In order to live a wealthy lifestyle, it’s very important for one to stay in the pink of health. And when it comes to living healthy the well-known quote, ‘Health is wealth’, certainly sounds good as we understand the importance of living a healthy lifestyle. But, as times have changed and prices have risen, healthcare in India too has witnessed a major change.
The cost of treatment for various diseases has witnessed a tremendous growth due to which more and more people have started opting for health insurance policies. Now purchasing a mediclaim policy is probably the first step you are taking towards maintaining a healthy life.
Considering the rising health conditions and medical costs, purchasing the best health insurance policy in India is becoming mandatory, all thanks to the enormous benefits of having one. But few people are still not wary about how they can choose the best health insurance policy in order to prevent their claims from being rejected.
So here we give you five factors, considering which you can opt for the best health insurance plan.
Co-pay is one of the most important factors that you need to consider while buying a health insurance policy as it requires the policyholder to pay a certain percentage of the medical expenses incurred. This means that if you have a claim settlement of 1 lakh then you will have to pay 10-30% co-pay as mentioned in your policy and the rest of the amount will be paid by the insured.
Similarly, the deductible requires you to make a fixed amount at the time of your claim settlement. So if you have a claim amount of 20,000 and if your policy carries a deductible of Rs. 10,000 then the insurer will only pay 10,000 and will pay more when your bill increases over the deductible limit.
Hence, it’s always advisable to opt for a policy with low or no sub-limit or deductible at all.
Maximum coverage amount:
Your coverage amount is the most crucial factor that decides the premium of your policy and also covers your future needs. So considering your lifestyle and health conditions, always opt for a policy that provides you maximum coverage amount as medical costs are slowly increasing at a much higher rate. A simple heart surgery today costs around 5 lakh in metro cities, so it’s always wise to opt for a policy which gives you a maximum coverage amount. Also, as per the National Sample Survey Office report of 2014, people opted for private sector, even though it cost almost four times as much as treatment in government institutions. The same report also stated that the cost of treatment rose at a double-digit pace of growth, outpacing average inflation in both rural and urban India over the past decade. Hence, opting for maximum coverage amount seems to be a better option.
Hospital room rent:
This plays an important role as it can certainly affect your claim amount. A few insurance companies have a room rent limit of up to 4,000 while a few have no room rent limit at all. The reason why you need to consider the room rent limit is because it will affect your hospital bill. Also, the premium for a policy with no room rent limit will be higher than the one with a room rent limit. You must also consider the inflation rates as the hospital room that costs you Rs. 5000 this year might double you in the next two years. So get a maximum amount coverage so you don’t end up paying for the treatment from your pocket.
Types of insurance policy:
The type of health insurance policy, you chose depends on your age and medical requirements. There are three types of health insurance plans available in India-Individual health insurance, family floater plan and unit linked health plans.
Individual health insurance plan:
An individual health insurance plan is designed to insure an individual against illnesses and cover his medical expenses for the same. In this type of plan, an individual is required to pay the premium on a monthly or yearly basis.
- Family floater plan:
If you are married and have a family, then a family floater health insurance works best for you. This type of health insurance covers medical expenses of all your family members. The policyholder receives a single cover which can be utilised depending on the medical needs of the family members. With this type of plan, the family members can use the policy simultaneously. Just like the individual health insurance plan, a family floater health insurance plan requires you to pay the premium on a regular basis and it is much cheaper than an individual plan as it covers all the members of the family.
- Unit Linked health insurance plan: This is a type of plan that offers you a mix of investment and insurance. A part of your premium is invested while the remaining amount is insured as a health cover. As you earn a return from this type of plan, you can utilise the amount for your health care as this plan acts as a safety net.
- Top up health insurance plan: This type of health insurance plan is a ready-to-use stand by to your existing policy which may not be adequate for you. In simple words, a top up plan is like and additional coverage for people who already have an existing health insurance plan or a medical cover from the employer. It is reimbursement of expenditure which arises out of single illness beyond the limit of the existing cover. A regular health insurance policy reimburses the amount up to the sum assured, but a top-up plan covers costs after a certain threshold is reached.
- Super-top health insurance plan: A super-top up health insurance plan takes care of your medical expenses once you have exceeded the deductible limit on your present health plan. For example, if your present health insurance plan has a deductible limit of 4 lakh and your medical bill is 6 lakh. So in such cases, the extra amount will be paid by the insurance company. Once you exceed your deductible limit, all the medical expenses during the whole year will be paid by the insurance company.
- Senior Citizen Health Insurance: Health insurance plan for senior citizens covers medical costs of individuals who are aged above 65 years and more. This type of plan offers various facilities like cashless hospitalization, critical illness coverage, ambulance charges, medical bills and room rent and others.
The network of hospitals:
While purchasing a policy always check on the network of hospitals covered by the insurance company. This gives you the benefit of cashless treatment so you don’t have to pay any money or wait for any reimbursement. It’s always wise to opt for a cover that covers all the hospitals in your area.
Waiting period of a pre-existing disease cover:
If at the time of buying a health insurance policy, if you have any pre-existing disease like diabetes, hypertension or kidney failure, then buying a pre-existing disease cover is good as several health insurance policies cover pre-existing diseases after a span of 3-4 years. For example: If Anish has an already existing sinus ailment and if he buys a health insurance in 2014 and if he requires a nasal surgery due to his sinus in 2015 then the insurance company won’t cover any medical expenses as it will be covered only after 2-3 years depending on the policy chosen. But if Anish opts for a pre-existing disease cover, then the company is liable to pay for the nasal surgery.
Insurance premium plays a crucial role in determining the benefits of your health insurance policy. Higher the benefits, more the premium. So ideally it’s essential that you compare premium rates online and look for the best plan that provides you with a maximum number of benefits at the lowest premium rates.
Claim settlement ratio:
While buying a health insurance policy always check on the claim settlement ratio of the company. This ratio defines the number of claims settled over the total number of claims received. This further helps you to avoid the rejection of your claims.
With technological advancement, comparing policies online has become easy. Today you can easily buy a health insurance policy from the comfort of your home and can also compare and check premium rates online in an easy way. Always keep the above factors in mind to avoid rejection of claims and most importantly always pay the premium on time.