As health care costs rise and new medical risks emerge, having your family’s health insured is no more a choice but a need. This guide explains how to evaluate and choose a health insurance policy for your family.
What does health insurance do?
How to buy the right health insurance plan?
There are many health insurance plans available in the market but not all may be suitable to you. Check these points to finalise the best working health insurance plan.
Coverage
A health insurance policy should cover following expenses incurred by a patient subject to the overall amount insured in the policy period.
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Expenses related to the room, boarding -
Expenses related to nursing, surgeon fees and fees of anaesthetist, physician, consultants and specialists -
Fees towards anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, diagnostic materials, X-Ray, dialysis, chemotherapy, radio therapy etc.
The policy’s financial coverage should be in line with the health aid that your family needs. In case of individuals or families with a history of pre-existing illness, a medical insurance that offers bigger financial coverage should be opted. This means the premium to be paid will also be more.
Fits your budget
While medical expenses are often unavoidable regardless of budget, health insurance plans can be selected based on how frequently an individual or their family expects to use them.
Assess the cost of medical treatment for your family in a year and based on that choose the plan that fits your budget. While for some making use of the bigger financial coverage plan makes sense, for some the basic plan is enough.
Family plan coverage or individual plan coverage
Based on the requirements, you can choose between family and individual plans.
Hospitals covered
It is important to check the list of hospitals covered under the health insurance policy and if your preferred hospital is part of that network. This will ensure seamless medical admission and treatment.
Claim settlement ratio
The ratio of claims that an insurance company has settled from the claims it received in a particular period is the claim settlement ratio. The higher it is, the better the company as you will have the trust that the company has money and will settle your claims too without any delay.
Note that once you decide on the health insurance policy and buy it from an intermediary, always fill the proposal form on your own and do not sign a blank form if the terms and conditions are not clear to you.
How to claim health insurance?
According to the Irdai, a health insurance policy can be claimed in two ways.
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Cashless basis: In this, the treatment of the individual claiming the policy should be done at a network hospital of the Third Party Administrator servicing your policy. Before starting, take authorisation for a cashless treatment based on the rules highlighted in the policy document. As the name suggests, you need not pay anything that is covered under the cashless health insurance to the hospital on discharge.
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Reimbursement: In this case, inform the insurance company after hospitalisation. Once you have paid the amount and discharged from the hospital, keep ready with you the claim form, discharge summary, prescriptions and medical bills that you should submit so that the money paid towards hospital expenses can be reimbursed.
How to renew your health insurance?
Like all products, health insurance also comes with an expiry date that has to be renewed. In case it is not renewed, there will be no medical coverage available until it is renewed.
Before renewing your medical policy, assess any development that has taken place in the family in the last one year and on the basis of it, decide if you want to stick to the same package or upgrade it.
If you have not applied for a claim during a policy year, you are eligible for a ‘no claim bonus’ details of which will be given in the policy document. To avail this, one has to renew the health policy within 30 days from the due date.
FAQs
What is the minimum stay period in a hospital to make a medical claim?
To be eligible to make a claim under the health insurance policy, most hospitals ask for a minimum stay of 24 hours. However, there will be exceptions in case of accident and other special treatments, which may be mentioned clearly in the policy.
Are there any tax benefits that I may get if I opt for health insurance?
Under Section 80D of the Income Tax Act, people who have bought a health insurance policy using any mode except cash can avail an annual deduction of Rs 15,000 from their taxable income for payment of Health Insurance premium for self, spouse and dependent children. This deduction is Rs 20,000 for senior citizens.
In a health insurance policy, what is pre-existing condition?
It is a medical condition that was existing before the health insurance policy was taken. Such conditions are not covered as part of the health insurance policy in the first 48 months.
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