necessary details before purchasing health insurance so that you are ready rather than waiting until the last moment to figure things out. You can pick the best health insurance for individuals or your whole family by being aware of all these factors, which will make the claims process easier for you.

Health insurance is one of the easiest ways to handle the stress that comes along with medical issues. It is crucial to realise that health insurance may provide a seamless flow through medical crises if purchased in advance and with the proper preparation. Before making a purchase, several aspects must be taken into account. So now, let’s look more closely at some key terminology related to health insurance that you need to understand.

Things to Consider Before Taking Health Insurance Plan

1.      Individual Plan vs Family Floater Policy

Choosing between a family floater plan and an individual policy should be your first and essential consideration when looking for a health insurance policy.

Families with children must decide whether to cover each child under a family floater plan, where each child is protected under the same policy, or insure them under health insurance for individuals. A family floater plan is significantly more affordable. Therefore, it is ideal for those with partners and dependent children to acquire family health insurance. The children must, however, be insured by separate health insurance if they are beyond the age of 25.

One thing to remember is that it is advised to get a separate policy and not include your dependent parents in your family floater policy if any healthcare plan does not insure them. And the reason for this is that a family floater healthcare plan always bases the policy’s premiums on the age of the oldest member. As a result, adding your parents to your family floater insurance can increase your costs.

2.      Sub-limits

The insurer will set a predetermined cap on a portion of your claim’s total value as a sub-limit. The 3 basic categories of sub-limits are discussed here:

  • Room Rent of Hospital: The amount of room rent that your insurance provider will normally pay is generally limited to a certain amount, usually around 1% to 2% of the value covered or some other fixed sum of money.
  • Treatment for specific diseases: Every day and scheduled operations, such as tonsils, tonsillitis, kidney stones, piles, gallstones, hernias, or sinus, are often covered up to a particular amount by your insurance company’s sub-limit clause.
  • Pre-/post-hospitalisation cost: If your coverage covers these costs, there may be a sub-limit on the amount of these you may claim. Pre-hospitalisation costs include those spent on diagnostic testing, forensic procedures, medicine, and other services before you are taken to the hospital for treatment. Post-hospitalisation expenditures are the medical expenses spent 45 to 90 days following your hospitalisation and subsequent treatment. This may include further tests in the future ongoing medical care, certain medications, etc.

As a result, you may only file a claim at the time of losses up to the sub-limit clause’s specified amount; anything over that would need you to pay on your own.

3.      Waiting Period

You must wait a certain amount of time before you may file a claim for any or all coverage under your health insurance policy. Each firm will have a different waiting time and set of terms. There is often a 30-day initial waiting period before you may use your health insurance in a meaningful way (other than accidental hospitalisation). Additionally, there are specific waiting durations for pre-existing conditions, maternity benefits, and other illnesses.

4.      Sum Insured

The maximum amount your insurance provider can pay out on your behalf in the event of medical claims is known as your sum insured. As a result, it is the highest compensation you might get from your health insurance.

You will be responsible for covering any additional expenses out of your pocket if your overall medical expenditures exceed this sum. Therefore, selecting the SI wisely is crucial. While choosing a more extensive sum insured can increase the money you have in case of an emergency, a lesser SI might result in a reduced premium.

5.      Co-payment

A co-payment is the proportion of compensation the insured will be responsible for under a health insurance claim. In short, it implies that you and your insurance will divide the cost of your medical care. As a result, although your insurer will cover a significant chunk of the bill, you will also be responsible for a lesser piece. For instance, if your co-pay is 15%, your insurance would cover 85% of the claim’s cost, and you will be responsible for the remaining 15%.

While choosing a higher co-pay can decrease your overall premium, you must pay more when filing claims. A reduced co-pay, on the contrary, will result in a higher premium, but you will ultimately pay less for claims. Some insurance contracts require a co-payment provision, while others allow policyholders to select a discretionary co-payment amount.

6.      Pre-Existing Diseases

Pre-existing ailments or diseases are any illnesses for which you have had treatment during the last 48 months or for which you have previously experienced symptoms. Asthma, high blood pressure, and major diseases like cancer and diabetes may all fall under this category. According to your seniority and the sickness or condition, there is generally a 2-4 year waiting period before an existing illness is covered.

7.      Cashless Healthcare Insurance Policy

In a cashless health insurance plan, your health insurer will pay the hospital expenses when you get the necessary care at a Network Hospital rather than after your treatments. You don’t have to pay anything out of your wallet. All that is required is approval from your insurance company or third-party supervisor, and the expenses will be settled between your insurer and the hospital.

8.      Add-on Covers

Furthermore, additional coverages (also known as add-ons or riders) are extra coverages that you may choose to add to your current health insurance policy. You may increase your coverage if you have this coverage by paying an additional fee. The premium for all add-ons chosen under one health insurance policy as per the IRDAI, cannot exceed 30% of the initial premium sum.

So, when you purchase family health insurance for 50000 per year and add five add-ons, the extra premium you will have to spend for such add-ons cannot be more than 15,000 (30% of 50000). Popular add-ons include provisions for maternity coverage, room rent waivers, hospital cash coverage, and AYUSH treatment coverage.

Hopefully, now that you know these terms, you will understand what to look for when purchasing health insurance. You won’t be as confused by the technical language or terminology the next time you choose or renew a necessary health insurance policy.

Health insurance won’t ensure rapid recovery, but it will undoubtedly save you from expensive, unnecessary medical costs. Therefore, it’s time to start searching for options if you haven’t bought healthcare coverage for yourself and your family.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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