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9 Pillars of Health Insurance You Must Consider!

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Published on February 22, 2020. EST READ TIME: 3 MIN

The rising cost of quality healthcare has made health insurance a necessity. Investing in health insurance ensures that you and your family remain protected and your finances are not strained in the event of a medical emergency.  To simplify this complex subject, we've listed a few critical points that first-time buyers should keep in mind. These points will lead to more informed decisions in choosing the right insurance provider.  We bring to you the Nine Pillars of Health Insurance:

#1 Age of the Insured
The insured individual's age is a critical factor of any health insurance policy. Before you decide to 'sign the dotted line' of your preferred healthcare policy, make sure to double-check the age of all the individuals mentioned on the policy. Age difference of +10 or -10 years can have a huge bearing on the premiums you have to pay. Business Today's report indicated that close to 12% of cashless claims are rejected due to mismatch of insured individual's details. Among them, age seemed to be a significant reason for rejects. This has led to considerable out-of-pocket expenses.  

One more critical factor to consider is age criterion . Some providers have an upper age limit of 60 years, while others have a limit of 50 years. There are even some that have no limits for the age of the insured. This means that the policyholder can take a long-term policy without worrying about exceeding the age criteria.

#2 Affordable Insurance Premiums
Policyholders often make the mistake of going for an insurance plan with the lowest premium. While this may seem like an inviting proposition, there are several factors  that you need to be aware of. Health insurance policies that are cheap are cheap for a reason. It becomes your duty to find out the reason they are priced low. These could be in the form of limitations on co-payments, private room accommodation, claim deductibles, and others. Remember to read the fine print and other policy conditions carefully before signing the dotted line. The best deals are often ones where you make few compromises. You can also consider using a Premium Calculator to give you complete details on your payments and where you might be missing out on.

#3 Cashless Claims
Cashless claims are another great feature of modern health insurance policies. This is when an insurance provider has a tie-up with a hospital, and the policyholder can avail medical treatment without having to pay upfront cash. The hospital gets direct approval from the insurance company and is paid directly by the said company. From a money standpoint, the insured has no part to play here. This does away with a lot of hassles and unnecessary paperwork while filing a claim. It's a good idea to check whether the insurance company has tie-ups with your hospital to see if you can avail the cashless claim facility. 

#4 Medical Cover
Healthcare coverage can be a tricky subject. While most insurance providers cover the cost incurred during hospitalisation like surgery, doctor-on-call, anaesthesia, and more. Pre and post-treatments costs are generally left out. These include path tests, doctor visits, scans, and many more. These costs can also spiral out of control. Therefore, it's important to buy a health insurance plan that covers pre and post medical treatment.  

#5 Maternity Specific Plans
Maternity costs are skyrocketing. This makes it highly critical that families don't leave-out maternity benefits. One of the advantages of a maternity-specific plan is that it covers the cost of delivery and pre and post-maternity care. Some plans also cover additional medical expenses associated with a new-born baby. These costs can often lead to considerable out-of-pocket expenses.

6 NCB (No Claim Bonus)
This is another subject that is often misunderstood. NCB is essentially a bonus that the insurance company provides for not filing any claims during the year. Most companies provide an NCB of 10% with a maximum limit of 50% increase in the sum assured. Check with the insurance company about their NCB policy before signing the dotted line.

#7 Policy Co-payments
Among the many things that confuse people about health insurance claims, co-payments are by far the most daunting. This is essentially when the insurance company is liable only to pay part of the claim filed amount. For instance, many insurance companies offer a 75% Co-payment. This means that if your total payment is Rs 100,000, your insurance company will pay Rs 75,000, while you will have to pay the remaining Rs 25,000. To know whether this will apply to you in the future, specifically ask the insurance company about their co-payments. Many insurers will insist on co-payments, especially if the insured's age crosses a limit or there are pre-existing medical conditions.

#8 Routine Health Checks
It is important to note that the cost of several routine health checks have gone up considerably over the years. The cost of a CAT scan can be as high as 55,000INR in some multi-speciality hospitals if you are considering a healthcare plan, its best to include routine health checks in the coverage even if it means having to pay a little extra premium.

#9 Read the Fine-print
Insurance companies are legally liable to put all the terms and conditions of their insurance plans in the fine print. Take the time to read the fine print before you sign the dotted line. Also, consider going online and comparing policies from different insurance providers. This way, you will choose one that fits your needs the best.  

Conclusion

Given the rising importance of health insurance, it is important to consider the aforementioned factors while opting for an insurance. This will help ensure that you choose a plan that is a good fit for you and gain the maximum benefits from the plan.

Disclaimer:  The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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