Things to be Aware While Buying a Health Insurance Policy

With changing times, insurance companies have become more customer friendly by ensuring that insurance agents are available across the country and a 24/7 customer care available throughout the year. Also, internet has proved to be a game changer as you can get information about all policies offered by various insurance service providers.

Since insuring your health has become a simplistic task, sometimes, it can also lead to last minute surprises. However, there are a few checklists which if you are aware of will help you get an insurance policy which will suit you as well as your family’s needs.

List of Network Hospitals

Network hospitals are the list of hospitals wherein the policy holder can claim cashless facility and get treated at the hospital without paying anything from his pocket. Network hospitals are most preferred for planned surgeries/treatment and medical emergencies. An insurance service provider having extensive list of network hospitals is an advantage to the policy holder as he can avail the best medical treatment possible in case of medical needs.

Sum Insured of the Health Insurance Policy

Sum insured is the maximum amount of claim which can be made during a year by the insurance policy holder in case of hospitalization. Any claim above the sum insured amount will have to be borne by the policy holder. For instance, you have a sum insured for Rs.1 lac, you got hospitalized during the year and the treatment costed Rs.1.50 Lacs. In such case, the insurance service provider will entertain claims up to Rs. 1 lac and the balance Rs.50,000/- will be borne by you.

Sum insured plays a pivotal role not only in determining the premium paid by you but also, an adequate sum insured gives you a peace of mind in case of medical emergencies. While taking a policy, the inflating medical costs and the number of members to be insured should be taken into account for the purpose of arriving at sum insured.

Room rent limits

Hospitals have different categories of room like Single room, double sharing etc. wherein the room rent per day varies. Generally, the capping on room rent is 1% of the sum insured. Suppose, your sum insured is Rs.4 lacs, then the limit of room rent will be Rs.4,000/-. This means that if the room rent is above than this, not only the room rent but all the expenses relating to hospitalization will be borne by the policy holder proportionately.

Claim Process of the Insurance service provider

Claim process should be simple, convenient and hassle free. It should not be tedious or a process wherein too many approvals are required to get the amount reimbursed. Also, customer care assistance particularly for the claim process and intimation regarding the processing of claim via SMS or email ensures that the process is consumer friendly.

Fine prints of the policy

Once the policy is issued and delivered to the policy holder, he should read the fine prints i.e. the terms and conditions of the policy to avoid last minute surprises.For example few ailments like ovarian disease, diabetes, ENT disorders, hypertension, osteoporosis, hernia etc. might have a waiting period clause in the policy document.

Top ups provided by the insurance service provider

A top up is an additional cover apart from the existing sum insured.Keeping in mind the ever increasing treatment cost, various insurance companies have come up with top up plans which support your medical expenses in case your medical expenses cross the sum insured limit.

No claim bonus

No claim bonus is a discount provided by the insurance company for not claiming or availing benefits under the medical insurance. This bonus is provided at the time of renewal of policy in form of discount in premium. Ideally, the health insurance policy should be renewed within 30 days of the due date to enjoy the benefits of no claim bonus.

Health insurance policy available Online

Various websites provide information regarding the plans provided by the insurance service providers. These websites help you compare the plans and suggest you the one which best fits your pocket. They also, offer discounts and other add on benefits which can help you take a desired plan.

Being well informed about the benefits provided by health insurance companies will help you insure your health needs in the long term.

All figures above are in Indian rupees.

Assuming a HCB of Rs.1000/- per day.

The premium is guaranteed to a period of 3 years from the date of initiation of policy. After the end of 3 years, LIC will review the premium as per the previous records and claims made during the period, and consider revising it (subject to approval of IRDA). If the premium is revised, it will be fixed again for another 3 years.

Benefits of this policy:

Hospitalization Cash Benefits

Hospitalization cash benefit is a unique benefit provided to the insured in case of hospitalization disregarding the expenses he incurs on the treatment.

Ambulance benefit

Up to Rs.1000/- ambulance charges will be provided to the insured in case of ambulance services obtained.

Major Surgical benefit

If the insured undergoes a major surgery during the term of the policy, this policy will provide major surgical benefits which are 100 times the HCB. Suppose, the HCB is Rs.3000/- , then the MSB shall be Rs.3,00,000/-

Other surgeries

If the insured undergoes medical treatment for surgeries not listed in the annexure relating to major surgical benefit or day care benefit, the policy will pay twice the HCB to the insured.

Premium waiver benefit

Premium will be waived for a period of 1 year if the insured has undergone major surgery as per the annexure of major surgery of LIC.

Day care procedure benefit

This benefit will be provided if the insurer avails listed day care procedure. This amount will be paid in lump-sum sum and is ideally, 5 times the HCB.

Term insurance rider and accident rider

You can add the rider of term insurance (which is 100 times of HCB) and accident benefit rider which can be for a maximum value of the term insurance rider to your existing Jeevanarogya plan.

Disadvantage in this policy :

The maximum limit of sum assured is Rs.4 lacs, which is inadequate keeping in mind the advancement in technology and inflation attached medical costs.

No benefit if you are hospitalized for less than 24 hours

Both parents/parent-in-law should be included (assuming they are live). You cannot insure only one of them.

Exclusions are :

• Pre-existing disease,
• Any treatment not in nature of allopathy
• Epidemic sickness
• Change of gender, cosmetic surgery.
• Surgery for donating an organ
• Congenital anomalies
• Dental treatment
• HIV/AIDS
• Physiotherapy treatment

After reading this article, it would be easier to decide whether to buy this plan or leave it considering it suits your needs and is adequate after taking into account your current situation and future financial goals.