It’s time you assess your health insurance cover – Here’s why

October 19, 2021 12:22 PM

The COVID-induced uncertainty along with the constantly-rising medical inflation is compelling more people to rethink their priorities and go for a plan that covers most blind spots.

Given these times, it’s better to be safe than sorry and opt for a policy that covers domiciliary expenses as well.

If this lingering pandemic has taught us anything, it is that health comes before anything else. However, health is an unpredictable entity, even in a normal world. Add a catastrophic pandemic and insufficient insurance cover on top of that, and you have the recipe for a potential disaster on your hands. It’s no wonder that in recent times, the awareness and demand for health insurance have significantly gone up. The COVID-induced uncertainty along with the constantly-rising medical inflation is compelling more people to rethink their priorities and go for a plan that covers most blind spots.

The impact of COVID-19 might be weaning off for now, but that shouldn’t be the reason to lower your guard. When it comes to health insurance, the key is to think, plan and prepare ahead. Does your health insurance guarantee the protection you need in these times or whether you need to re-assess?

If you find yourself asking this question, rest assured, you are not alone. Insurance is a thoughtful investment for the unforeseeable future and hence, a lot goes into picking the right policy. Here are some deciding factors that will help you evaluate your current one.

Adequate sum insured to cover exorbitant bills

COVID-19 rendered people helpless by jeopardizing their lives and livelihoods. In such a scenario, an exorbitant hospital bill is the last thing one needs. Ever since COVID wreaked havoc, it’s not uncommon to come across hospital bills as high as Rs 85 lakh to even Rs 1 crore, especially in the metro cities.

To help mitigate huge medical expenses, it’s essential to choose a plan that offers adequate sum insured. Sum insured is the maximum amount that the insurer pays to the policyholder in the event of hospitalisation. To put this into perspective, a plan that at least offers a cover of Rs 10 lakh or above can be deemed adequate due to the rapid pace of rising medical costs. Having insurance will be of little help to you if the amount doesn’t cover your expenses and you ultimately end up draining your personal savings. There are several plans from insurers like Max Bupa or Aditya Birla Capital that offer a cover of up to Rs 1 crore with a very reasonable premium that can range anywhere from Rs 800 to Rs 1000 per month.

Consider domiciliary treatment expense coverage

Domiciliary treatment occurs when the patient requires hospitalisation but is treated at home due to room unavailability or because of the patient’s co-morbidity or critical condition. The devastating second wave of the pandemic still continues to be an unfortunate reminder of how important it is to stay prepared. There was no dearth of cases – plenty of severely critical ones – who couldn’t find a hospital bed or resources and had to be taken care of at home itself. An illness brings along a sea of vulnerability and uncertainty. Given these times, it’s better to be safe than sorry and opt for a policy that covers domiciliary expenses as well. These expenses include home-care package costs, medications, nurse/doctor fees, tests to measure vitals, X-rays, CT scans, home ICU.

Check for sub-limits and co-payments

Several policies come with a cap either on the sum insured or on coverage of room-rent expenses during hospitalisation. This essentially means that there will be a limit on the amount paid by the insurance company, and some percentage will need to be paid by the policyholder upon hospitalisation. Under the co-payment clause, the policyholder is required to pay around 10-20% of the total hospital bill. For instance, if the hospital bill comes around Rs 10 lakh, you will have to pay anywhere from Rs 1 lakh to 2 lakh out of your own pocket. Similarly, in sub-limit, there could be a room rent cap of 1-2% of the sum insured. So, if you have a cover of Rs 5 lakh and there’s a room rent limit of 1%, then the insurer will only pay Rs 5,000 for the room.

The policies that have a sub-limit and co-payment clause come at a lower premium as compared to the ones without it. But the important thing to note here is that you shouldn’t lose out more than you gain in the long run in a bid to reduce your premium. Sub-limits might reduce your premium, but may cost you heftily during hospitalisation.

OPD, consumables and additional charges

Hospitalisation usually entails a slew of other activities like – doctor consultations, check-ups, tests, medication and also the use of several items like PPE kits, gloves, syringes, etc. All these consultations and check-ups that don’t require the patient to stay overnight in the hospital come under OPD or out-patient department. On the other hand, the medical aid items used during this entire process are known as consumables. Every case of hospitalisation comes with these added expenses. So, it’s important to make sure that you choose a plan that covers end-to-end medical costs, including the overheads like OPD and consumables.

Health insurance is an investment to secure your health and wellness in the face of adversity. Re-assess your current policy and make sure to take a thorough decision that covers all bases.

(By Amit Chhabra, Head-Health Insurance,

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