The Essential Guide to Choosing The health insurance – which one to take?
By Tushar Rahangdale · Published · Updated
Health insurance is an important consideration to prevent unexpected costs in case of hospitalization of your family members. In that sense health insurance provides protection of your accumulated wealth. Nowadays a small surgery or hospitalization etc., can put a dent of a few lakhs in your saving. Therefore, health insurance acts as a crucial financial tool that provides protection against the high costs of medical care.
However, identifying the right health insurance is a difficult task if you do not know the standard and special features or coverages that come with it.
Who do you want to buy health insurance for: If you are getting health insurance from your employers group policy, check if it covers your spouse and children, does it include your parents, what is the coverage offered under your employer’s medical policy etc., based on this, you can conclude if you want family floater policy and who should be added in that or should you buy separate policy for parents etc.
Sum insured: Based on your general health of the family health history, assess how much amount of coverage you want. Nowadays, some insurance companies offer cover up to 1cr at very affordable costs.
Health Risks: Consider the potential health risks associated with your lifestyle, occupation, or location. Certain activities or professions may expose you to higher health risks.
Standard Coverages:
Double Benefit: Look for polices which give 2x times the sum insured from day 1, which means if you buy sum insured of 5 lakhs from premium perspective you get double coverage of 10 Lakh from day 1. For example, HDFC Optima Secure, which offers 4x times the sum insured from Day 1.
Restore Benefit: Some policies offer to restore your sum insured amount to base sum insured during the year after the claim is made with cap up to 100% of the sum insured. For example, if you have taken base sum insured of 10 lakhs then even after claiming 10 Lakh, policy will cover another 10 lakhs. Please look for nuance to see if this extra restore is offered for same individual of the family, same cause and both. For example, Reliance Health Infinity & Care Supreme and many more.
Sum Insured Protection: If you do not make claims in the first year, then some policies offer double the sum insured next year, some even go as high as 10 times the base sum insured in 5 years, if no claims are made. For example, in a 10L sum insured case if there is no claim made for 5 years the sum insured increases to 1cr with same premium or marginally higher premium.
Hospitalization expenses: cover your hospitalization expenses such as room rent, ICU, investigations, surgery, doctor consultations etc. due to illnesses and injuries seamlessly
Mental Healthcare: we cover hospitalization expenses incurred for treating mental illnesses.
Pre and post hospitalization expenses: Most policies allow prehospitalization expenses up to 60 days before the date of admission and post-hospitalization expenses up to 180 days after discharge from the hospital. These are covered only when hospitalization occurs.
Day care treatment: Some medical surgeries are wrapped up in less than 24 hours or without hospitalization most policies cover these also.
Home Healthcare: Most claims are settled directly with hospital in case of Home Healthcare for medically necessary treatment of Illnesses, if prescribed by treating medical practitioner, are also paid by most policies.
Preventive health checkup: Most insurance companies offer regular health checkups free of cost based on plans, some offer from day 1 and some offer after 1 year.
Ayush Benefit: Select insurers offer covers for alternate therapies like Ayurveda, Unani, Siddha, and Homeopathy etc.
Claim Process:
Cashless: After the hospital discharges the patient, the bills and discharge summary is sent to the insurance company by the hospital. If that hospital is in the list of network hospitals for the insurance companies, then the company pays the hospital directly and you are not required to pay anything from your side, barring policy exclusions.
Reimbursement: Certain hospitals are not in the list of the network hospitals of insurance companies in which case you pay the bills and settle payment, then you submit those bills and discharge summary to the insurance companies and claim the amount.
Tax Benefits:
Health insurance premiums are eligible for tax deductions under Section 80D of the Income Tax Act in India, providing tax benefits.
Look for Discounts:
Many insurance companies offer discounts if you pay premium for 2 years and 3 years upfront. Normally you get a 7.5% discount if you pay 2 years premium and get 10% discount if you pay 3 years premium.
Long-Term Planning:
Health insurance is not just about immediate needs; it's a long-term financial planning tool. Evaluate your long-term financial goals and how health insurance fits into your retirement planning.
Government Schemes:
Explore government health insurance schemes available in India, such as Ayushman Bharat. Depending on your eligibility, these schemes can provide financial assistance for medical expenses.
Conclusion:
Health insurance is an asset that can provide financial security and peace of mind, particularly in a country like India with rising healthcare costs. Assess your health, financial situation, family needs, and use the above pointers to select the right health policy for you. It's advisable to consult with a financial advisor or insurance expert to make an informed decision that aligns with your unique circumstances and long-term financial goals.
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