Unforeseen events like hospitalisation and associated costs can derail anyone’s financial plans. With the ever-increasing cost of medical expenses, you must buy a health insurance policy with adequate cover. Therefore, it is important to understand the benefits you are receiving in exchange of the premiums you are paying.  

Let us understand the parameters to analyse a health insurance policy:

Age limit 

Your health insurance policy must not have any age limit so that you are covered for your entire life. 

Sub-Limits  

Health insurance plans usually have sub-limits on certain critical illnesses, ICU charges, room rents, Day-Care treatments and on certain other expenses. Plans with no sub-limits usually come at a higher price. Therefore, it is necessary to go through policy details.

Outpatient (OPD) expenses  

Check if the health insurance plan covers expenses incurred on OPD consultations and investigations. Claims against OPD expenses do not lead to increase in premium; neither do they affect the no-claim bonus. 

Day-Care Procedures  

These days many critical illnesses are treated in day-care and therefore, having a day-care procedure insured becomes essential. Look out for policies that cover maximum day care procedures.

In absence of day-care cover (rare), hospitalization for at least 24 hours is mandatory for claiming reimbursement for the treatment.  

Network Hospitals  

Carefully check the list of hospitals covered under the cashless scheme. Choose a plan that has maximum hospitals covered near your residence.  

Co-Payment  

Co-payment means that the insured will have to bear a certain pre-defined percentage of the total approved claim amount. Avoid policies with co-pay clause. 

Pre/Post Hospitalization  

Hospitalisation is usually preceded by investigations and consultations with doctors and some part of the treatment extends beyond the hospitalization. These form a sizeable portion of the medical expenses.

Although, this is a standard clause and is included in almost all health insurance policies, choose a plan that covers the maximum days for both pre and post.

No Claim Bonus or discounts 

Some insurance providers offer a discount if there is no claim lodged in a previous policy year and provide a top-up over base sum assured. Further, there are those who provide an increment in sum assured but with a clause that if any future claims are lodged then the sum assured will be reduced to the base sum assured of the policy. 

Refill benefits 

Refill benefit means; in case the entire sum assured under a policy is exhausted in the policy period for one illness/one member, the insurance policy will cover the insured for second illness or any illness to another member covered under the same policy.

In short; the insurer will reinstate the full amount on exhaustion of the sum insured.

For example: If the sum assured under your policy is Rs 5 Lacs and you have utilised the entire amount on a treatment. Now, if in case you are diagnosed with some other illness in the same policy period, the insurance policy will cover you for the second illness as well up to your total sum assured. 

Maternity Benefits  

This benefit may be required depending upon your life stage. If in case you are planning to start a family, this cover is a must due to rising costs associated with pregnancy.  

Other things to look out for:

• Waiting period: There is usually a waiting period before you could claim these expenses. 
• Specific exclusions:Check for any specific exclusions from the policy 
• Medical Check-ups:You should opt for a health insurance policy that provides free health check-up at least once a year to all the policyholders. 
• Ease of Claim Settlement Process: Your policy should provide easy and fast claim settlement process to the policyholder. Your focus should be on taking care of self and family rather than worrying about the claim process.