scorecardresearch7 features you must have in your health insurance policy

7 features you must have in your health insurance policy

Updated: 28 May 2023, 10:25 AM IST

Before choosing your health insurance policy, it is important to consider factors such as room rent limits, pre and post hospitalisation cover, sub-limits, waiting periods, network of hospitals, claim settlement process, day care facility, and the co-payment feature.

Health insurance policy’s pause feature enables policy holders to halt their coverage when they are travelling abroad.

Health insurance policy’s pause feature enables policy holders to halt their coverage when they are travelling abroad.

Health insurance is pretty complicated and picking a right policy can be difficult with so many different policies with different features out there. The number of options are bound to leave you confused. Do not worry. Here is a list of things that you must consider before choosing your health insurance policy -

Room rent limits

Your health insurance cover should have no room rent limit & no room type limit. This will help ensure that most of your insurance bill is settled.

For example, if you buy health insurance cover with a room rent limit of 5,000/day and you end up staying in a room that costs 12,000/day (due to let’s say non-availability of 5,000 room or due to minimum room rent in the hospital be 12,000), your entire hospital bill will be settled proportionately. Let’s say the bill amount for 10 days is 12 lakhs rupees, you may think that you only need to pay the 7000 differential for 10 days i.e. 70,000.

But, this is not true, the insurance company will deduct the proportionate expenses and hence the bill approved by the insurance company will be 5 lakhs (12 X 5/12) and not 12 lakhs. You will be left with a hole in the pocket and will be disappointed that health insurance is useless. In reality, you were not aware about how health insurance works and the chosen health insurance by you was a substandard policy. Health Insurance policies with no room rent and room type limit will be a bit more expensive but this feature is a must have in health insurance.

Pre and post hospitalisation cover

Pre and post hospitalisation costs are also covered in health insurance. Pre-hospitalization expenses are incurred before you are admitted, and include expenses related to diagnostic tests, investigative procedures, medication, etc. Post-hospitalization expenses are incurred after the person has been discharged from the hospital and include follow-up tests, continuing treatments, etc.

An average policy provides 30 days and 60 days of cover, respectively. It is recommended to look for policies with maximum cover of 60 days and 180 days.

Do not overlook the sub-limits

Sub-limits are additional limits to a health insurance policy coverage applied on pre-defined medical expenses.  Sub-limits are like capping the claim amount for certain covers.These sub-limits are either expressed as a fixed value for a particular illness/disease/treatment (for example 50,000 for cataract surgery or 5,000 for Ambulance) or expressed as a percentage of the total sum insured (for example room rent can be 1% of the sum insured). There are policies with higher or no sub-limits, slightly expenses but worth it.

Waiting periods

All diseases and procedures are not covered as soon as you have bought the health insurance. It has a waiting period of illnesses which you already have at the time of buying the policy. Pre-existing diseases generally have a waiting period of 2 to 4 years. It is important that you understand the waiting periods and exclusions. You can go for a policy with a lower waiting period. There are certain conditions like diabetes and hypertension that can be covered with a higher premium from day 1.

Network of hospitals and claim settlement process

Make sure that your preferred network of hospitals is covered in the policy you are buying. All insurers today provide you with a cashless claim settlement process provided the hospital is empanelled with the insurer. In case you take your treatment at an non-network hospital, you will have to pay the bill and file for a reimbursement claim. Please note the reimbursement claim is not as smooth as cashless claim.

Day care facility

A lot of treatments that required hospitalisation can now be done in less than a day. Such treatments are called day care procedures. Some examples of day care procedures are dialysis, radiotherapy, chemotherapy among others. Make sure that you have an extensive list of treatments that are covered as a part of your policy. Best is to go with a policy which mentions ‘All day care treatments’ are covered.

Co-payment feature

A co-payment feature means that only a percentage of the total bill will be paid by you. For example, if the co-payment amount is 20%, then 20% of the bill has to be paid by you. This does reduce your upfront premium but it will definitely pinch your pocket during hospitalisation. It’s always recommended to go for a policy with zero co-payment.

Nishant Batra CWM® is Chief Goal Planner of Holistic Prime Wealth.

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First Published: 28 May 2023, 10:25 AM IST