Things to Check Before Buying Health Insurance Policy

Health insurance serves as an agreement between the policy buyer and the insurance provider which says that the insurer will provide the insured with financial coverage that is equivalent to the specified sum assured. A health insurance policy essentially offers financial coverage to account for the cost of hospitalization and more in case of a medical emergency. Having a health insurance policy also entitles policyholders to claim tax benefits on the premiums paid under Section 80D.

Read along to learn more about what is a health insurance policy and what one needs to check before buying one.

Which Things Are Not Covered in a Health Insurance Plan?

Policy buyers need to know the exclusions of a policy to make a better assessment of its scope and limitation. 

While the list of exclusions may vary among insurance providers, these are some of the most common ones that are not included in health policies -

• Pre-existing illnesses are subject to a waiting period of  2- to 4 years
• Claims raised within 30 days after getting a health insurance plan are not covered. However, an exception can be made in case of an emergency
• Injuries resulting from war, terrorism, and nuclear activity
• Self-inflicted injuries and suicide attempts 
• Terminal illnesses, AIDS, or any other fatal ailments
• Cosmetic or plastic surgery, hormone replacement surgery, and similar procedures are not covered
• Common disease and rehabilitation 
• Eye surgery or dental surgery 
• Treatment or diagnostic testing
• Injuries resulting from any adventure sports

Things Covered Under a Health Insurance Policy

A leading health insurance policy tends to cover the following expenses. Make sure to check your policy in detail before you sign the document -

In-patient Hospitalization Charge: Health insurance plans in India typically cover the medical expenses incurred during hospitalization for an injury or any illness. However, the reimbursement amount would be only provided if the insured patient stays in the hospital facility for over 24 hours.

Pre-existing Illnesses: After the waiting period of the health insurance policy, individuals can also claim their expenses for pre-existing illnesses or any medical conditions.

Pre and Post-Hospitalisation Charges: Besides covering hospitalization expenses, leading health insurance plans also cover both pre- and post-hospitalization charges. These charges include pre-hospitalization expenses on blood tests and x-rays, as well as medication and preventive health check-ups that follow after discharge. 

Ambulance Fees: Emergency ambulance fees are also included in most health policies, although the amount of coverage could vary significantly depending on the choice of insurance provider.

Maternity and Preventive Coverage: Maternity coverage is included in most leading health insurance plans in India, which cover medical expenses related to pregnancy, delivery, and comprehensive newborn baby care. Some insurance providers also offer insured individuals preventive health check-ups, helping them to diagnose health issues early. 

Day-care Procedures: Daycare procedures include eye surgery, routine dialysis, and other health procedures that do not require hospitalization of the insured for more than 24 hours.

Home care Coverage: Leading health insurance plans also cover the costs of availing timely medical care at the insured’s home on the recommendation of a qualified doctor.

Besides these, many health insurance plans cover medical costs one incurs while availing Ayurveda, Siddha, Homeopathy, or Unani treatment. However, the cost is subject to a predefined limit. Such policies also account for mental illnesses named under the provision of the Mental Healthcare Act, of 2017. Besides the inclusions and exclusions, individuals should make it a point to check the features accompanying the health insurance plan. 

Things to Pay Attention To Before Getting a Health Insurance Plan

Individuals need to check these details carefully to compare leading insurance policies effectively and make an informed decision that works out in their favor. 

• Scope of Coverage

When selecting a health insurance plan, it's crucial to know what is health insurance policy coverage and choose one that comes with extensive coverage. Make it a point to look for insurance plans that cover hospitalization charges, critical illnesses, entire maternity expenses, major surgeries, and other medical needs.  

• Sum Insured 

Sum insured is an important factor to consider when buying an insurance policy. With inflation rates on the rise, it's important to choose a health policy with a minimum value insured of a minimum of Rs 10 lakhs and a sum of a maximum of Rs. 1 crore. Notably, the higher sum insured amounts on family floater health policies or senior citizen insurance policies will provide the insured with better coverage.

• Waiting Period Clause

When purchasing a health insurance policy, it's vital to know the waiting period clause of the chosen plan. This means that the insurance policy will become effective only after a certain period of buying the plan. During this waiting period, insurance claims for anything other than an accidental hospitalization may end up getting rejected. To avoid this rejection, it's best to choose a health policy that comes with a shorter waiting period.

• Network of Cashless Hospitals

It is important to look for insurance policies that come with a wide network of hospitals in your nearest area where they can lodge a cashless claim. The more hospitals in the policy network, the better the insured’s chances of availing of cashless hospitalization perks.

• Policy Type

When looking for a health insurance plan, you must select a policy that meets your specific needs and requirements. There is more than one type of policy to choose from, including individual health insurance, family floater plans, senior citizen health insurance, and critical illness policies. You may also consider opting for a comprehensive top-up plan to extend your insurance coverage if the sum insured gets used up during ongoing treatment. For senior citizens, it would be wise to get a health policy that caters to their needs and does not affect their retirement plans.

• Check the Claim Settlement Ratio

A claim settlement ratio is essentially a measure of the insurance provider’s ability to settle claims successfully. It shows the percentage of cases the provider settled out of the total claims it received in a year. It is recommended that one opts for an insurance provider with a strong claim settlement ratio that is over 80%. 

Hence, when selecting a health insurance policy, it's vital to assess one’s needs to make an informed decision. Keeping these discussed factors in mind, individuals can select the best insurance policy for their coverage needs.