How Do I Choose Health Insurance

Can anyone help me choose the right health insurance? Which are the things I should be aware of and what to search for in the policy document?

There are few things you can do to ensure that you buy the right Health Insurance for you and your family. It’s gonna be a long answer in the form of a question and answer session, but bear with me:

Buyer: Am looking to buy a Health Policy but don’t know much about. Which are the things I should be aware of and what to search for in the policy document?

Answer: Good that you started to look at buying a Health Insurance policy and even better that you are asking the question as to what things you should be aware of. Let me list out few pointers:

  • What does health insurance policy mean? what does it cover, what expenses does it take care of?
  • What does the sum insured mean?
  • What if the sum insured gets exhausted?
  • What are the various add-ons and / or options
  • Can we start from here?

Buyer: Certainly yes.

Answer: Health Insurance policy is an indemnity policy that seeks to reimburse the cost of expenses that you have incurred either for you or for your immediately family members. These expenses should have been incurred on account of hospitalization, in few cases treatment at home with the consent of the attending doctor. And the reimbursement will be done, provided the claim is admissible and payable.

All the Insurers provide Cashless arrangement with majority of the hospitals. So, reimbursement is a figure of speech so to say. The idea is you incur minimal out of pocket expenses. However, be aware that, prior to hospitalization, even with Cashless approval, you would have to deposit some money to the hospital, which is refundable largely.

Buyer: Thanks. But what kind of treatments are allowed? Is the policy meant for specific illnesses or medical conditions?

Answer: Health Insurance policy is by and large, illness agnostic. There are specific exclusions, and people suffering from certain medical conditions, at the time of taking the policy, they cannot take the policy.

Buyer: Could you elaborate what expenses are covered.

Answer: Generally, all the policies cover expenses incurred for In-patient treatment covering: Room Charges, OT charges, ICU Room Charges, Nursing expenses, Oxygen expenses, Anesthesia related expenses, diagnostic charges in relation to the treatment expenses. In addition, pre and post hospitalization medical expenses – that are incurred in relation to the ongoing treatment. There are some variances between the companies but broadly speaking these are the expenses.

Buyer: I understand that there are some exclusions. Could you elaborate?

Answer: There are broadly 3 types of exclusions:

     a. First 30 days, no hospitalization expenses on account of  treatment of diseases is covered except arising out of accident.

     b. Specific medical conditions are excluded either for 1 or 2 years by all the companies.

    c. Any pre-existing medical conditions are excluded for a period ranging from 2 to 4 years. Pre-existing conditions are those conditions for which a treatment / consultation was done within the last 4 years of taking the policy. My explanation here is to give you an idea but go through the individual company’s definitions of pre-existing medical condition.

Buyer: I understand that 100% of the expenses are not reimbursed.

Answer: There are expenses that are not covered such as Registration charges, taxes, consumables and like. Again, you need to check the individual insurance company’s definitions.

Buyer: What about No Claim Bonus? What is it?

Answer: No Claim Bonus is a way of rewarding the policy holder for not making any claim(s) in the previous policy year. The reward is by way of increase in the Sum Insured during the renewal. Many companies increase the sum insured by 20%, some by 10%.

Buyer: You mentioned something about add-ons and optional covers. Can you elaborate?

Answer: Sure –

     Medical Check up: many companies provide annual check up. Some companies provide it every 2 years and quite a few companies do it every 4 years
    Global Treatment: Some companies have started providing this option as well, as long as the diagnosis was done and confirmed in India.
    Companion Travel: If the insured gets sick when out of station and requires someone to be with him / her, then the cost of the travel of a relative is permitted.
Tata AIG provides for reimbursement of Bariatric Surgery
Organ Donor expenses and organ transplantation
These are some of the add ons.

Hope I have been able to understand your PoV and answered some of your questions. If you still have more questions, please let me know.


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