Health Insurance 12 Points Check List

12 POINTS CHECKLIST FOR BUYING HEALTH INSURANCE
1. The Right Combination of Premium and Coverage

It can be lucrative to buy health insurance with the lowest premium. But there can be two
sides to it. A policy with a lesser premium can be good if it is offering you extensive coverage
at a premium that you can pay. The other aspect is lesser premium at the cost of the insurance
coverage.
So, the best approach is to look for the reasons behind a reduced premium, as it should not
be at the cost of the insurance coverage. Check if there is any additional clause of co-payment,
deductibles, and sub-limits, and if it is then you would actually end up paying more at the
time of claim.
You should buy a policy that offers adequate coverage, without compromising on the benefits
and at a premium that you can afford.
2. Waiting Period
A waiting period is the time you need to wait before you can make a claim for some or all
benefits of your health insurance policy.
This waiting period and its terms and conditions will vary from company to company. Usually,
there is an initial waiting period of around 30 days after which you can actively start using
your health insurance (except for accidental hospitalization). There are also specific waiting
periods for pre-existing diseases, maternity benefits, and for certain other ailments
3. Pre-existing Diseases
Pre-existing diseases or conditions are any disease or health condition that you already have
had symptoms of or have been treated for within 48 months before you got your health
insurance policy. These can range from serious conditions like cancer or diabetes to high
blood pressure, or asthma.
Depending on your age and the disease or condition, there is usually a 2-4 year waiting period
before a pre-existing condition is covered.
When it comes to pre-existing diseases, it’s best to be as transparent as possible! Include all
the diseases and treatments you would need covered in your health insurance policy so that
your insurance provider won’t reject your claims later
4. Inclusions and exclusions of the plan

The coverage of the health insurance plan (inclusions) and the conditions against which a
claim cannot be made (exclusions) determine the scope of the policy. You must have total
clarity about both before purchasing health insurance. Being unaware of the coverages can
lead to an increase in out-of-pocket expenses. And being unaware of the exclusions can lead
to claim rejection
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5. Specific Treatments and Diseases

Medical insurance Plans list some specific illnesses and treatments for which coverage is
available after a specified duration. For instance, in many plans, coverage for piles, fistula,
hernia, etc., is available only after the first 2 policy years. These ailments are called specific
diseases. Reach out to the insurance company if you are unsure about this coverage being
offered.
6. Coverage of Maternity Expenses

Ignoring the maternity benefits in a health insurance policy is a common mistake that a lot of
people make. With the cost of delivery and maternity care already hitting the roof, it is better
to buy a health plan that covers maternity expenses as well. Usually, there is a waiting period
of 2 to 4 years before you can claim the benefits. For instance, if you are planning to get
married or are planning a family let’s say after three years then a plan with a waiting period
of 2-years will work for you.
Choose a plan that also covers newborn baby medical expenses apart from the delivery cost.
Also, do not forget to check the limitations that are attached to it.
7. Day care procedures

Nowadays, certain medical treatments are completed within a day. Thus, it is important to
ensure if such treatments are covered under your health insurance plan. These are small
medical procedures like cataracts, tonsillectomy, etc
8. Sub-limits
A sub-limit is a pre-determined cap that is placed on parts of your claim amount by the
insurer. These sub-limits won’t be applicable to the entire bill amount, but rather to certain
conditions. The three main types of sub-limits are those placed on:
• Hospital room rent – your insurer will usually cover the room rent per day, but only
up to a certain limit, usually between 1–2% of the sum insured, or some other fixed
amount of money.
• Treatment of certain diseases – common and pre-planned procedures, such as
kidney stones, cataracts, piles, gallstones, hernias, tonsils, or sinus are often subject
to a sub-limit clause, where your insurer will only bear a certain percentage of the bill
for these treatments.
• Pre- and post-hospitalization charges – if your policy covers pre-hospitalization
expenses and post-hospitalization expenses, these may also be subject to a sub-limit.
So, at the time of claims, you can only make a claim for the amount set out by the sub-limit
clause, and beyond that, you need to pay out of your own pocket

9. Cashless Health Insurance

Instead of getting your hospital bills reimbursed from your health insurer after your
treatments, a cashless health insurance is where after you get the required treatment at a
Network Hospital, your health insurer will take care of the bills directly. You don’t need to pay
any cash out of your own pocket.
All you need is an approval from your insurer or third party administrator, and the costs will
be taken care of between the hospital and your insurance company
10.Free Medical Check-up

You should look for a policy which insures the person for a free medical check-up. However,
this does not affect the premium when policies undergo renewal
A medical insurance plan is your best help during times of medical emergencies. Consider
these 10 points before you buy one
11.The co-payment clause

A lot of people find this term confusing and tend to ignore it at the time of purchase. It is
basically the percentage of the amount that you would need to pay at the time of claim and
the rest will be paid by the insurer. So, before you sign your mediclaim policy check if there
is any co-payment clause applicable that might impact your claim amount. If possible buy a
plan that does not have sub-limits. However, if you have any pre-existing medical issues or
have crossed a certain age limit most insurers would have a co-payment clause.
12.No-Claim-Bonus/No-Claim-Discount
NCB refers to the discount offered by the insurance company for all the years that you have
not filed a claim. Basically your coverage amount is increased at the time of subsequent
policy renewals for all claim-free years.
However, most health insurance provides specify the NCB limit. And the increase in the sum
insured would depend on the limit that is specified by the insurer


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12 POINTS CHECKLIST FOR BUYING HEALTH INSURANCE

1. The Right Combination of Premium and Coverage

4. Inclusions and exclusions of the plan

You can compare Health Insurance by clicking on the link below 1

5. Specific Treatments and Diseases

6. Coverage of Maternity Expenses

7. Day care procedures

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9. Cashless Health Insurance

10.Free Medical Check-up

11.The co-payment clause

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