Today most individuals and families are well prepared for health adversities by buying health insurance with an adequate cover so that they can access medical treatment without being worried about the ensuing expenses.
It is very important to buy health insurance, though at the same time it is equally or more important to choose the best health cover plans. There is a vast choice of plans in the health insurance segment. Basic health insurance plans and top-up plans can cover your daily and basic health needs, existing chronic ailments and even maternity-related expenses. Since there are a wide range of products and insurers, the consumer is often very confused - this is why there are some guidelines to help you choose the most suitable plan.
First study the plan: When you choose a health plan make sure the features and services match your healthcare requirements, study the plan in detail and see that it suits your requirements. There is a surgical cash plan which is a fixed benefit if the insured undergoes a surgery, but it is important to understand that a comprehensive hospitalization indemnity plan is most important. It would then be beneficial to add a top up plan - so that you can cover the deductible amount with the existing health insurance funds or your personal funds.
The Sum insured should be realistic with the inflation that looms in the future, as today a knee replacement will cost Rs. 4 lakhs, the same operation would cost Rs. 14 lakhs after 7-8 years. It would be better to be aware of what your future needs would be and the cost increases in relation to the future and provide for these needs.
The premium amount should be commensurate to the features and services of your policy and the quantum of coverage. Check among insurers to understand that you are paying the correct premium for the chosen policy. Also make sure that the health insurance cover offers automatic policy recharge, annual health check-up, daily hospitalization allowance, allowance for treatments abroad and cover for second opinions are some benefits need to considered and the insurance company which will be most suitable to take care of all these benefits.
Look for a cashless benefit as this is the key aspect of your insurance policy, as when your insurer has a direct tie-up with the hospital you will not have to arrange for money for hospital expenses - the insurance company can settle directly - this will save you from the hassle of reimbursement. Opting for a policy in your vicinity with a well equipped hospital is what you must keep in mind while choosing your policy, which offers cashless facility.
All health insurance policies have 'exclusions'. It is best to read the fine print and question the agent with your doubts as it is very important to be aware of all the illnesses and treatments that your policy will not cover. It is better to be prepared so you are not taken by surprise when you file a claim.
Most policies have a no-claim bonus feature, when you don't make claims for a year the insurance company gives you a no-claim bonus, which can be in the form of an increase in your sum assured or the premium amount is reduced. You must ensure that the company you have taken the insurance from gives you a significant benefit with this feature.
The co-payment means that the policyholder will have to share a part of his medical bill with the insurance company. For example, if the co-payment clause says 20%, it means that for every Rs 100 of a claim, the insurance company will pay Rs 80 while the remaining Rs 20 would be borne by the insured. This clause is at times a part of the terms of the policy and many times it comes into force after a certain age and at times when the premium paid is low. It is best to look for a policy that offers favorable co-payments consistently.
Health insurance policies have a 15 day free look period which offers you the convenience of returning your policy if you don't find it suitable. You can return the policy within 15 days of receiving the policy documents and the premium paid can be refunded after pro-rata deductions. After you have studied the policy in detail and find it does not meet your expectations you should return the policy at the earliest.
Choose a policy that is suitable and a combination of all the features. Make sure the insurer you have chosen has a customer oriented approach and delivers health care requirements as and when you need them. Try to check the insurance company's past history and their reputation.
When you spend and choose the right product you will feel secure in your future.
Anuj Gulati-MD Religare Health Insurance