Choosing the right health insurance policy can be tricky, but it’s super important for your peace of mind and wallet. With medical costs constantly on the rise, having solid coverage is a necessity. In this guide, we’ll break down the key features in a health insurance policy. We’ll talk about everything from covering pre and post-hospitalisation expenses to including modern treatments, etc.
Whether you’re new to health insurance or just looking to find a better plan, we’ve got you covered. Let’s dive in and make sure you’re getting the best protection possible!
10 Must-Have Features In A Health Insurance Policy
Here are some of the key features you should look for in a health insurance policy –
1️⃣ Pre- and Post-Hospitalisation Cover
Medical bills can pile up quickly, often surpassing what many people can comfortably pay out of pocket. Therefore, it’s essential to ensure that your health insurance policy covers both pre and post-hospitalisation expenses. Pre-hospitalisation coverage includes the tests and reports conducted 30 to 60 days before you’re admitted to the hospital. Post-hospitalisation coverage, on the other hand, handles costs such as ambulance fees, follow-up tests, medications, etc. for 60 to 90 days after discharge. Checking for these benefits in a policy can provide significant financial relief and ensure comprehensive protection during medical emergencies.
2️⃣No Room Rent Limit
Room rent limits are restrictions set by health insurance policies on how much they will cover for your hospital room per day. These limits might be a percentage of the total sum insured (like 1% per day) or specify certain types of rooms (such as twin sharing). For instance, if you have a sum insured of Rs 4 lakhs and a room-rent limit of 1%, you can only claim full coverage for rooms costing less than Rs 4,000 per day.
If you choose a room costing more than your limit, not only will you have to pay the extra room charges out of pocket, but your insurer will also proportionately reduce the coverage for all related hospitalisation costs. This means higher overall out-of-pocket expenses.
To avoid this, opt for a plan without room-rent limits. This way, you can make the most of your insurance coverage and choose a room based on your comfort and needs without worrying about additional costs
3️⃣ Inclusive Day Care Treatments Coverage
With continuous improvements in medical research, many treatments now require only a day at the hospital, reducing the need for prolonged stays. These are called day care treatments, which allow you to receive treatment and go home the same day. Some of the day care treatments include dialysis, appendectomy, chemotherapy, etc.
Be aware that health insurance policies often have restrictions on which day care procedures are covered. Insurers can be misleading about the number of treatments they include. For example, while one insurer might list “knee surgery” as a single treatment, another might break it down into “arthroscopic knee surgery” and “knee ligament repair” to make their coverage seem more extensive.
To avoid this confusion and ensure comprehensive coverage, it’s wise to choose a policy that offers blanket coverage for all day care procedures. This way, you’ll be protected for any new treatments that might be added in the future, giving you both peace of mind and flexibility.
4️⃣ No Copay Clause
Many health insurance plans, especially those for senior citizens, include a copayment clause. This means you’ll need to cover a portion of the hospital bill before your insurer pays the rest. For instance, with a 10% copay clause, a hospital bill of Rs. 2 lakhs would require you to pay Rs. 20,000, while the insurer covers the remaining Rs. 1,80,000.
Copayment costs can add up quickly, making it harder to manage your finances, especially as medical expenses continue to rise. To avoid this, try to find a policy without a copayment clause. If that’s not possible due to pre-existing conditions or because you’re buying for a senior citizen, look for a policy with the lowest copay requirement. This way, you can minimize your out-of-pocket expenses and better manage your healthcare costs.
5️⃣ No Limits On Specific Treatments
Some health insurance policies impose caps on coverage for specific treatments or diseases. For example, a policy might limit coverage for cataract surgery to Rs. 50,000. If complications increase the total cost beyond this limit, you’ll need to pay the difference out of pocket, even if your overall sum insured is much higher.
To avoid such surprises, it’s crucial to be thorough when reviewing policy details before committing. Pay special attention to any caps or limits on specific treatments and compare multiple policies to find one with the fewest restrictions. By understanding your policy thoroughly, you can prevent unexpected costs and ensure you have the comprehensive coverage you need.
6️⃣ Modern Treatment Cover
Modern treatments such as stem cell therapy, immunotherapy, deep brain stimulation, robotic surgeries, etc. can come with a high price tag. When selecting a health insurance plan, it is vital to check whether these advanced treatments are covered. If they are not part of the standard coverage, you should consider adding them as an optional add-on to prevent substantial out-of-pocket costs.
Consider Meera’s case, for example. She was diagnosed with Parkinson’s disease, and her doctor recommended deep brain stimulation. The procedure costs around Rs. 10 lakh, with additional follow-up treatments costing Rs. 1 lakh each year for the next three years. The total cost will exceed Rs. 13 lakh. Unfortunately, Meera’s health insurance doesn’t cover these advanced treatments, so she has to pay the entire amount herself.
To avoid situations like Meera’s, it’s wise to select a health insurance plan that includes coverage for modern treatments either in the basic plan or as an add-on. This way, you can ensure comprehensive coverage and avoid significant financial strain.
7️⃣ Shorter Waiting Period
When you get a health insurance plan, you need to keep an eye on the waiting period clause. This is the time frame during which the insurer won’t cover claims for certain illnesses or pre-existing conditions. Depending on the insurer and the plan, the waiting period can range from 2 to 4 years.
To avoid any surprises during a medical emergency, it’s best to choose a health insurance plan with the shortest waiting period possible. This ensures you can access your benefits sooner and reduces the stress of being uninsured when you need coverage the most. Always compare different plans and their waiting periods to find the one that fits your needs best.
8️⃣ No Claim Bonus
No Claim bonus in health insurance is like a little reward for taking good care of yourself. If you manage to go a whole year without making any claims, your insurer gives you a bonus, either by reducing your premium or by boosting your coverage.
In other words, the longer you stay healthy and avoid making claims, the more you can benefit when it’s time to renew your policy. It’s a great way to motivate yourself to maintain a healthy lifestyle!
There are two main types of no-claim bonuses:
1. Discount on Premium:
If you choose this option, your renewal premium gets reduced by a certain percentage each year you don’t make a claim. However, even though you’re paying less, your coverage amount stays the same.
2. Cumulative Bonus:
Alternatively, with a cumulative bonus, your sum insured (or coverage) increases by a set percentage every year you don’t file a claim. The catch? Your premium remains unchanged, so you’re getting more coverage for the same price.
9️⃣ Consumable Cover
When selecting health insurance, prioritize policies that cover medical consumables often excluded from standard plans, such as gloves, nebulization kits, and oxygen masks. These items, while essential for treatment, are typically not covered by the Insurance Regulatory and Development Authority of India (IRDAI), leading to potential out-of-pocket expenses.
Choose plans that offer coverage for these items either as a standard inclusion or an optional add-on to help manage associated costs and protect your savings.
🔟 Restoration Benefit
One of the essential features to look for in a health insurance plan is the Restoration Benefit. This feature in health insurance acts as a financial safety net, providing you with a top-up on your sum insured if you exhaust it within the policy year. While commonly known by various names such as Restore, Reinstatement, Refill, or Reset, the core function remains the same across different insurers.
Typically, the Restoration Benefit is available for use once per year. However, some insurance plans offer the flexibility of utilizing this benefit multiple times within a single year, enhancing your coverage significantly. For those seeking comprehensive protection, options for unlimited restoration are also available, albeit at a higher premium.
Curious about the features in your health insurance policy?
Let CoverSure’s “Know Your Policy” feature clear things up for you! It makes it easy for you to understand your insurance coverage.
With “Know Your Policy,” you’re not just reading dry insurance lingo; you’re getting a personalized breakdown that helps you grasp what you’re really getting. No more guessing games when it comes to understanding your policy!
