Lifestyle diseases like hypertension, diabetes and obesity have long been on the rise in India. Consequently, the need for health insurance is ever growing. Many people, however, don’t exactly know what to consider before investing in a health insurance plan.
Apart from a side-by-side comparison of policy premiums, you need to understand special terms and how they impact your policy. This is extremely relevant as it makes certain that your policy adequately covers your medical needs.
Read on to know what terms and conditions to look out for to fully reap the benefits of your health insurance policy.
5 Terms You Need to Understand in Your Health Insurance Policy
Your employer’s group health policy may just not cut it anymore. With medical care becoming more expensive by the day, a smart health insurance plan is the need of the hour. You may be familiar with a few health insurance terms, including:
● Pre-existing conditions
● Critical illness insurance
● Accident cover
While an understanding of these terms can direct your choice of health plan, it is not enough. Aside from hero features, make sure to review the terms which have a great impact on insurance payouts to policyholders. These are as follows:
· Consumable Cover
Items such as gloves, surgical masks, PPE kits, and more that have to be discarded after use form around 10% to 15% of your hospital bill. Sometimes, your bill includes administrative charges, housekeeping charges and even attendant charges. Many insurance policies do not cover these consumable charges, which can put a dent in your finances. Make sure to opt for a plan that covers at least some consumable charges, if not all.
· Room Rent Limits
All the costs for services that a hospital charges you for are linked to your room type. The more premium your room is, the higher your overall hospital bill. This includes higher rates on everything, including the consumables charges, procedure charges, doctor’s fees and more. Room rent limit refers to the maximum hospital room cost that will be borne by your insurance provider. This is typically capped at 1% to 2% of the sum insured.
For example, say you have a policy of ₹10 Lakhs that caps room rent at 1% of the sum insured. Your policy assigns you a room costing ₹7,000, but you decide to upgrade to a room costing ₹15,000 per day. You cannot plan to simply pay the differential ₹8,000, expecting a cover of ₹7,000.
This is calculated on a pro-rata basis as follows:
Insurance Covered Room Rent / Actual Room Rent * 100. This means that around 46.6% of the room rent will be covered by the insurer.
Make sure to pick a plan without room rent limits so that your room choice doesn’t get limited. This way, irrespective of your room choice, your room rent is fully covered.
· Pre- and Post-Hospitalisation Coverage
This refers to diagnostic tests, follow-up treatments, doctor visits, X-rays, MRIs and more conducted before or after hospitalisation. Insurance policies allow only a reimbursement of such charges outside of the hospital claim settlement.
You have to file pre- and post-hospitalisation bills within the time period mentioned for each of these covers. Make sure to save all the associated bills, file them for timely claim settlement and ensure that your policy accounts for them.
· Waiting Period Clause
The waiting period is the predetermined duration during which you cannot raise a claim against the health insurance plan. Typically, it can stretch from 9 months to 4 years, depending upon the insurer and the plan that you are looking to purchase. While shopping for health insurance, make sure to check the applicable waiting period.
· No Claim Bonus
Your insurer offers you a bonus for all the years you do not raise a claim. Basically, your insurance coverage is increased for each claim-free year. However, most health insurance companies cap the bonus limit, and the increase in the coverage depends on this limit.
For example, say you buy a health insurance plan of ₹45 Lakhs. The insurer offers 10% NCB for every claim-free year up to a maximum of 40%. The maximum sum insured allowed here is ₹63 Lakhs, which is 40% of ₹45 Lakhs, arrived at the end of 4 claim-free years. Before signing on to the health plan, make sure that you check the policy terms for this clause and choose the best option.
To get the best coverage at a premium appropriate for your age, health conditions, and needs, make sure to compare various health plans before you buy. You can get a comprehensive health cover from top insurers up to ₹2 Crores on the Bajaj Markets App, with premiums starting at just ₹160 per month. Download it today from Google Play or the App Store and secure your health and finances in a single shot.
Vivek is a published author of Meidilight and a cofounder of Zestful Outreach Agency. He is passionate about helping webmaster to rank their keywords through good-quality website backlinks. In his spare time, he loves to swim and cycle. You can find him on Twitter and Linkedin.