Introduction
In today’s world, the cost of medical treatments is skyrocketing. A simple surgical procedure that costs Rs 5 lakh today will cost Rs 5,70,000 next year due to medical inflation. This rise in medical costs puts a huge financial burden on individuals and families. In fact, 70-80% of the population in our country is just one hospital bill away from becoming poor. It is the responsibility of the government to provide quality healthcare to its citizens, but unfortunately, this is not always the case. The government encourages individuals to take health insurance plans by offering tax benefits. However, even with health insurance, there is no guarantee that all your medical expenses will be covered. Insurance companies often hide terms and conditions in their policies, leading to rejected claims and a sense of betrayal. In this blog, we will discuss how to choose the right health insurance plan and understand the hidden aspects of insurance policies that insurance companies do not want you to know.
Why Do You Need Health Insurance?
Before diving into the details of choosing the right health insurance plan, let us first understand why health insurance is necessary. Consider your current savings and ask yourself if you can afford to pay off a medical bill of 10-15 lakhs. Even if you can, it will deplete your savings significantly. Additionally, the time and effort required to save such a large amount of money will hinder your financial goals for retirement, education, and marriage. Health insurance provides financial protection in such situations, ensuring that you do not have to bear the burden of high medical expenses alone. It is a safety net that allows you to receive quality healthcare without worrying about the financial implications.
How Much Coverage Do You Need?
Determining the ideal coverage for your health insurance policy depends on several factors. Firstly, consider where you live. Rural areas may require less coverage, while tier 1 cities may require more coverage due to higher medical costs. Next, assess the average medical costs in your area. Research the cost of common procedures like heart surgery to get an idea of the expenses you may encounter. Additionally, take into account any pre-existing conditions you may have that increase your chances of hospitalization. Based on these factors, it is recommended to have a minimum coverage of 5 lakhs for children and 10 lakhs for elders in today’s time.
Choosing the Right Policy
Now that you understand the importance of health insurance and the coverage you need, let’s discuss how to choose the right health insurance plan. Policy Bazaar is a great platform to compare different policies and select the one that suits your requirements. Simply visit the website and fill in the necessary details, such as your name, age, and pre-existing conditions. Filter the results based on your preferred coverage amount, room rent type, and other factors. Policy Bazaar will provide you with a list of policies from different companies, along with their premiums and features. It is essential to review the sub-limits, room rent caps, and co-pay clauses of each policy to ensure you make an informed decision.
Understanding Policy Terms and Conditions
When choosing a health insurance policy, it is crucial to be aware of the various terms and conditions that insurance companies may hide from you. Here are some important aspects to consider:
1. Sublimits
Many policies may advertise a high coverage amount, but they often have sub-limits for different diseases and treatments. For example, a policy with a coverage of 50 lakhs may have a sub-limit of 1 lakh for cataract surgery and 2 lakhs for angioplasty. This means that even with a high coverage amount, you may only receive a fraction of the total cost for certain treatments. It is important to thoroughly check the sub-limits of a policy before making a decision.
2. Room Rent Cap
Another important factor to consider is the room rent cap. Some policies limit the amount they will cover for room rent, which can affect your overall claim amount. For example, if your policy has a room rent cap of 10,000 rupees per day and you choose a room that costs 12,000 rupees per day, you may have to pay the difference out of your own pocket. Ideally, you should choose a policy with no room rent cap to ensure you have the flexibility to choose any type of room during hospitalization.
3. Co-pay
Co-pay is a cost-sharing arrangement where the policyholder pays a percentage of the medical expenses, while the insurance company covers the remaining amount. It is important to understand the co-pay clause of your policy and assess whether it is beneficial for you. In some cases, policies with high co-pay may not provide the financial protection you need, especially if you have significant medical expenses.
4. Waiting Periods
Most health insurance policies have waiting periods for specific conditions, such as pre-existing diseases or certain treatments. It is essential to be aware of these waiting periods before choosing a policy. Waiting periods can range from 30 days to several years, depending on the policy. If you have any pre-existing conditions, consider policies with shorter waiting periods or no waiting periods for specific illnesses.
5. Exclusions
Every health insurance policy has a list of exclusions, which are treatments or conditions not covered by the policy. It is crucial to review these exclusions before purchasing a policy to understand what treatments and conditions are not covered. This will help you avoid any surprises when filing a claim.
Choosing the Right Insurance Company
When selecting a health insurance policy, it is important to consider the reputation and stability of the insurance company. Some companies specialize in health insurance and focus on providing quality services to retail customers. These dedicated health insurance companies may offer faster claim processing and better customer support. However, it is important to note that no insurance company is perfect, and there may be complaints against any company. To find the best insurance company, consider the brand name, goodwill, and the specific policy you are interested in. It can also be beneficial to choose a company that offers both health insurance and super top-up plans to ensure seamless cashless treatment.
Conclusion
Health insurance is a crucial aspect of financial planning and provides a safety net in times of medical emergencies. It is important to choose the right health insurance plan that suits your needs and offers comprehensive coverage. Consider factors such as coverage amount, sub-limits, room rent caps, co-pay clauses, waiting periods, and exclusions before making a decision. Additionally, research reputable insurance companies that specialize in health insurance to ensure you receive quality service and support. By being aware of the hidden aspects of health insurance policies and understanding your own requirements, you can make an informed decision that provides financial protection and peace of mind.
