Stop fretting over and follow our instructions to get the best protection for yourself as well as for your family members
The news of uncertainty and death all around triggered by the second wave of the Covid-19 pandemic has convinced even skeptics and fence-sitters of the need to buy a health insurance for themselves and their family. Amid the spectre of financial ruin, a comprehensive health insurance is the prudent way to ride out this calamity.
Buying a health cover, though, required meticulous planning. So, what are the factors you need to keep in mind to make an informed choice? Let us find out.
1. Sum Insured
Sum insured is the maximum coverage offered by a policy. It is the amount up to which the insurance company provides coverage if you are hospitalised within the policy term. It is essential to choose this with utmost care, as medical inflation has pushed up healthcare costs significantly. What seemed adequate yesterday may not suffice today. If you live in a metro, hospitalisation for even a couple of days can run bills into lakhs. Hence, make sure to choose an optimum sum insured, so that you don’t end up incurring out-of-pocket expenses.
2. Network of Hospitals
This is another essential consideration. It refers to hospitals with which the insurer has a tie-up, and where you can avail cashless treatment. It’s vital to ensure your insurer has a wide network of hospitals under its ambit, including some close to your residence, so that you can avail top-notch facilities in an emergency without worrying about funds.
3. Coverage for Covid
With rising Covid cases, it is paramount that your health insurance policy offers coverage for expenses incurred due to SARS-CoV-2. Note that Insurance Regulatory and Development Authority of India (IRDAI) had directed all insurers to provide hospitalisation coverage due to Covid under regular health policies, and to settle claims quickly. Still, it is better to read the fine print and get clarifications before buying a plan, to avoid shocks later. Also, do find out if the insurer provides additional coverage for expenses incurred on home treatment, as many Covid patients undergo treatment in home isolation. Do also find out if your policy would reimburse costs of PPE kits, oxygen cylinders, ambulance, etc. in case of hospitalisation.
At the same time, do consider add-on benefits such as tele-consultation, ambulance assistance, virtual consultation, etc., as these are really handy.
4. Claims Settlement Ratio
Claims settlement ratio refers to the percentage of claims settled by the insurer against claims received. Higher this ratio, greater the chances of your claims being settled. Almost all insurers publish this key metric on their websites.The IRDAI also publishes this data every year. Obviously, you should go for an insurer with a high ratio.
5. Co-pay and Sub-limit Clauses
Co-pay refers to the amount you need to pay from your pocket, with the insurer settling the remainder. Sub-limit is the cap on expenses such as room rent, doctor’s consultation fee, etc., to prevent misuse.
For instance, if your health policy has a 10 per cent co-pay and the bill amounts to Rs 1 lakh, you will need to pay Rs 10,000 from your pocket, while the insurer will pay the remaining Rs 90,000.
If the policy has a sub-limit of Rs 1,000 on room rent per day, and you stay in a room amounting to Rs 1,500, then you need to pay the extra Rs 500. A health policy with low co-pay and high sub-limit commands a higher premium.
The Final Word
Lastly, while buying health insurance, do provide accurate details of your pre-existing conditions. Concealing any information could lead to rejection of a claim later on.
The author is Chief, Claims, Underwriting & Reinsurance at ICICI Lombard General Insurance Company Limited