Choosing Health Insurance is a very challenging gigantic🌀 task because there are hundreds of policies in India offered by different Health Insurance and General Insurance companies
Each policy has its own terms and conditions, limitation, exclusions, waiting period etc
Also, each individual who wants to purchase has different pre-existing medical conditions which makes it even tougher to choose a health insurance policy 🛌
I have personally seen insurance companies denying issuing health insurance policy due to various complexities and high risks involved which insurance companies do not want to take.
So lets look at Top 20 secrets to know before purchasing Health Insurance
1. Sum Insured 💰
Sum Insured is the amount that is provided to the insured in an unforeseen event such as a medical emergency and hospitalization 🚑
This amount is a reimbursement of the cost that the insured person has to pay for hospitalization. The sum assured amount could be 2 lacs, 5 lacs, 10 lacs to 100 lacs depending on the policy you choose.
2. Daycare procedures 🌞
As per the standardized procedure, a hospitalization of at least 24 hours is mandatory to claim benefits. However, some processes do not call for the hospital admission. It is possible due to the advent of technology.
These treatments 💉 do not require hospitalization and yet you can claim insurance fall under day care procedures. A prime example is cataract treatment wherein the claim is settled even with a minimum duration of hospitalization.
3. Domiciliary treatment 🏠
Domiciliary treatment means medical treatment for an illness which in the usual course would need care and treatment at a hospital.
But treatment is done at home on the advice of a medical practitioner. In domiciliary treatment cases, claim benefits depends on case to case basis as per policy document guidelines. ⚠️
4. Network hospitals 🖧
An insurance company associates with a group of hospitals, these hospitals provide cashless treatment to the beneficiaries of the insurance company.
Thus prior to opting for a policy, one should identify if there are reputed hospitals nearby that are affiliated with the insurance company by visiting the list from their official website.
5. Blacklisted hospitals 👎
Insurance companies blacklist some hospitals because of fraud practices and high charges. You are not likely to get the claim benefits if you opt for treatment in such hospitals. The official website of the insurance company is the best avenue to find the list of blacklisted hospitals.
6. Free Look Period 🆓
Free look period is a liberty time an insurance company gives to a policy holder to cancel the policy. Generally, the period is of 15 days from the date of receiving the policy document online or physically.
In case you are not satisfied with the terms and conditions, then you can cancel the policy. The company will make sure to return your premium after deducting stamp duty and health check-up charges if any.
7. Ayush Cover 🏡 🍃
Ayush treatment cover is not a standard element in health insurance policies. But yes you can always opt for as per your choice. With this cover, you become eligible to accrue benefits of your Homeopathic and Ayurved treatment.
8. Claim Settlement Ratio (CSR)
Claims settled versus claims received in a year gives you CSR ratio. If the company decides 83 of the 100 cases in a year, then its rate would be 0.83. It is an important parameter and can be a deciding factor while purchasing a policy.
9. Incurred Claim Ratio (ICR)
ICR refers to the value of the claim paid divided by the premium received in a year. The ratio would be 0.76 if the company has paid 7.6 crores and recived ten crores as a premium.
It is a tricky ratio; if it is over one, then the company must be facing operational difficulties. If the value is quite less, then it points towards a higher number of claim rejections. Therefore having a look at this ratio is advisable while opting for a policy.
10. No Claim bonus 💸
No claim bonus is an amount which an insurance company is going to add in your sum assured in case of no claim taken in a year.
If your free claim bonus is 10 per cent and your sum insured is four lacs, then your sum assured would become 4.4 lacs after a claim-free year. In case you have not taken any claim in 4 years then your sum assured would become 5.6 lacs.
11. Co-payment 🤝
Co payment in insurance refers to the percentage portion of the claim amount that a policy holder has to pay and the rest of amount will be paid by the insurance company. If 20% co-payment means the insurance company will only pay for 80 per cent of the total hospitalization expenses.
12. Free medical check-up 🆓
Medical check-up facility is a resounding benefit which some insurance companies provide once in a year or once in a couple of years to the policyholders. This facility only covers the adult policyholders.
13. Life Time Renewal 👨🦳
Lifetime renewal is a facility wherein a company is liable to continue the policy and cover until you are alive. But on a condition that you keep paying the premiums well with in the period.
14. Out Patient Department (OPD) cover
OPD cover is not a standard feature which a health insurance policy covers. It is an add on provided by a few companies. If you have this add on in your plan, then you can claim OPD expenses with hospitalization expenses. In addition to that, it covers medical bills and doctors visit charges. As it is uncommon, this one has to query while choosing a policy.
15. Maternity cover ⚠️
Maternity cover feature makes your life easier by covering most of the delivery expense. It covers costs in both cases, caesarean or standard delivery. Moreover, some policies cover new born baby expenses. However, these came with several limitations and considered a non-cost compelling affair.
16. Pre-existing conditions ⏱️
Proposer who is applying for insurance having existing medical conditions are reffered as pre-existing conditions. The pre-existing conditions might include health issues like high blood pressure, thyroid, diabetes, surgeries, over weight, smoking, alcoholic etc.
Usually insurer does not pay any claim for hospitalization for pre existing conditions for 12 – 48 months. If proposer fails to disclose pre exiting conditions then it can result in rejection of claim and policy.
17. Permanent Exclusions 👎
Permanent exclusions are the medical cases that a policy does not cover. The prime examples are infertility treatment or hazardous sports. These exclusions vary from policy to policy
18. Congenital health issues 👎
Congenital issues are birth defts and inherent health issues. It is quite common that these fall under permanent exclusions in most policies.
19. Pre & Post Hospitalization expenses 👍
Pre hospitalization expense includes doctors visiting fees, cost of diagnosis🥼 and aligned tests 💊.
Post hospitalization expense refers to cost a policyholder borne for pharmacy, consultation and treatment needs after hospitalization.
Usually, both Pre & Post hospitalization expenses are covered in several insurance policies.
20. Restoration Benefits ✔️
Restoration benefits is a facility provided to policyholders in which their sum assured is restored if it gets over because of hospitalization. This feature comes with several restrictions, including a policyholder cannot claim restoration benefits for the same disease.
We hope you can make informed decision now in selecting right Health Insurance Policy
If you further need any assistance, Please get in touch with us 📱
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