Health Insurance guide: Everything you need to know before buying a health insurance policy

It could be challenging for you to navigate through the jargon and options available in health insurance today. But don't worry! In this article, you will learn all that is required to help you make rational choices while purchasing health insurance. From learning policy language, this report covers everything there is to know about this issue.

Step 1: Identify the Need

Assess your specific requirements when you're planning on purchasing health insurance. Among other things, you should think about things like pre-existing conditions, maternity benefits, as well as coverage for older people. For example, if you intend to buy health insurance coverage for an aged parent, the ideal policy could be one meant for elderly people since it has special provisions that shall be used with them in mind like shorter waiting times on pre-existing diseases.

Step 2: Determine Coverage Amount

When it comes to health insurance, you must get it right. As a general guideline, you should be covered for at least six times your monthly earnings. In case of a family floater policy, ensure that the sum assured is sufficient for all members.

Step 3: Understand Policy Coverage

One must take into account the details provided in whatever coverage to analyse health insurance policies effectively. Here is a more comprehensive disclosure of the main things to focus on:

• Inpatient Hospitalisation

When you are admitted into the hospital for an equal or more than 24-hour period, your insurance policy comes into play. Comprehensive coverage of inpatient hospitalisation which includes inpatient hospitalisation, including room charges, doctor's fees, medical tests, and surgical procedures among others is so important.

• Day-care Treatment

Day-care treatments refer to medical procedures or therapies that require hospitalisation for less than 24 hours. Examples include chemotherapy, dialysis, or minor surgeries. Ensure that your policy covers a wide range of day-care treatments, as they are becoming increasingly common and may be essential for certain medical conditions.

• Room Rent Allowance

Some policies limit the amount of money that you are supposed to claim in cases of hospitalization by putting a cap on the room rental charges payable. For this reason, it is necessary to look into the matter more critically because if you go for a room exceeding the stated limit, then extra costs shall be incurred that will be paid from your own pockets. Buy a policy that does not have any restrictions on room rent charges; alternatively, choose one whose maximum is what you feel comfortable with financially and agrees with your requirements.

• Pre- and Post-Hospitalisation Coverage

Whenever you stay at the hospital, charges are incurred pre-hospitalisation and post-hospitalisation. Such charges may refer to the money that was used during diagnosis, the prescription given, consultancy, or even any appointment for review through the period that a policy covers before and after admission in a hospital usually 30-90 days. Make sure you are okay with whatever is therein.

Step 4: Know Policy Clauses

Avoiding surprises and making sure you have complete coverage means understanding the fine print of your health insurance policy very well. Below are essential policy clauses that you need to keep in mind.

• Waiting Period

The term waiting period refers to the time frame in which particular conditions or treatments are not included under the terms of your insurance policy. It is important to know about these different waiting periods since they can differ greatly in ailments, procedures, or pre-existing conditions. Go for policies that have low waiting periods; particularly for those who have current health concerns or are hoping for medical attention soonest.

• Co-payment Clause

Co-payment provisions require policyholders to split the cost of medical bills with their insurance company. The proportion of expenditures incurred by the insured varies according to the insurance conditions. While insurance with co-payment provisions may have reduced premiums, consider the financial consequences of splitting medical expenditures, especially during major medical crises.

• Sub-limits

Sub-limits act as restrictions on certain medical costs like room rents, surgery costs, or diagnosing tests. Knowing what the sub-limits set out in your policy can help you avoid un-serviced claims or bills. Go for a policy that has high sub-limits or choose one that does not have them at all if you want full protection.

• Exclusions

Your insurance policy does not cover, cannot cover, or will not cover certain medical conditions, treatments, or services. Look at the list of exclusions closely and find out whether you can fill in any blanks or provide additional protection against these risks. There could be common exclusions but also ones that differ depending on individual needs.

Step 5: Check the Hospital Network for Cashless Facilities

Ensure that the insurance company has a wide network of hospitals whereby they offer cashless services, particularly with renowned healthcare providers within your region.

Step 6: Explore Enhancement Facilities

Enhancement Facilities can increase your health insurance policy’s protection and offer more financial assurance. Here is what you look for in enhancement services:

• No Claim Bonus (NCB)

NCB rewards policyholders for claim-free years by increasing coverage or reducing premiums. This incentivizes healthy behaviour and responsible use of insurance benefits. Consider policies offering substantial NCB benefits to maximize your coverage over time and enjoy additional financial savings.

• Restoration Benefit

Restoration benefits in health insurance let the insurer restore your sum insured to the original amount even if it has been claimed. Make sure to buy a health insurance plan that offers 100% restoration benefits so that it's restored if it gets exhausted after a claim.

While affordability is essential, prioritize policies that meet your specific needs rather than opting for the lowest premium amount. By understanding policy features, clauses, and benefits, you can make an informed decision that provides comprehensive coverage for you and your loved ones.