10 things you must know in a health insurance policy
Sep 10 2013
To meet the anticipated increase in demand, health insurance companies have introduced several innovative health insurance plans catering to the needs of the consumers and the target buyer group.
However, buying a health insurance calls for greater awareness and cost-benefit balancing by consumers in order to buy best product to provide maximum cover at reasonable cost. A buyer needs to keep these things in mind while making an informed choice of a health insurance that provides adequate benefits at reasonable costs without any disappointments:
>>Comprehensive and flexible: The plan should offer a premium versus benefit comparison. Even if the sum insured is the same, there are other benefits to check, such as critical illnesses covered, OPD cover, ambulance service and insurance against pre-existing diseases.
>> Daycare procedures: Ask yourself if your health cover provides a comprehensive list for coverage under daycare procedures.
>> Premium loading: It is recommended that you buy a plan from insurers who guarantee not to charge additional premium on renewal in case a claim is made.
>>Sub-limit and co-payment: In order to avoid inflated charges that hospitals levy on patients with an insurance plan, some plans have sub-limits on room rents or ambulance charges. But one needs to be wary if the policy has sub-limits on important expenses, such as doctors’ fees and daycare procedures. Sub-limits may also come in the form of co-payments where the insurer will ask you to pay a predetermined percentage of the claim amount.
>>In-house claim settlement: Most insurers are moving from outsourcing claim settlement procedures to an in-house claim settlement team that helps them to enhance their customer service delivery and reduce the risk of erroneous approval or rejection of claim.
>>Differential pricing: Customers living in non-metro cities pay a lower premium, reflective of healthcare costs in that area and not bear the high cost of healthcare services in metros that they may rarely use.
>>Maternity benefits: Women insurers need to ensure whether maternity benefits are covered under given health insurance or not. Generally, the benefit comes with a waiting period of two to six years. Otherwise, it would be advisable that they opt for a top up plan or specific coverage facility to avoid disappointment at a later stage.
>>Exclusion: It is important to remember that health insurance products deals with aspects of people’s health and requires detailed explanation and understanding compared to other financial products. Therefore, we urge customers to read the policy documents carefully before they buy it. Also, at times customers are not aware about the things that their policy covers or does not cover and they claim for illnesses that the policy does not cover which leads to disappointment later. It is important to discuss all the terms and conditions very carefully with the insurer at the time of purchase.
>>Top up: Top-up policies are deductible medical reimbursement policies aimed at providing reimbursement for expenses arising from a certain illness over and above threshold level. It will be prudent for customers to compare features of top-ups carefully before purchasing one. Some companies offer top-up plans that get triggered only when a single claim breaches the threshold limit.
>>Hospital network: For availing cashless insurance facility, where an insurer pays directly to the hospital for the expenses incurred by the insured person, it is important to check the list of empanelled hospitals as well. This would help in avoiding any problems at the time of an emergency.
(The writer is the CEO of
Max Bupa Health Insurance)