Buyer’s Guide – Medical Insurance

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Many people in India don’t realise the need for buying medical insurance until and unless they meet with an accident or suffer from a lifestyle disease or illness. These people realize the need to get health cover after facing the vulnerable situation of high medical bills and hospitalisation payments that are incurred from just one visit to a hospital. The rich can afford such heavy bills of hospitalization and surgery costs, but what about an average middle class person?

In order to get paid for such medical expenses at times of serious health hazard to you or any of your family members, you need to take adequate health cover. This article will guide you on how to choose medical/health insurance from among number of health insurance products offered by various insurance companies in the market today. Find the checklist along with the do’s and don’ts while buying the policy.

1. Decide a suitable product for your family

Do: Understand the benefits of taking policy and look for highest cover affordable.
Don’t: Don’t think that the product with cheapest premium is good. Compare premiums along with benefits.

2. List of policy exclusions

Do: Look for company offering fewer exclusions. Check all the details of the expenses that will be reimbursed e.g. diagnostic and medication costs might not be covered under all health insurance policies.
Don’t: Don’t forget to compare treatment costs for common illnesses which are payable under most health insurance policies.

3. List of network hospitals

Do: Look for quality of hospitals in network. You might prefer a specific doctor or hospital where you might have been seeking treatment in the past. Check whether this doctor or hospital is a part of the insurer’s network of hospitals for cashless settlement.
Don’t: Don’t look at lowest premium and big list of hospitals. Look whether high quality hospitals (even smaller ones) are in the network.

4. Efficiency not innovation

Do: Look how efficiently and helpfully insurer will process a genuine claim.
Don’t: Don’t focus on insurers for their innovative product which may not be suitable to your family.

5. Empathy not bureaucratic

Do: Look whether insurance company acts as a support system to you and your family when you need to use a hospital.
Don’t: Insurance is a subject matter of solicitation; a genuine claim has to get compensation; don’t ever mislead the insurance company or ignore to disclose material fact in the proposal form.

6. Waiting periods

Do: If you have undergone treatment for an ailment or illness within 2 years before buying health insurance policy, it will be considered as pre-existing disease. Now, most of the policies are offered with 2-4 years as waiting period for the pre-existing diseases. So, take health policy as soon as possible to get cover for your pre-existing diseases.
Don’t: If you have any pre-existing disease and you want to use portability option, then don’t switch to other insurance companies since the transfer of waiting period credit is generally not allowed in all health insurance companies.

7. Know about sub-limits

Do: Look for no sub-limits on room rent, doctor’s fee, operation theatre charges, as new health plans are coming up by various insurers.
Don’t: Don’t consider taking policies that have sub-limits.

8. Copay and loading

Do: Copay is the small portion or the percentage of the claim that a policyholder agrees to pay in the event of the claim. Ex: If you have claimed for Rs.1 lakh and if you agreed to a copay ratio of 10%, then you need to pay Rs.10,000 from your pocket and the rest will be paid by the insurer. Whereas, loading is the amount charged by your health insurance company on renewal of your premium when you make claims in your policy. So, ask your insurer about these copay and loading amounts before signing the policy.
Don’t: Some companies offer or do not offer copay and loading clauses. But, don’t make it as sole criteria to select the policy, as the companies which do not include them in the agreement have higher chances of including them in later stages.

9. Terms and conditions

Do: Be aware of the procedure of intimation and submission of reimbursement claims. Ensure you are updated with changes in the terms and procedures of your mediclaim (health insurance) product.
Don’t: Don’t ignore to read terms and conditions in policy documents.

10. Research before taking

Do: Use Internet or ask insurance agent about the details in the policy documents.
Don’t: Never buy an insurance blindly either from a friend, a friend’s relative, or a relative, or a relative’s friend based on purely emotional factors.