Guide to choosing the health insurance you need

However many policyholders Trust that the insurers are bound to settle their claims in full. Although it is not so. Insurers settle claims only on the basis of terms and conditions laid down in the insurance policy document. In addition, they follow a pre-determined rate recommended by the General Insurance Council (GIC) in India while settling such claims.

Here are a few ways that can help you get the most out of your health policy.

Comprehensive Health Policy: Most health insurance policies have a deductible, commonly known as super top-up plans. In such plans, there is a limit (deductible) on the payment. You must reach that limit before your health policy will fully cover your medical costs.

Depending on your plan, your annual deduction could be a few thousand or even lakhs of rupees. In other words, a super top-up plan generally works on a cost-sharing basis. This means that the plan does not cover the entire cost; Only part of it is covered based on your deductible.

However, a comprehensive health policy covers all types of medical costs without any deductible. It covers a wide range of medical expenses including hospitalization costs etc. without letting the policyholders pay out of their own pocket.

Multi-Year Health Policy: When you buy a multi-year health policy, the premium remains the same throughout the policy term. This way, you are protected from any subsequent premium adjustments made by the insurer while the policy is in force. Generally, policyholders have to pay multi-year premiums for up to three years at a time. And therefore, the increase in the cost of insurance will not affect you for three years.

Marsh India Managing Director Praval Kalita said healthcare costs are rising. A distinctive advantage provided by a multi-year contract is the premium lock-in which is availed at the time of opting for such a policy. “However, you have to weigh the financial and practical benefits of multi-year policies when choosing them,” Kalita said.

Terms and conditions: Insurance documents provide an in-depth explanation on the terms and conditions of the policy which can run into several pages, whether it is purchased online or offline. Most of the policyholders avoid going through the documents as they are very worrying, and it can prove costly during the claim process.

Room Rental Section: If you are hospitalized then some expenses are unavoidable and these include fees paid to surgeons, consultant doctors, medical bills and charges for operation theatre, etc. Most of these are completely taken care of by your health policy, with an exception fee being paid for the ward or room where you are admitted. Insurance policies have prescribed a limit on the charges to be paid for this. If the insured lives in a room whose rent is more than what is mentioned in the insurance policy, this may result in a deduction from the claim amount.

Ankit Agarwal, CEO and Co-Founder, InsuranceDekho, said that most insurers usually allow basic or a single standard private room under health insurance policy coverage. “You should always opt for a rented room that meets the limit prescribed by the insurer. In addition, you can also opt for the policy without the room rent sub-limit or opt for additional cover at an additional cost. It is necessary to verify the ceiling of room rent in the health insurance policy,” Agarwal said.

Co-Payment Section: It refers to a clause in the policy in which the insurers agree to pay a pre-determined percentage of the claim amount as most health insurance policies do not cover certain expenses.

Agarwal said, “You should choose a health insurance policy that does not have a co-pay clause. Also, health insurance policies do not cover most of the costs associated with maternity, dental, and optical checkups or treatments. Treatment arising out of substance abuse, voluntary organ donation etc. is also not covered. In some cases, it is good to opt for an add-on cover. For example, you can use your own money to meet maternity related expenses. Maternity cover can be added to the policy.

Claim Settlement Process: No insurance policy can serve its purpose unless it provides proper claim settlement to the insured. Indranil Chatterjee, Co-Founder, Renewbuy, said, “Even today, there is a serious question regarding the settlement of claims made by the traditional branch-led model. It is better to go for cashless facility regarding health claim settlement.”

“Usually, insurance companies have tie-ups with network hospitals. Due to this affiliation, they manage to offer discount package rates to policyholders for repeated treatments, if they file a cashless claim. Insurers and network hospitals offer discounts on cashless treatment only as it helps them manage the cost of claims for multiple planned surgeries,” said Abhishek Bondia, principal officer and managing director, SecureNow.in.

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