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The Covid-19 pandemic has made people realise that we must be prepared to deal with medical emergencies. While having a good health insurance policy may seem simple, there are a few intricacies involved in finding a good plan. Here are some key factors that one should look at when buying a good comprehensive health cover for yourself and your family.
Check sub-limits
Sub-limit is a cap put by an insurer on medical treatment, doctor consultation fee, ambulance charges, and hospital room rent. Sub-limit means that if you incur charges on say medical treatment beyond these caps, the policyholder will have to bear the expense. However, many health insurance policies come with no sub limit. Choose one such plan, despite a little higher premium.
Co-payment clause
Co-payment clause means that you are agreeing to pay a certain percentage of the claimed amount. Suppose your policy has a co-payment of five per cent, it means you are agreeing to pay five per cent of the total claimed amount while the remaining 95 per cent will be paid by the insurer. It is always better to go for a policy with a no co-payment clause.
Waiting period
Before you buy a health policy, you must also look at the waiting period. Say, someone buys a health policy without checking the specific waiting period related to specific diseases. Within a month, that person is diagnosed with uterine fibroids but, she can’t claim for hospitalisation as her policy has a two years waiting period for the disease.Normally, there are two widely prevalent waiting periods across all the policies. One, a normal waiting period of one month when you buy a new health insurance policy. For the Covid-19 coverage the waiting period is 15 days. Two, pre-existing illness waiting period which varies across insurers and policies(two to four years).
Network hospitals
In order to avail cashless treatment during any emergency, one must check the insurance provider's hospital network. At a network hospital, your insurer and the hospital together will take care of the expenses related to the treatment. You will enter the picture only when the hospitalisation expense will shoot up beyond your sum insured limit.
Claim settlement ratio
To ensure that there is minimal probability of your claim getting rejected, one should look at the claim settlement ratio of the insurer. This ratio shows how many claims have been settled/rejected by the company. You can also check the time taken to settle claims.
OPD cover
One must know that a regular health insurance policy does not cover you for OPD expenses like doctor’s consultation fees, different tests and X-rays, though these expenses can cost a considerable amount. So, it is important to buy a health cover that provides coverage for OPD expenses. An OPD cover assists the insured to claim expenses incurred other than on hospitalisation. Under OPD cover of your policy, you can claim expenses without a waiting period and make multiple claims within the same year until the limit is completely exhausted.
The writer is Head, Health Insurance, policybazaar.com