Top 10 Factors To Consider Before Buying A Health Insurance Policy

If you’ve just purchased or are going to purchase a health insurance policy for the first time, you may be feeling a little confused by all the complicated phrases and jargon you’ll encounter both online and in your policy documentation. But, rather than being perplexed till the last minute, we can assist you in being prepared with some of the things you need to know before purchasing health insurance. Knowing all of these data can assist you in selecting the best health insurance plan for you, as well as reducing any problems and confusion during the claims process. So, let’s take a deeper look at some key factors to look into before buying health insurance.

Things You Must Know Before Buying Health Insurance

Inclusions and exclusions of the plan

The extent of the policy is determined by the health insurance plan’s coverage (inclusions) and the conditions for which no claim may be made (exclusions). Before obtaining health insurance, you must be completely clear on both. Unawareness of the coverages can result in an increase in out-of-pocket payments. In addition, being unaware of the exclusions can result in claim denial.

Age Criteria

When it comes to health insurance, one of the most important decision factors is age. Keep in consideration the age of the family members who need to be insured when acquiring a medical policy. The cost of the premium, like with a family floater policy, would be determined by the age of the eldest family member. When purchasing health insurance, you should also consider the age restriction criterion. For example, some health plans offer a minimum entry age of 91 days and a maximum entry age of up to 60 years. There are other plans with a minimum age limit of 25 years and a maximum age limit of 50 years. There are, however, plans that do not have any age restrictions. As a result, you have the choice to select accordingly.

Waiting Period Clause

You will be in a better position to make a decision if you are aware of the waiting period provision. During this time, the insurer will not accept any claims based on pre-existing conditions or specific illnesses. And it can last anywhere from 24 to 48 months, depending on the insurance and the plan you choose. Furthermore, you will be able to collect the benefits only once this time period has passed. This waiting period will apply to pre-existing ailments such as thyroid, high blood pressure, diabetes, and so on that one may have prior to purchasing the policy. Furthermore, it is suitable for certain treatments and ailments such as arthritis, varicose veins, cataracts, and so on. As a result, you can compare and select a plan with a short waiting period before claiming benefits in the event of a medical emergency.

Cashless Hospitalization Perks

Health insurance companies typically have agreements with network hospitals through which covered people can receive cashless treatment in the event of a medical emergency. It saves you from the time-consuming documentation required for admission and claim. Furthermore, the insurance pays the insured amount directly to the hospital. As a result, you do not need to arrange for finances and then file for reimbursement. It will be beneficial if you check with your insurance for a list of impaneled hospitals and are aware of all network hospitals in your area.

No Claim Bonus

NCB refers to the insurance company’s discount for all years in which you have not submitted a claim. For all claim-free years, your coverage amount is enhanced at subsequent policy renewals. However, the NCB limit is usually specified in most health insurance policies. And the increase in the sum covered would be determined by the insurer’s set limit. For example, suppose you purchase an Rs. 5 lakh health insurance plan, and the insurer offers 10% NCB for each claim-free year up to a maximum of 50%.

Co-Payment Clause

Many individuals are perplexed by this term and tend to disregard it while making a purchase. It is essentially a proportion of the amount that you must pay at the time of claim, with the remainder reimbursed by the insurer. So, when you sign your mediclaim policy, see if there is a co-payment condition that may affect the amount of your claim. If feasible, purchase a plan with no sub-limits. However, if you have any pre-existing medical conditions or have reached a particular age, most insurers will impose a co-payment.

New Age Treatments

Because of the success of technical advancements in modern medicine, a variety of “new-age” operations are occasionally covered as part of your health insurance coverage. They include therapies such as:

• Stem cell therapy
• Balloon sinuplasty
• Immunotherapy
• Oral chemotherapy
• Deep brain stimulation
• Intra vitreal injections
• Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
• Stereotactic radio surgeries
• Robotic surgeries
• Vaporization of the prostate
• Bronchial thermoplasty
• IONM (Intra Operative Neuro Monitoring)

These procedures are frequently covered up to 50% of the entire sum insured.

Add-On Covers

Additional covers (also known as add-ons or riders) are additional coverages that you can add to your existing health insurance policy. When you have these covers, you can upgrade your coverage for a fee. The total premium for all add-ons selected under a single health insurance policy cannot exceed 30% of the original premium amount, according to the IRDAI. So, if you get a family floater health insurance policy for $5,000 per year and wish to include 5 add-ons, the additional premium you must pay for those add-ons cannot exceed $15,000 (30% of $5,000). Popular add-ons include Maternity coverage, Room Rent Waiver, Hospital Cash Coverage, and AYUSH treatment coverage.

Exclusions

Your health insurance coverage may have limitations and restrictions, such as diseases, ailments, or situations in which your medical expenses will not be reimbursed. Exclusions are classified into two types:

• Permanent exclusions- these are never covered by your policy and can include things like hospitalization without a doctor’s approval or pre- and post-natal medical expenses.
• First-Year Exclusions – These are certain conditions or treatments that are only covered beginning in the second year of your coverage, such as cataracts, hernia, endometriosis, or neurodegenerative disorders.

It is important to understand what is excluded from your policy before purchasing it so that there are no surprises when it comes time to file a claim.

Sub-Limits

A sub-limit is a pre-determined cap imposed by the insurer on portions of your claim amount. These sub-limits will apply to specific conditions rather than the entire bill amount. Sub-limits are classified into three types: those imposed on:

• Hospital room rent – Your insurance will normally cover the per-day room rent, but only up to a specified limit, which is typically between 1-2% of the sum insured or some other defined amount of money.
• Treatment of specific disorders – common and pre-planned operations such as kidney stones, cataracts, piles, gallstones, hernias, tonsils, or sinuses are sometimes subject to a sub-limit clause, which means that your insurer will only cover a set percentage of the bill for these treatments.
• Pre- and post-hospitalization charges – If your policy covers pre- and post-hospitalization expenses, they may be subject to a sub-limit as well.

So, when it comes to claims, you can only submit a claim for the amount specified in the sub-limit clause, and anything above that must be paid out of your own pocket.

Understanding these factors should now help you know what to look for when purchasing health insurance, so you won’t be overwhelmed by all the confusing terminology or jargon the next time you buy or renew your vital health insurance policy! Like this post? Don’t forget to check out our other short stories in our Quick Read section