With healthcare costs – along with lifestyle diseases – rising like never before, health insurance has become a necessity for every individual today. More because medical emergencies can eat into all one’s savings if one is not adequately insured. However, buying the right policy from the array of options available in the market is not easy. Apart from pricing, there are many important factors that should also be taken into account.
“It is highly recommended that the decision of buying a health Insurance product should not be based solely on the premium pricing. In addition to the price, other factors like ease of policy purchase and renewal, servicing, add-on covers etc should also be kept in mind,” says Rajiv Kumar, MD & CEO, Universal Sompo General Insurance.
Here are 10 important things that you must look for before you buy a health insurance cover:
1) Add-on covers: First of all, you need to check whether the policy you are planning to buy is offering add-on covers or not. Many health insurance products offer add-on covers, which may prove to be beneficial for the insured and his/her family in times of distress. Critical Illness add-on, for instance, pays the sum insured as a benefit amount for listed critical illnesses, e.g. first heart attack of specified severity, cancer of specified severity, permanent paralysis of limbs, open chest CABG, open heart replacement or repair of heart valves, coma of specified severity, kidney failure, bone marrow transplant, multiple sclerosis, motor neurone disease etc. “The number of Critical Illness covers may vary from product to product and requires attention while making purchase decisions. Other additional covers generally available with health products are Personal Accident Cover, Hospital Cash Benefit, among others, which you may opt as per your needs and get a seamless comprehensive cover at payment of an extra price,” says Kumar.
2) Waiting period: The insurer is not liable for any treatment which begins during the waiting period, except in case of an accident. Generally, there are 30 days’ waiting period for all claims. Outpatient treatment, mother and child care benefits, listed illness and treatments, pre-existing disease coverage all have specified waiting periods after which the coverage comes into the picture. You need to heed to these waiting periods as they may vary from insurer to insurer, product to product and plan to plan.
3) Cumulative Bonus benefits: Health insurance policies generally have this feature whereby the sum insured is increased by a specified percentage for every claim-free year up to a specified maximum percentage. “The same ranges from 5% to 10% per annum to 100% of the maximum sum insured. In case of a claim, the increased sum insured (base sum insured remains unchanged) gets reduced by a specified percentage amount. You must check if this feature is present in your mediclaim policy and at what terms,” says Kumar.
4) AYUSH treatment: AYUSH stands for Ayurveda, Yoga, Unani, Siddha and homeopathy. Popularity of this alternative form of treatments is increasing by leaps and bounds not only in India but abroad as well. Inpatient treatment of AYUSH is covered by most health insurance policies with no sub-limit. Have a look if your health policy covers for the same and do not forget to check for the applicable sub limits, if any.
5) OPD coverage: Some health insurance products offer outpatient treatment, which does not require hospitalization of 24 hours with a waiting period of specified years through a network medical practitioner. The coverage generally is for consultation, diagnostic tests, dental treatment and spectacles/contact lenses/hearing aids. Terms may vary from product to product and you should have a closer look about the availability and terms of the OPD coverage.
6) Sub limit: One more area where you should have a detailed look are sub-limits, which are coverage-wise limits placed by insurers on the overall sum insured that will be payable if the coverage triggers. Some of common sub-limits placed are on room rent, ambulance charges, outpatient treatment, maternity charges etc. Some insurers also provide discounts for opting for sublimit options.
7) Wellness and value added benefits: Most health products offer wellness benefits like vouchers for availing discounts at gym and other health care centers. “As prevention is always better than cure, you should select a product which have a tie-up with branded and reliable wellness centers and offers services at affordable discounted prices. Range of value added services include telephonic or doctor consultations, health newsletter and library, specialist consultation with follow up sessions, second opinion etc. Research a bit and choose a product which provides a range of standard and reliable value added services,” says Kumar.
8) Network Hospitals: For your convenience and better treatment, you must have a look at the network hospital list of the insurer and select an insurer who has cashless tie-ups with reputed hospitals in vicinity of your place.
9) Discounts and Loadings: Have a look at the discounts and loadings offered by the insurer and select a product which offers more discounts like family discount, long-term policy discount, e-policy discount, lifestyle discounts, treatment in tiered network and others. Loadings for adverse features like tobacco consumption should also be looked upon.
10) Other important features and coverages: Other features you may look in a health insurance product are health checkups, convalescence benefits, vaccination charges for post bite treatment, daily cash for accompanying an insured child, maternity coverage, restore benefits, cover for people living with HIV/AIDS, global coverage etc. “In all, you should, after a careful consideration of the above factors, select a product which meets your risk and budget requirements and provides comprehensive protection to you and your family,” advises Kumar.