The Covid-19 pandemic has made people aware of the importance of having health insurance policy. Present situation made every family to have at least minimum level of health coverage. As a result, now Health insurance companies are booking more premiums than pre-covid period. Buying a good health insurance policy may seem simple but there are a few factors involved in finding a good plan.
Here we provide some important factors that everyone should look at when buying a comprehensive health policy.
- Sub-Limits Clause
- Co-payment Clause
- Waiting Period
- Network Hospitals
- Cash Less treatment
Table of Contents
What is Sub-Limit?
Sub Limits are predetermined limits (or caps) fixed by health insurance provider for a particular disease expense, doctor consultation fee and hospital room rent. It means that if you incur charges on medical treatment beyond these limits/caps, you have to bear the expense.
For example, some of the companies provide Rs. 1.00 Lakh sum assured health insurance with sub-limits as Tonsillectomy – R. 18,000/-, Septoplasty – Rs.26,000/-, Appendicectomy – Rs.32,000/-, Hydrocele – Rs. 18,000/- etc., which means that this policy will cover only Rs. 26,000/- for Septoplasty though your sum assured is Rs. 1.00 Lakh.
However, many health insurance policies come with no sub limit. You may choose such plan, despite a little higher premium.
What is Co-payment clause?
Co-payment means that you are agreeing to pay a certain percentage of the claimed amount. Suppose your policy has a co-payment of 5%, it means you are agreeing to pay 5% of the total claimed amount while the remaining 95% will be paid by the insurance company. It is better to go for a policy with a no co-payment clause, or else you will have to pay from your pocket during claim.
What is ‘Waiting period’?
Waiting period is a certain span of time which will be given by the insurance company for covering pre-existing deceases. Before you buy a health policy, you must also look at the waiting period.
For example, let us consider you buy a health policy without checking the specific waiting period for specific diseases/treatment. Within a month, that person is admitted in hospital for Maternity treatment, in this case the Maternity treatment will not cover under health insurance as most health insurance company will include a waiting period of 2-4 years.
Normally, there are two widely prevalent waiting periods across all the policies.
One, a normal waiting period of one month when you buy a new health insurance policy. Now, for Covid-19 coverage the waiting period is 15 days.
Two, pre-existing illness waiting period which varies across insurers and policies, usually two to four years.
What is ‘Network hospitals’?
In order to avail cashless treatment during any emergency, one must check the insurance provider’s hospital network. At a network hospital, your insurance company and the hospital together will take care of the expenses related to the treatment.
What is Cashless Treatment?
Cashless treatment allows you to get hassle-free treatment at the network hospital. While buying insurance policy, you must ensure the availability of cashless treatment option. In cashless option, you no need to pay any amount diagnosis, treatment, room rent, medical expense and others within the limit of your sum insured. You will come into the payment picture only when the hospitalization expense exceeds beyond your sum insured limit.
HintIt is better to go for a policy with a no co-payment clause and no sub limit clause or else you will have to pay from your pocket during claim