Buying Health Insurance Online? Check These Conditions Before You Pay

Buying health insurance online may feel hassle-free and full of choices, especially when you are able to curate your own plan. With a sea of choices, selecting a health cover online goes beyond comparing premiums or the coverage amount. Many buyers focus on the coverage and benefits shown on insurance websites, but miss out on the important details in the policy document. These conditions can make a big difference when they need to file a claim.

Check Room Rent And Treatment Limits

Some health policies set a daily limit on how much the insurer will pay for a hospital room. If the patient chooses a costlier room, they may have to pay the extra cost themselves.

There are some specific treatments, such as cataract surgery, which can have a fixed limit even if the total coverage is Rs 10 lakh. Therefore, before buying any policy, buyers should crosscheck whether the benefits vary across hospitals within the insurer's network.

Says Abhishek Bansal, CEO, Insurance Business, InsuranceDekho: "Buying a Rs 10 lakh health insurance policy does not necessarily mean that every hospital bill up to Rs 10 lakh will be paid in full... Some policies also have tiered hospital networks, where the benefits or costs can vary depending on the hospital chosen.”

Check What The Policy Document Says

The benefits shown on an insurance company’s website may not match the terms of the policy a customer finally buys. The actual cover amount depends on the options selected and the conditions mentioned in the issued policy document.

For instance, a website may advertise a plan with no room rent limit, while the policy document mentions a cap. In such cases, the insurer will generally settle the claim according to the terms in the issued document.

Adds Bansal: “Insurance websites generally highlight the maximum benefits available under a particular plan. However, the benefits that a person finally receives depend on the features they have selected while purchasing the policy. This is why checking the issued policy document is important.”

Buyers should compare the policy document with the information shown during purchase. They should also save screenshots, brochures and emails as proof. If they find any difference, they should contact the insurer or intermediary for an explanation.

Policyholders get a 30-day free-look period to review the policy and cancel it if they are unhappy with the terms. The insurer may deduct certain charges before refunding the premium. If mis-selling is established, consumers can seek a full refund. They can also approach the Insurance Regulatory and Development Authority (Irdai) through Bima Bharosa if the insurer does not resolve their complaint.

Check Waiting Periods And Your Share Of Expenses

Buyers should also understand when their coverage starts and how much they may have to pay themselves.

“Consumers should look beyond the headline coverage amount and understand when benefits become available and how much they may need to pay themselves...they should check how the policy defines pre-existing diseases, the applicable waiting period and any specific conditions governing related treatment,” Bansal adds.

Co-payments and deductibles can also reduce the amount paid by the insurer. Under a 20 per cent co-payment, the policyholder must pay Rs 20,000 on an admissible claim of Rs 1 lakh. The insurer pays the remaining amount, subject to policy terms. A deductible is the amount the customer must pay before the insurer starts paying.