We know that safeguarding our family from financial distresses during unforeseen medical emergencies is of utmost importance. And so, buying the right health insurance plan is a crucial task. When doing so, one must keep in mind some important points to look at while choosing an insurance plan. Let’s dive right in!

How Much Insurance Should One Take?

This can vary from individual to individual. It is crucial to understand what you want your policy to cover, what it covers, and more importantly, what it does not cover.

Let us see the coverage and clauses one should keep in mind while deciding on health covers.

1. AGE: Age is one of the crucial deciding factors when it comes to health insurance. Like in a family floater policy, the cost of the premium would depend on the age of the eldest family member.

2. Hospitalisation: Most health plans cover the medical expenses that are incurred during hospitalisation. It is advisable to buy a plan that covers expenses incurred before and after the hospitalisation as well to save expenses incurred on ambulance charges, medical tests, medicines, doctor fees, etc.

The decision about which cover to take will depend on several factors including age, family size, health history, cost of healthcare in your city of residence and, of course, the insurance company’s reputation and claim settlement track record, among other things.

Pre- and Post-Hospitalisation Charges – Choose a Policy That Covers Both

While health insurance coverage is comprehensive, it is essential to read the fine print. This includes pre and post-hospitalisation charges. Check to see which tests, treatments, doctor visits, etc., done before or after hospitalisation is considered under pre- and post-hospitalisation. Different insurance providers have varying terms and conditions for this.

In most cases, charges incurred by an individual 30 days before admission to any hospital fall within the ambit of pre-hospitalisation charges. E.g., Blood tests, x-rays, and body tests, among others, are categorised as pre-hospitalisation expenses.

Similarly, in most cases, charges incurred for 60 days from the discharge date like consulting fees, and medical costs, can be claimed as post-hospitalisation charges on submission of original bills.

It is essential to know the exact number of days for which the cover is applicable since it tends to vary depending on the type of policy.

Room-Rent Limitations

Room rent limit is one of the most common coverage limitations that you can find under medical insurance plans. There are mainly four types of room rent coverage in the health insurance policy.

          1. Room rent without sub-limits
          2. Room rent with co-payments
          3. Room rent without sub-limits as an add-on cover
          4. Room rent with specified room types

Sub-limits refer to a specific percentage of the sum insured amount that the insurance company will bear for different hospital expenses. Surgery/operation charges, doctor’s fees, medicine costs, nursing expenses, and room rent all have a sub-limit applied cap applied to them.

In most health insurance plans, the limit on reimbursement of the claim for all the other medical costs is related to the room-rent limit. Thus, it is always advised to stick to the room rent limit. If the health insurance policy sum insured amount is Rs. 10 lakhs, then it is advised to select a hospital room with the rent amount equal to 1% of the sum insured i.e., Rs 10,000 per day. The Room rent limit is usually 1% of your entire insured amount.

Disease-specific Limits

Most insurers have sub-limits on pre-planned medical treatments in the form of a defined cost for procedures such as cataract removal, knee ligament reconstruction, kidney stone removal, tonsils, and sinus removal. The list of ailments and the treatment cost cap differs from one insurer to the next. The treatment sub-limit is not related to the sum assured, which means that even if a policyholder has a high amount assured, the sub-limit clause in the policy will prevent him from claiming all his treatment expenses. For instance, if your policy has a 50% sub-limit clause on a certain medical procedure and your total sum insured is Rs. 5 lakhs, you will be unable to claim more than Rs. 2.5 lakh for that treatment because of the sub-limit clause.

Today, several medical procedures are finished in a single day, not requiring an overnight stay in the hospital. Therefore, it is crucial to confirm if your health insurance policy covers such therapies.

There are also modern medical procedures such contemporary procedures like Robotic surgery, and stem cell therapy are a few examples of modern therapies.

Alternative medical practices such as Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) are often not covered under the policy. However, several health insurance policies cover these non-allopathic therapies to a certain amount. So, if you haven’t purchased health insurance for yourself and your family, it’s time to start looking for options.

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