6 Essentials of Health Insurance Plans to Keep in Mind

Written by

Getting a health insurance plan may seem to be the most important thing to do. But many of us, in the hurry to buy a health plan do not take time to understand the policy terms, conditions, features, inclusions, exclusions, before the purchase. Some even treat medical insurances only as tax-saving instruments, while a health plan must actually suit your requirements, more than save taxes.

So, we are here to brief you about crucial aspects of health insurance policies, which must be duly noted before you select one.

  1. Coverage Limit

Along with coverage features, you must also pay attention to underlying limits. Check if the plan has any restrictions or sub-limits. You must keep a note if your claims are in the sub-limits or you will have to pay for the excess amount, yourself.

  • For instance the sum insured is Rs. 7 lakhs.
  • The sub-limit on hospital room rent under the plan is 1% of the sum insured.
  • In such a case, you can avail Rs. 7,000 per day for hospitalization.
  • If the room rent is Rs. 8,000 per day, then, you will have to pay the excess of Rs. 1,000 per day from your own pockets.

  1. Coverage Features

When buying a medical insurance policy, you must study the coverage features in detail as these influence the coverage you receive. Higher the features, more inclusive your health insurance cover will be. So always choose a plan with more number of features, which also meet your requirements.

  1. Waiting Period

Waiting period is the time until which you cannot make any claims. Pre-existing illnesses that are covered usually have a waiting period of 2 to 4 years, as per the policy terms. Specific treatments such as cataract, piles, hernia, fistula, etc may also have a longer waiting period.

  1. Applicable Deductibles and Co-pay

Co-pay is applicable if the insurance plan taken, covers individuals aged 61 years and over. Co-pay ratio denotes the claim portion that you and the other covered individual must pay. Deductibles on the other hand are the claim portions that you have to pay over and above what the insurer is bound to pay.

For instance, if your claim amount is Rs. 20,000 and deductible is Rs. 12,000, then insurer will pay a claim of up to Rs. 8,000 and you will have to pay Rs. 12,000.

  1. Increase in Premium

You can take health insurance plans for one, two, or three years, but the premium amount will differ as per your age. The premium rates are based on your current age. When purchasing a health plan, you must know that the premium amount may increase as you move to a higher age bracket.

  1. Know How to File a Claim

You have to follow a particular protocol when filing claims. Look for the terms and conditions, check the timeline for claim intimation, arrange the documents you have to submit as proof, and understand the other steps involved easing the process of raising a claim.

Apart from the above-mentioned necessaries, when taking a health insurance policy, you must also keep in mind age restrictions in a floater plan, pre-entrance medical check-ups, and conditions regarding policy renewal and its grace period.

Article Categories:
Insurance