Earlier, there were only one or two promising insurance companies, but with the boost in competition, the number of such companies has also risen. New opportunities and possibilities have also opened the door for confusion for the end users.
To make it uncomplicated for the customer, we have documented some terms and conditions that one must review before buying the insurance policy.
In and out hospitalisation cover
Most medical insurance policies cover expenditure on pre-hospitalisation, hospitalisation, and post-hospitalisation but not out-hospitalisation. Let us examine each of these three in detail.
- Pre-hospitalisation is the expenditure incurred by the insured before admitting to the hospital, and it includes expenses for medical tests, consultations, etc. It is usually a 30 or 60 days period before hospitalisation and is covered by most insurance companies.
- Hospitalisation includes expenditure on treatment and hospitalisation costs.
Despite having a good insurance policy, hospitalisation won’t be entirely cashless, and you will pay some percentage of the bill out of your pocket.
Consumables such as housekeeping charges, nursing charges, toiletries, gloves, sanitizer, etc., are not included in the policy. Therefore one must check for the consumables cover before buying the insurance policy.
- Post-hospitalisation is the expenditure incurred by the insured after being discharged. It comprises expenses for follow-up, consultation, medical tests, medications, etc. It is usually 90 to 180 days post-hospitalisation and is covered by most insurance companies.
- Outpatient hospitalisation is the OPD expense incurred on medical treatment but without hospitalisation. It includes lab tests, consultation, etc. This is included only in some of the policies.
Pre-existing diseases and when they will be covered
A pre-existing disease is any condition, injury, or illness that started before you purchased the insurance policy. It includes conditions such as asthma, cholesterol, cancer, high and low blood pressure, diabetes, etc.
A pre-existing disease is not covered under your health insurance plans in India, or it is covered after a certain period called a waiting period.
Hence, if one is suffering from any pre-existing diseases, one must review whether the condition is covered in the policy and, if not, by when it will be covered. One must buy a policy with the least waiting period for pre-existing diseases.
Special features
In this competitive era, insurance companies provide many innovative attributes in their policy. Some of the many features one must review before buying the policy are listed below.
No-claim bonus benefit
It is the increment on the sum insured (bonus) you earn if you don’t claim in a particular year. The sooner you buy the policy, the more chances you receive a no-claim bonus, as the possibilities of making a claim when we are young are very few. And a no-claim year means an increase in the sum insured by some percentage yearly.
Condition of room type
Some companies have restrictions on the kind of room one opts for. Before buying the policy, one must check that there should be no constraints, and the insured can avail of any room he desires. Niva Bupa Health Insurance is a company that offers policies with no cap on the room rent category.
Restoration benefit
This benefit is an advantage for older adults. If the sum insured is exhausted in a particular year, insurance companies restore it.
For instance, if you were hospitalised for joint replacement surgery, and your sum insured gets exhausted, the insurance company will refill it for further use in the same year.
But with the condition that you can’t use the top-up for the same disease again in that particular year. Only some insurance companies restore it for both related and unrelated diseases.
Claim settlement ratio and co-payment
Before buying health insurance plans in India, one must check these essential terms and conditions.
An insurance policy with all the benefits of the world is of no use; until its claim settlement ratio is more than 95%. A good ratio suggests that claims received by insurance companies are settled entirely and on time.
According to IRDAI, the highest claim settlement ratio, more than 95%, is of Niva Bupa Health Insurance (source policybazaar).
Before buying the policy, an intelligent investor should check whether there is a co-payment condition or any deductible. Co-payment states that the insured and insurance company will pay the bill jointly.
Cashless hospitals around you
Insurance companies might promise an extensive network of hospitals, but what is essential to understand is the network hospital should be near your house. Again a policy with the best of benefits, but if the network hospital is not near you is less helpful to you.
In conclusion
One must know the above-listed basic terms and conditions before buying an insurance policy. With the advent of technology, one can make an informed decision as all the world’s information is available in customers’ hands on their smartphones.
