Things to know before buying a Health Insurance Policy

Choosing the right health insurance policy for you and your family becomes a difficult task when there are a lot of options available. Many insurance companies are providing different types of Health Insurance policies in India. While so many insurance companies and their health insurance policies create difficulty in selecting right health insurance policy, the policy terms and conditions/policy wordings/policy clauses add more to the confusion. Though buying health insurance is a difficult task you can consider below mentioned points to finalize your decision in buying a suitable health insurance plan for you and your family.

Coverage amount/Sum Assured

One should select the right insurance amount considering one's age, number of family members and past medical history, if any. Choosing coverage amount carefully helps in the times of uncertainties. Healthcare cost are on the rise, many treatments cost in lakhs of rupees and therefore one should choose a considerable coverage amount to avoid future problems. An adequate Sum Assured is always beneficial as compared to a small coverage because now a days medical treatment like Kidney Failure, Heart Disease, etc. costs large amounts.

Protection for entire family

You should always consider all the family members while looking for a health insurance policy. Floater policies are considered as a good option in covering the entire family members under a single health insurance policy. There are many companies which allow coverage for Husband, Wife up to 3 children, Parents and Parents in laws in a single policy.

Sub limits on treatments

Many insurance companies apply a sub limit on certain treatments. A sub limit in a health insurance policy is a condition where the insurer puts a cap on claim amount for certain treatments. For example, If you buy a health insurance policy for Rs. 10 Lakhs sum assured and if there is a sub limit of Rs. 50,000/- for treatment of cataract in a single year for one eye and Rs. 75,000/- for treatment of cataract in a single year for both eyes. Then you can get a maximum of Rs. 50,000/- if there is cataract surgery for one eye and Rs. 75,000/- for both eyes.

Co-payments

Co-pay is a term in which the policy holder needs to pay a specified percentage of claim amount. It is an arrangement where in a policy is issued with a specified percentage of claim amount to be borne by the policy holder. For example, Mr. A bought a health insurance policy of Sum Assured of Rs. 10 Lakhs where there was a co-payment clause of 20% of admissible claim amount. Subsequently there was an approved claim of Rs. 2 Lakhs in the same year. Therefore Mr. A had to bear Rs. 40,000/- (i.e 20% of Rs. 2 Lakhs) and the remaining Rs. 1.6 Lakhs were paid by the insurance company.

Cashless claim facility

Cashless claim settlement is a facility where the hospitalization expenses incurred by the policy holder are paid by the insurance company directly to the network hospital. It may however be noted that, to avail the cashless facility, the hospital where the policy holder has done his/her treatment should be empanelled as a network hospital of that particular company.

Cumulative Bonus

Exclusions

One should be aware that there might be some Exclusions in a particular policy. Some policies might exclude certain treatments or procedures from coverage. The clauses of Exclusions may vary from Exclusions for ranging from One or Two Years to Permanent Exclusions. Some common exclusions in a health insurance policies are Cosmetic Procedures, Sexually transmitted diseases, Dental Treatment unless arising due to an accident, Deliberate Injuries and more.

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