Six important things to know while buying health insurance in 2021


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Amid the coronavirus pandemic, having a health insurance policy is a must. These policies protect your savings from any unexpected expense arising from medical treatments.

Such a policy generally covers expenses incurred on pre- and post-hospitalization, room rent, ambulance facility, doctor’s fee, and cost of medicines.

Also Read | How India’s banking model has changed

Thus, having the right health insurance policy can provide you with much-needed financial assistance in case of any medical emergency. In this context, here are six important things that must be kept in mind while buying a health insurance policy.

Company’s reputation of claims settlement

Higher claim settlement ratio is one of the most critical factors to be considered while selecting the insurance company. If claims are not paid in time, or cashless approvals are not approved, then the policy is useless for the customer. Claims settlement ratio numbers are publicly available or you can check with your intermediary.

Salient features of the policy

The policy should provide an overall protection for diseases, injury and chronic illnesses. For this, it is imperative that one checks the policy terms and conditions.

Pallavi Roy, executive vice president (product development), IFFCO Tokio General Insurance said, “An effective medical insurance would offer comprehensive insurance coverage. Pre-existing diseases are not covered, and that should be borne in mind while purchasing health insurance. The best way is to check the salient features of the policy. Check whether it is available for individual or family. A floater policy covering all family members will be ideal. There are policies that can also provide cover to the members of the extended family such as blood relatives.”

Deductions in claims

In some cases, insurers may impose some deductions in the final claim amount such as co-pay or sub-limits or treatment in non-network hospitals. Roy says, “While checking the salient features pay attention to whether there is a co-pay which means you have to share a part of the claim, sub-limits which means if there are any limits like room rents or limits on certain surgical procedures, if treatment is availed in a non-network hospital, some insurers may deduct a certain percentage from the payable claim amount.”

Premium based on towns and sum insured

The premium payable will depend on the sum insured, where the sum insured is the maximum value that an insurer can pay for a year in case one is hospitalized. Any amount above the sum insured will have to be taken out from your own pocket. “While there is no ideal sum assured for health Insurance policy for an individual, there are two market-broadly-accepted rules on its quantum. First, your health coverage should be at least 50% of your annual income,” said Roy.

Network of hospitals

It will be a good idea to check the network of hospitals provided by the insurer. Network hospitals are those hospitals that provide cashless claim settlement mode because of their special arrangement with the insurer or TPA. The policyholder can just walk in and walk out of the hospital without paying anything for the treatment or room charges. They may have to pay only nominal charges that are not covered under the policy like consumables, special diet, toiletries, and registration charges if any.

Complementary covers

Roy said, “Most working individuals in blue-chip companies feel secured as they and/or their family is covered with their employer’s group health cover. But what happens if you leave the job or are laid off? Suddenly you will be left without an adequate health cover. So, it is better to have complementary covers such as critical illness benefit cover if you have basic health cover from your employer or top-up cover if the group health cover sum insured is not adequate.”

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