There can be no bigger pain than knowing that you cannot afford medical treatment to save the life of an ailing family member. There can be no bigger sense of relief than knowing that you have adequate health insurance to tide over medical emergencies. Close to 85 percent of financial crises stem out of medical emergencies; the rising medical costs can not only throw your financial goals out of gear, they can puncture your present lifestyle too.
Rising healthcare costs warrant the need to take a comprehensive heath cover so that we are insured against medical emergencies. It makes sense to get a health cover early in life, especially before hitting 40, because post that age, most insurers increase the cost of premiums, as well. It is equally important to choose the right kind of health cover, so that you get optimum protection. Here are some of the features that you should consider when you choose a health insurance plan
1. Network hospitals – These are hospitals that have a direct association or tie-up with the health insurance company. The benefit of having network hospitals within the fold of a health insurance cover for you is that you can avail of the cashless facility, where you do not have to spend anything out of the pocket. You do not have go the reimbursement route, wherein you end up paying to the hospital directly and then claim the money from insurance. In this case, the health insurance company settles the bill directly. So look for a health insurance plan with a maximum network of good hospitals in or near your area.
2. Sub-limits on room rent – This is one feature that most people tend to overlook when they choose a health insurance. Some health plans put restrictions on the room rent limit one can choose, during hospitalization. This is normally 1 percent of the sum assured. So, if a person has an insurance policy of Rs. 5 lakhs, then the room rent that he can avail of during hospitalization should not exceed Rs. 5000. If he shifts into a room that charges Rs.8000 as room rent, the insurance company will only pay for the room-rent based on Rs.5000 (his eligible room-rent amount). Also, all ancillary charges like surgery costs, doctor’s fees, medical tests, etc; that vary with the kind of room you select, will also be proportionally deducted during claim settlement. So ideally look for health insurance plan with no sub-limits.
3. Co-payment – In co-pay insurance policies, you have to pay part of the medical expenses, regardless of the sum assured. So, if you have a health insurance with a 20 percent co-payment clause, it means for a claim amount of Rs. 1 lakh, you will have to fork out Rs. 20,000 from your pocket, while the insurance company pays the remaining amount. Ideally go for a health insurance plan that does not have a co-payment clause.
4. Pre-existing disease – Most insurance companies do not cover pre-existing diseases from day 1. There is a waiting period which can be anywhere from two to four years before you can file a claim for conditions that arise out of pre-existing diseases. Go for a health plan that covers pre-existing diseases and entails a low waiting period.
5. Premiums – While most people look at the premium to be paid, it should not be the central part of your decision making process when you apply for a health insurance. There is no sense in paying less premium and then finding to your shock (that too when you are recovering) that your insurance claim cannot be settled because the condition was not covered in your policy. Instead pay more emphasis on maximum coverage of all diseases and conditions and keep the above mentioned point in consideration, while choosing a health plan.