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Before Purchasing Health Insurance, Read This Review By Research Team | Posted On Wednesday, November 14,2018, 03:24 PM

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Before Purchasing Health Insurance, Read This Review By



Health Insurance compensates for medical and surgical expenses on paying a premium to an insurer. You can also avail a family floater health insurance plan, where the entire family is covered for hospitalization expenses. The rising cost of hospitalization and medical treatment make health insurance plans very important.

Health insurance is an agreement where the insurer agrees to compensate for medical expenses in case of sickness or an accident. Insurers have tie-ups with leading hospitals to give you cashless treatment. Health insurance helps cut out-of-pocket expenses on hospitalization. If the insurer doesn’t have a tie-up with the hospital, you are reimbursed for the expenses spent on hospitalization.

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Before Purchasing Health Insurance, Read This Review By

Health insurance is very important for family and you must take time to review health insurance plans to check suitability.

1. Check the waiting period of health insurance plan

Waiting period is a certain length of time before a set of diseases is covered under a health insurance plan. Health insurers have a waiting period of 1 month except for accidental cases. Many insurers have a waiting period for pre-existing diseases. The time period ranges from 2-4 years and differs across insurers. This means that hospitalization expenses vis-à-vis these ailments can be claimed only after 2-4 years as applicable. advises you to check the pre-existing disease clause before opting for a health insurance plan. Select a plan with a low waiting period for pre-existing diseases.

2. Check Network Hospitals

If you are opting for a cashless health insurance plan take a look at the Network hospitals. Health insurance providers have a tie-up with certain hospitals, making them a part of their network called network hospitals. If you are admitted in these hospitals and have a cashless health insurance plan, you get excellent medical treatment without spending a rupee. advises checking if the hospital you plan to get admitted is a network hospital.

3. Individual vs family floater plans

You need to make the individual health insurance plan vs family floater plan choice. The individual health insurance plan is expensive vis-à-vis family floater. Family floater offers flexibility vis-à-vis insurance coverage among family members. Opt for family floater with a sum assured sufficiently high in case more than one family member needs to be hospitalized in a particular year.

IndianMoney says don’t pick a health insurance plan just because it’s cheap. Look for maximum cover and also pre and post hospitalization, day care procedures, OPD cover, maternity benefits and ambulance services.

4. Check sub-limits of health insurance plan

A sub-limit is a monetary cap an insurer places on your health insurance claim. Sub-limits are usually placed on hospital room rent, doctor’s consultation fees, ambulance charges and even medical procedures like cataract removal, knee ligament reconstruction and so on. Sub-limits are of two types. Hospital room rent and certain specific diseases. Hospital room rent is capped at 1% of sum assured and ICU charges have a ceiling of 2% of the sum assured.

IndianMoney advises you to opt for a health insurance plan free of sub-limits to avoid nasty surprises. These plans may have a higher premium.

5. Check the reputation of the insurer

You may be tempted to avail health insurance based on suggestions from family and friends, without doing your research. You have to do a due diligence check before opting for a health insurer like claim settlement process, claim settlement ratio and so on. Check the guaranteed renewability clause where the insurer has to offer coverage as long as premiums are paid.

IndianMoney says the insurer must be fair and fast when settling claims. Check the claim settlement ratio of the insurer before opting for a health insurance plan.

6. Check exclusions in the health insurance plan

All health insurance plans have a set of diseases which are not covered by the insurer. These could be self inflicted injury, injuries in war or attempted suicide, injuries suffered under intoxication and so on.

  • Health insurers have a 1 month waiting period except for accidents.
  • Pregnancy could have a waiting period.
  • Dental surgery, cosmetic surgery and so on.
  • Alternative treatment like ayurveda and homeopathy.
  • Permanent exclusions like HIV, self inflicted injury and congenital diseases.

IndianMoney advises you to check exclusions before availing a health insurance plan. Check for the co-payment clause where the insurer has a cut-off cost and bills are settled by the insurer, only when the limit is breached.

Which Type of Health Insurance Policy will Best Suit You

  • This depends on age, family structure and existing insurance cover.
  • Family floater plans are good for nuclear families.
  • Newly married couples must have a maternity plan. Buy a policy that covers maternity costs immediately after marriage. 
  • A top-up health plan will cover hospitalization expenses beyond a certain threshold.
  • If you are self employed, make sure to avail a health insurance plan.
  • If you live with parents, go for individual plans rather than family floater health insurance plans. There are greater chances of an elderly person making a claim, causing you to lose the No Claim Bonus.
  • Many health insurers offer health insurance plans tailor made for senior citizens.

SEE ALSO: Before Purchasing Life Insurance, Read This Review By

Why is it important to review your Health Plan?

  • Rising medical expenses can swallow health insurance cover. A top-up or super top-up plan may be necessary.
  • Increase in family size might necessitate a higher cover.
  • There are too many sub-limits in the plan.
  • You may need a specific illness policy.
  • A critical illness policy is a must with today’s sedentary lifestyle.
  • Senior citizens might need a senior citizen’s health plan.

SEE ALSO: What Is Custom Duty?

Health insurance fraud In India

  • There are two types of fraud in health insurance. Deliberate fraud is making a false claim. Opportunity fraud is over stressing a genuine claim.
  • Eligibility fraud where a person claims for a dependent who is not covered under the plan.
  • Application fraud where a policy holder might not enter details regarding a serious ailment or a pre-existing disease.
  • A person avails several health insurance plans and enjoys claim settlement for same illness called claim fraud. A person joins with the physician to defraud the insurer.

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