Here are some of the important terms that you will come across while subscribing to a health insurance policy.
In simple terms, the sum insured can be the maximum coverage amount in a policy year. It forms the basis of all your claims. Consider the increasing costs of hospitalisation, medicines and treatment before deciding on your insured amount. It is advisable to choose a higher cover. At the same time, the cover should not be high enough for you to dig into your pocket to pay the premium.
Co-pay and Sub-Limits:
The co-pay and sub-limits system has been introduced by some health insurance companies to prevent the patients from billing improper room rent to hospitals. In a co-payment policy, you have to pay a portion of the expenses irrespective of any sum insured. If a policy has a co-payment of 10%, the insurer will pay 90% of the expenditure and you have to bear the balance. In addition, some insurers limit the expenses of therapies to reduce the claims of hospitals. It is known as sub-limits. While buying Mediclaim, choose a policy that has less sub-limits. There are some mediclaim policies, which do not have a co-pay or sub-limit. Try to select such a plan.
Some employers provide health insurance to their staff under the Group Insurance scheme. But you can still have a mediclaim of your own which covers the whole family. The second Mediclaim policy cannot be considered if your employer leaves your job and you can transfer the policy. It is important that you compare several policies before you buy one.
Most comprehensive mediclaim policies are covering serious illness. You don’t need to buy another policy. It is advisable to subscribe to a comprehensive plan and then do it with a crash insurance plan which does not cost much. Two policies are enough to meet your mediclaim needs. If there is a family history of a certain ailment like thyroid or blood sugar, then you should ideally buy a different serious illness mediclaim. If there is no such history in your family, then there is no need for a critical illness plan.
If you have already finished the multiplier benefits within the year as well as your policy. But in most cases, the benefit on the same disease is not available if the limit is already used.
But a restoration benefit can be useful if you have a family floater plan where the full insured amount is subscribed to only one family member is terminated for treatment. The remaining members will not have any cover to come back in case of hospitalisation for the remainder of the policy year. In such a situation, some members may be covered for other diseases, which have already been paid by the insurance company.
No claims bonus (NCB):
If no claim has been made in the preceding year, the insurer usually expands the NCB to a policyholder. Please check the NCB while buying a mediclaim, before signing the dotted lines. NCB may range from 5% to 100% of the insured amount. A higher NCB gives cover against inflation and you don’t need to worry about increasing your coverage year by year.
Pre-existing illness, waiting period, exclusions:
There are people who already have existing diseases when you subscribe to the Mediclaim policy. Most health insurance companies specify a waiting period for these diseases. The insurance company is unlikely to cover against it. In most cases, a pre-existing disease is covered after less than two years of buying a policy.
Exclusion means the diseases which are not covered under the Mediclaim. For example, if you are suffering from diabetes while taking a policy, kidney diseases are likely to be excluded from the cover if it is caused by diabetes. Never hide any pre-existing diseases from your insurer when purchasing a mediclaim policy. This may lead to reduction in your hospitalisation claim.
Most health insurers provide free health check-up to the policyholder. But what is called Free “That’s not really so. The cost of check-up is included in the premium. Buy such a policy only when you are eager to get this facility every year. Also check whether the Mediclaim policy gives coverage for the entire life afresh every year. This is important because life expectancy is increasing due to improved medical technology. While most insurance companies provide full life coverage, some cover only up to 75-80 years.
Maternity and Daycare:
Medical insurance policies provide cover on hospitalisation, which does not require overnight stay. These are called daycare processes. See how many processes are involved in the scheme. In addition, most insurers do not consider motherhood as a medical emergency. So do not look for a maternity cover if you have no plan for a child.
Top up Plans:
The medical costs are increasing. It adds to the large cover. But not all can afford a higher premium. In such a case, the top up plan may come useful. This reduces the cost of deductibles i.e. you pay the amount before the insurance company pays. The insurance company will pay only upto the sum insured. A top scheme, on the other hand, does not pay unless the hospital bill has a specific border violation. Say, if the hospital is billed? As a deduction of Rs 8 lakh with RS3 million, you need to pay later, while the insurer pays the remaining Rs5 lakh. But you have to pay the deductible amount to your personal/ Can use Group Policy. The combination of a basic Mediclaim plan with a top plan is much cheaper than a single wrapper. For example, for a 26-year-old male, the premium for RS5 million regular cover would be around RS6, 500. The top up with RS15 million cover will have an additional premium of RS5, 000, much cheaper than the standalone policy of the same amount.