Medical expenses have become very high in today’s time. It is very expensive for an average person to get treatment. In such a situation, health insurance comes in handy. Every year, in exchange for a premium, you receive health coverage. This prevents you from facing financial trouble in any medical emergency. If you are also considering buying a health insurance policy, you should first understand which medical policy is right for you. Understanding this beforehand will ensure you don’t face any problems when the need arises.
According to the insurance regulator IRDAI, whenever you are buying a health insurance policy from any company, make sure to check if the policy covers room and boarding expenses, nursing expenses, surgeon, anaesthetist, physician, consultant, specialist fees, anaesthesia, blood requirements, oxygen, operation theatre charges, surgical devices, medicines, drugs, diagnostic materials, X-rays, dialysis, chemotherapy, radiotherapy, cost of pacemaker, prosthetic limbs, and similar expenses. Be sure to ask the company about these details.
Sum Assured and Cumulative Bonus
The sum insured may be offered on an individual basis or a floater basis for the entire family. Health insurance policies may also offer cumulative bonuses. In these policies, the sum insured increases by a certain percentage for every claim-free year at the time of renewal, subject to a maximum percentage (usually 50%). However, if a claim is made during the year, the cumulative bonus will be reduced by 10% at the next renewal.
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Cost of Health Check-Up and Minimum Length of Hospital Stay
Some health insurance policies provide reimbursement for the cost of health check-ups. It’s important to read your policy carefully to understand what is covered. To be eligible to make a claim, the hospital stay must usually be for at least 24 hours. This time limit may not apply for the treatment of accidental injuries or certain specified therapies, so be sure to review the policy for specific rules.
Pre and Post-Hospitalization Expenses
Health insurance policies often cover expenses incurred before and after hospitalization, provided these expenses are related to the illness or disease. Typically, there is a specified period for which these expenses will be covered. Make sure to read the policy’s special provisions regarding pre and post-hospitalization expenses.
Cashless Facility
Insurance companies have tie-ups with a network of hospitals across the country. If you are treated at a network hospital, you won’t need to pay the hospital bills upfront. The insurance company will arrange for direct payment through its third-party administrator (TPA). However, expenses that exceed the policy’s sub-limit or are not covered under the policy will need to be paid directly by the insured. If you choose to get treated in a non-network hospital, you must pay the bills first and then seek reimbursement from the insurance company. No cashless facility will apply in this case.
Critical Illness Cover in the Policy
Check whether your health insurance policy includes coverage for critical illness. Critical illness benefit policies provide a fixed lump sum payment if you are diagnosed with a specified illness or undergo a specified procedure. This amount helps mitigate the direct and indirect financial consequences of a critical illness. Once the lump sum amount is paid, the policy may cease to be in force. However, continuation of coverage for other critical illnesses depends on the terms of the policy agreement.
Additional Benefits and Standalone Policies
Insurers offer various additional benefits as add-ons or riders to health insurance policies. There are also standalone policies designed specifically to provide hospital cash, critical illness benefits, and surgical expense benefits. These policies can be purchased separately or in addition to a basic hospitalization policy. Some insurers also offer top-up policies to cover expenses beyond the limit of the basic health policy.