Health Insurance: Try to understand whether the health insurance policy covers critical illness. Health insurance policies can provide cumulative bonus, in which for every claim free year, the sum insured is increased by a certain percentage at the time of renewal.
Health Insurance: Medical expenses have become very high in today’s time. Getting treatment is very expensive for any common man. In such a situation, health insurance comes in handy. In exchange for a premium every year, you get health cover. This ensures that you do not face any financial problems in case of any medical emergency. If you are also considering buying a health insurance policy, then you should first understand which medical policy you should have. If you understand this beforehand, then you will not face any problem at the time.
Buy a policy that…
According to insurance regulator IRDAI, whenever you are buying a health insurance policy from any company, check whether the policy is covering room, boarding expenses, nursing expenses, surgeon, anesthetist, physician, consultant, specialist fees, anesthesia, blood requirement, oxygen, operation theatre charges, surgical devices, medicines, drugs, diagnostic materials, X-rays, dialysis, chemotherapy, radio therapy, cost of pacemaker, prosthesis and similar expenses. Ask the company clearly about this.
Sum Assured and Cumulative Bonus
The sum insured offered can be on an individual basis or on a floater basis for the entire family. One thing to note, health insurance policies may offer cumulative bonus, wherein for every claim free year, the sum insured is increased by a certain percentage at the time of renewal, subject to a maximum percentage (usually 50%). If you make a claim that year, the cumulative bonus will be reduced by 10% on the next renewal.
Cost of health check-up and minimum period of hospital stay
Health insurance policies may also have a provision for reimbursement of the cost of health check-ups. Read your policy carefully to understand what is allowed. To become eligible to make a claim under the policy, the hospital stay must be for a minimum of a certain number of hours. Usually it is 24 hours. This time limit may not apply for treatment of accidental injuries and certain specified therapies. Read the policy rules to understand the details.
Pre and post hospitalisation expenses
Expenses incurred during a certain number of days before hospitalisation and post hospitalisation expenses for a specified period from the date of discharge may be considered as part of the claim, provided the expenses are related to the illness/disease. Read the specific provision in this regard.
Cashless facility
Insurance companies have tie-ups with a network of hospitals across the country. If the policyholder gets treated in any of the network hospitals, the insured need not pay the hospital bills. The insurance company will arrange for direct payment to the hospital through its third party administrator (TPA). Expenses that exceed the sub-limit prescribed by the policy or items not covered under the policy will have to be paid by the insured directly to the hospital. The insured can also get treated in a non-tie-up hospital, in which case he will have to pay the bills first and then seek reimbursement from the insurance company. No cashless facility will be applicable here.
Critical illness cover in the policy
Try to understand in the health insurance policy whether that policy is covering critical illness? Critical illness benefit policy provides a fixed lump sum amount to the insured in case of diagnosis of a specified illness or undergoing a specified procedure. This amount is helpful in mitigating various direct and indirect financial consequences of a critical illness. Usually, after the lump sum amount is paid, the plan ceases to be in force. However, continuation of coverage for other critical illnesses is subject to the terms of the policy agreement.
Additional Benefits and Other Standalone Policies
Insurers also offer a number of other benefits as add-ons or riders. There are also some standalone policies designed to provide benefits such as hospital cash, critical illness benefit, “surgical expenses benefit”. These policies can be either taken separately or in addition to the hospitalization policy. Some companies have come up with products in the nature of top up policies to meet actual expenses above the limit available in the basic health policy.
