5 Key Features of Health Insurance Policy

Health is wealth, period. Ever since global pandemic hit us, the need for a well-balanced medical insurance plan has become higher than ever. And this requirement is always followed by a lot of questions from the first time buyer. Starting with the obvious one, ‘how much does it cost?’,the list of hospitals’ and so on. It is thus important to be aware of the features of health insurance.

Five Features of Health Insurance

1. How much does a Health Insurance Policy cost?

Emergencies come unannounced and health insurance is the key, which allows you access to best medical facilities despite the rising hospitalisation expenses. The premium of the policy increases with age, so start young. Bear in mind the type of policy that you would like to take. It could be a critical illness insurance, a family health insurance, or a personal accident insurance - there are several kinds of health insurance plans that can be availed based on your need. For some insurance plans, you may be asked to undergo a health check-up for the insurer to get a sense of your health status. the list of hospitals’ and so on. It is thus important to be aware of the features of health insurance.

2. Do you have any Pre-Existing Conditions?

Pre-existing conditions are health problems that exist before you invest in a health insurance policy. Some common examples of such cases are, heart diseases, asthma, hypertension, or they can be as small as an injury from a previous accident. So before you avail a health insurance policy be it for you or your family, check with your provider which of the pre-existing conditions are included and excluded - as they wouldn’t cover them for a minimum of 48 months to a maximum of 4 years once you have purchased the policy. Some may also add more according to the medical condition. So it is always advisable to check whether the insurance company provides coverage for pre-existing conditions or not and what difference it brings in the premium that you pay. As it is very much possible that the insurer might charge you higher premiums in case you need coverage for pre-existing diseases.

3. What are the types of Health Plans and their Benefits?

Based on your current need or your future planning, you need to carefully select your health insurance keeping in mind the different benefits of health insurance. There are various types of individual health insurance plans and family health insurance plans. So compare health insurance plans and choose a policy that covers all your needs or if you are taking a family health insurance, make sure it covers them all adequately. 

Check whether your policy is providing you with cashless coverage or not, and if yes, then what hospitals, treatments and medications are covered. Also, carefully go through the inclusions and exclusions of the healthcare policy you are opting for. Check whether it provides you with pre and post-hospitalisation expenses or not and what are various top-ups available for your benefit.

4. What is Capping of your Health Policy?

Say you have bought a policy whose cover is Rs.5 lakhs, your insurance provider would have added a feature or clause known as ‘disease wise capping’. This adds a restriction to the amount of pay-out you can avail on a list of specific illnesses which may be set to Rs 1 lakh. So, to bring it to your advantage make sure the cap is high. So, be it your individual health insurance policy or your family health insurance policy - check the sub-limits in the policy before buying your health insurance plan. This is highly important, as it is easy to ignore it while opting for the policy. However, when there is a medical emergency, this capping will cause issues for you or your family. These restrictions are usually imposed on the rent of rooms, nursing, and boarding expenses.

5. What’s the Claim Settlement Ratio of your Policy?

The most vital feature you need to know and check for is, what is the percentage of claims for the insurer in question that gets declined and how many get through when a claim is raised? With rising hospital expenses, always remember to get a policy which has a high claim settlement ratio. Which means, your policy needs to be above 90 to 95% and if it is less than 80% then you need to look for a new provider or a new policy. CSR data can be found on the websites of the healthcare company. However, another measure that gives you a better picture is the incurred claim ratio, which tells us the ability of the company to pay a claim, the data for which is released on the website of the Insurance Regulatory and Development Authority of India(IRDAI).

Conclusion:

When you avail a health insurance plan, you need to bear in mind these five key features before you sign the policy documents. Today you can even avail them online in a day or two, with or without basic health check-ups, especially if it is an individual health insurance plan.