There are various factors to be considered before going solid with the type of health insurance and the insurance company. Premiums charged are not the only factor to be considered while selecting a Medical claim policy as there are many other clauses and concepts that needs a proper assessment before finalizing the decision.
1. Basic Health cover
These days, brochures of almost every type of health insurance cover offered are available over the internet. This should be read in detail to ascertain the exact treatments covered under the policy. All the defined benefits offered by the policy should be understood well. If needed, the insurer can be contacted and they can email the brochure or can have one posted to your address too. Another way is to contact agent and get a proper understanding on the exact cover offered by the policy. Reading the brochure yourself, can help double check the details provided by the agent.
2. Avoid comparing premiums
It is a common practice to get quotations from 2-3 different health insurance companies and compare the premium that is to be charged. Health Insurance is long-term purchase and it is more than a New York-Alaska Air Ticket, which you can compare and buy from comparison / aggregator websites.
Health Insurance is a long-term complex contract coupled with complex services. Comparison of premiums could be largely misleading and could result in a disaster. Comparing Health Insurance requires deeper insights into the overall insurance contract (called policy wordings) over and above price comparison. Either you need to get yourself into comparing the features in detail, or take help of an unbiased health insurance adviser.
3. Maximum Renewal Age Limit
Maximum Renewal age is the age at which the coverage on your health insurance would discontinue. This could be for all members or for a specific proposer/member, depending on the product you choose. Remember, your core goal, when you buy Health Insurance is to save yourself from mounting healthcare costs all through your life. A product, which ceases renewal at an early age or while you are still alive and it the time when you need assistance from such health insurance the most, is not a suitable product. So, avoid buying policies that ceases health insurance at an early age. Shift through all products and find out the maximum renewal age. Better, look for Lifetime products. Rule out all products, which do not cover your family members for a reasonable lifetime. As medical science progresses and becomes more accessible to the common man, life expectancy in India will move higher from the current average of around 70 years. A product with a lower renewal ceasing age than 70 years can be blindly avoided.
4. Limit of Treatments
Treatment wise limits basically cap the amount you can claim for a particular surgery under the policy. Say, there could be limits for Cardiac treatments of $2000 or for Cataract for $1500 per eye. Such limits would cap your claim, even n when you have a large sum insured under the policy. You need to weigh this in, before you sign up. It is very important to know what all treatments are not forming part of the policy!
5. Cash Limit
There are some products marketed and sold as Health Insurance which provide a daily cash benefit for the number of days one is hospitalization. Most surgeries require an average of 6-10 days, so at the $100 per day limit multiplied by 10 Days would pay $1000 per hospitalization, irrespective of the actual charges incurred. An Angioplasty in this will unknowingly burn a big hole in your pocket. Please avoid this product for your core healthcare expenditure risks or as an alternative to a Standard Health Insurance product. This product is more like an add-on cover, than the bigger solution.
6. Switching to a higher Sum Assured
Since this is a long-term product, you should look at the maximum available cover you can afford. Remember, a sum insured of $2000 to $3000 will have no value, by the time you start using it. The option of upgrading the cover at a later stage when you are older is dicey and complicated. There could be a requirement for a medical test. Moreover, if you or any of the family members contact a new disease in the interim, the ailment would be excluded for the upgraded amount. Upgrade would be almost like taking a new policy at that age, which I would not recommend.
7. Insurer credibility check
If it is a new company, you could look at the history of the promoters and their businesses. Generally, a company or set of promoters known for their ethics and excellent governance, venturing out into Insurance would be a decent bet. Get information from your adviser, on the overall claims experience, on responsiveness, about changes and number of changes in the product, since it was launched. Too many or too large changes, indicates there could be more tomorrow.
8. Network of Hospitals
In the case of hospitalization, the hospital to be visited should be listed on the Network of Hospitals. The quality of services provided by any such network hospital should also be considered. It is important to know that in the event of hospitalization, the medical treatment and facilities will be up to the mark. Such list is commonly available on the health insurance company website, or this information can be gathered by contacting the help desk.
9. Relation between the Insurance Company with the Network of Hospital
It’s important to note, how fast the Insurance company makes the settlement with the Hospital in case of cashless hospitalizations. The Insurance Company may provide cashless hospitalization, but if the Insurance does not settle the Hospitals claims on time or only has a partial payout, then there’s high possibility that the hospital will increase billing to the insured to claim the amount. If the company pays the claims on time and in full, then the Hospital would not try to increase the bills as they know that particular insurance company is a prompt paymaster.
10. Ensure to have a good Adviser
Ensure you spend good time in deciding, who is your intermediary. Once you have taken pain to finalize a good adviser, you are more than half way done. A good adviser is one who would provide:
- Unbiased advice, without any special affiliation to any Insurance Company.
- Provides Routine services like Pickups, Renewals etc.
- Assists and Guides you at the time of Claims.
Health Insurance industry is witnessing huge changes both in products, price as well as processes, being an insider, it is sensible to have an expert on your side, who updates you on changes, their impact on your coverage and suggest change in course, in case necessary.