How To Choose The Right Health Insurance Policy For Yourself
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How To Choose The Right Health Insurance Policy For Yourself

  • Highlights

  • Age, family history and pre-existing conditions define your premium

  • Understand the sum insured thoroughly

  • Conduct a cost benefit analysis to see if your policy covers your needs

  • Be aware of auto renewal and co-payment clauses

Life has its share of uncertainties and one of the important areas where this unpredictably reigns is when it comes to your health and that of your loved ones. Whether it is the physical wellbeing of yourself or members of your family, remember that healthcare expenses are mounting each subsequent year. Having a health insurance policy, therefore, becomes imperative for you so you can take care of yourself or your family without a misstep. Here’s how you can choose the best policies to not only insure, but also keep yourself in the pink of health.

1. Understand your requirements thoroughly first

When it comes to health insurance, one size doesn’t fit all. A policy that’s suitable for you won’t be a perfect fit for another individual who may be of your age. Consider factors such as life expectancy, existing health conditions and family history before choosing a policy. For instance, you will be charged a higher premium by your insurer if there is any indication of a pre-existing illness in your family history. Premiums also increase with age. In both cases, the costs increase because of the risk.

It therefore, makes little sense to pay a high premium if you are young and enjoy a relatively healthy life with no hereditary ailments or diseases. The calculation of your premium will also differ if you want to club your requirements with those of your spouse, children and/or parents.

2. Find out if the sum insured covers all or most of your needs

To understand what ‘sum insured’ means, you have to think of insurance policies as risk protection or covers. Were you to meet the damages for a hospital stay and treatment on your own, it would dent your pocket considerably. Sum insured is therefore simply a predetermined amount that you, the insurer, pays should you be struck with a disease requiring treatment in a hospital. Today, even the fees of simple health check-ups or minor surgeries can be expensive. To make sure that you are not wasting your precious money on a high premium, you need to conduct a cost benefit analysis. This means that you match the health treatment benefits that the sum insured entitles you to. Here you have to consider even the worst-case scenarios like heart attack and cancer. If your sum insured covers even these scenarios, the premium cost is justified.

3. Know the number and type of illnesses covered under the policy and when

Not all health insurance companies offer the same kind of policies. In some cases, the number of sicknesses covered may be limited and in others coverage of certain types of illnesses like AIDs or other sexually transmitted diseases may be omitted. It is a good idea to read the policy offer document and decide whether you want to stay or opt out of the subscription, since you have a 15-day look-up period. By carefully reading your policy document, you will know both the number and type of illnesses covered irrespective of whether they are pre-existing ones or unforeseen. Most health insurance companies in India do not cover pre-existing illnesses until a certain number of years have lapsed from the effective start date. Knowing which pre-existing or unforeseen illnesses diseases aren’t covered and, if they are covered, when their protection is effective, will go a long way in saving you time and money when filing insurance claims.

4. Find out if your policy has an auto-renewal and if so up to what age

It is a good idea to have a health insurance policy that has an auto renewal feature. This is not only because of the income tax deduction, but also because it prevents your policy from getting lapsed. It also ensures that you are safeguarded against any health-related eventualities or emergencies since you can never be certain of the turn your health can take. Putting the policy on autopilot may mean that you have to continue paying premiums, but don’t let this dissuade you. In the long run, this only means that you are emerging as a champion in the survival game! Though not mandatory, it is always better to opt for the auto renewal feature when you are comparatively younger, since some companies may not extend this facility after the insured crosses a certain age.

5. Learn about how your insurer settles claims and if co-payment is involved

A health insurance company’s popularity is also affected by the way it settles your claims. If the settlement is done systematically and transparently, it becomes a win-win situation for both you and the company. It also presents you with a huge saving advantage if your health insurance company agrees to co-pay a high percentage of your health insurance claim. Ensure that the company is co-paying 80% to 90% of your insurance claim, as that is the standard arrangement.

6. See whether the policy eases your out-of-pocket load

Out-of-pocket expenses are simply the additional bills you have to pay that are excluded in the amount provided by the insurer. These may include the cash memos for tablets, certain prosthetic devices, doctor’s consultation fees, room rent charges, nurses pay, and so on. Sometimes health insurance may help you ease these out-of-pocket damages by offering to pay a certain amount but not beyond a certain limit. This means that it does not extend beyond a certain percentage of the sum insured. You should familiarize yourself with this cap or limit, since it means that crossing these caps obligates you to pay the balance.

7. Check the insurer’s network of hospitals

The worth of your policy is also dependent on how far the reach of your health insurance company extends to. The wider the network of hospitals empanelled with it, the better your chances of getting timely treatment should you or anyone from your family fall ill. It also means that you cut your travel costs when there is an empanelled hospital in a locality or district close to you. Going further away to seek the treatment for the same ailment may mean that you have to shell out more. Sometimes quick access can make a load of difference especially in emergency or critical care cases.

Keeping these 7 things in mind, make an informed choice about your health insurance policy and prepare for the future with greater peace of mind.

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