If you are buying a health insurance policy, look for things like restrictions on rooms and room rent, disease-wise limitations, pre and post hospitalisation care, and a low waiting period. Also ensure that your daycare treatments are covered along with free health checkups, alternative medicine treatments and bonus in case there is no claim.
Let's face it: Buying health insurance is like math for most of us. No matter how many hours you spend figuring out the kind of health insurance you want to buy, there is always something more to find out and another complicated decision to make. We mostly buy health insurance hoping that we never have to use it. But we end up using it when we are not in our best state - either mentally or physically. There you could be, trying to sleep on those white beds in air-conditioned hospitals, with injection scars all over your hands and bandages on your legs, wishing for it to be all over really soon.
Why is this complex? The thousands of features that don't make sense but seem important, technically confusing terms, big figures for every benefit, a different plan for different kinds of health situations, a gazillion premium sizes, etc make this a complex affair. This hotch-potch often distracts us from learning about what is really needed in a health insurance policy.
1. Restrictions on rooms & room rent: Sometimes insurance companies don’t let you pick a room of your choice and impose a limit on the room rent that can be claimed. If you breach this limit, you will pay extra for every little service that is offered in the room and pay a good portion of the bill. So opt for a policy that doesn’t have too many restrictions in this regard. Generally, these limits are restricted to 1% to 2% of the sum assured. But there are various insurance companies that do not have any maximum limit on room rent, so look out for such health insurance plans.
2. Check for disease-wise sub-limits: When insurers offer a massive cover (say Rs 20 lakh) and charge a really modest fee, they impose restrictions on how the cover can be used for each disease. So even if you have a cover of Rs 20 lakh, you might not be able to use it entirely.
3. Opt for pre and post-hospitalization care: Generally, people opt for regular annual tests or take random diagnostic tests and then get treated to heal whatever issues crop up. These pre-hospitalisation diagnostic tests cost a lot of money which you would ideally like your insurance policy to cover.
Also, when a customer is discharged from the hospital post-treatment, medication generally continues for the next few weeks or months and also cost a bomb. Thus it would be a shame to have a policy that does not cover these expensive costs.
4. Seek a low waiting period: Insurance companies generally have a waiting period to cover customers who have certain particular ailments. For eg: If customers already have a pre-existing disease (like say diabetes or blood pressure) at the time of purchasing the insurance policy, then they might have to wait for a few months before the insurer starts covering claims arising out of these ailments. So it’s best to get a policy that has the least amount of waiting period.
5. Coverage for daycare treatments: Procedures like Chemotherapy and Dialysis are intense procedures that need customers to visit the hospital, but since these procedures last for less than 24 hours, they are sometimes ignored in the coverage. Thus you need to buy an insurance policy that includes these treatments.
6. Restoration benefits: Say you get a policy for your family and someone ends up being hospitalized. After you make a claim, your cover runs out. Say someone else in the family falls sick in a few days. Now if the insurance company rejects your claims because you’ve already used up the cover, what do you do? This is when you need restoration benefits i.e. your insurer will restore your cover each time you make a claim.
7. Free annual health checkups: Some insurance policies pay for your health checkups each year and if you are someone who loves or takes these checkups often, this coverage will come in handy.
8. Cover alternative treatments: You might want to ensure that your policy covers alternative medicines like Ayurveda, Yunani, and Siddha. This ensures that even if you have to opt for other alternative treatments (like say you want to get treated at a famous Kerelite Ayurvedic center instead of being admitted to a posh Reliance hospital), you don't have to think twice about it.
9. Bonus for no claims in past years: Some insurers offers you extra bonus covers for every year that you go without making a claim. Since you might get good benefits from this feauture, check for this feature too.
Choosing the wrong policy has bad consequences, especially at a time when you need support. Picking bad insurance plans leaves people worse off financially and when many people get it wrong, mixed signals to insurance companies encourage them to offer more bad plans. So to avoid these issues, look for these basic 7-8 features when you choose your health insurance plan.