10 Things to Look at While Buying Health Insurance

Health insurance is one of the best solutions to manage the expenses of medical problems. But people may avoid buying health insurance unless they need a financial backup for medical treatment. Instead of buying insurance at the last minute, be prepared with good coverage to ensure a smooth sail through the medical emergency.

So, If you are planning to buy a health insurance policy, you need to be aware of the policy terms also these 10 things to look at while buying health insurance.

1. Premium and Coverage

A policy with a lower premium might be beneficial if it provides comprehensive coverage at a price you can afford. The other benefit is a lower rate for insurance coverage. So, the best strategy is to investigate the causes for a lower premium, which should not come at the expense of insurance coverage.

Check to see whether there are any additional co-payment, deductible, or sub-limit clauses. If there are, you will wind up paying more at the time of claim. You should get the insurance that provides enough coverage without sacrificing features and at a cost, you can afford.

2. Cashless hospitalization

Another important factor you need to consider while buying your next policy is to check if your preferred hospitals are part of their network hospital’s list. You need to make sure that the insurance company has tie-ups with the network hospitals which are easily accessible to you. Also, this should be taken into serious consideration when you are based in a non-metro city.

While receiving treatment from a network hospital, there is no need to worry about making financial arrangements at the last minute. The health insurer pays the hospital bills directly, relieving the Policyholder of the financial burden. Especially if the treatment is unplanned, the primary focus should be on saving time and effort in order to achieve greater and greater efficiency.

3. Individual Policy vs Family Floater Plan

The first and foremost thing to decide on when planning to buy a health insurance plan is whether to enroll in a family floater plan or an individual policy. People with families must make sure whether they want to cover all the members under individual health plans or under a family floater plan where all members share the same policy.

Ideally, individuals with spouses and dependent kids should have health insurance coverage under a family floater plan, as it is much more economical. However, if the kids are above the age of 25 years, they must be covered under individual health plans.

An important thing to remember is that if you have dependent parents and they are not covered under any health insurance scheme, it is suggested to buy a separate plan for them and not cover them under your family floater plan. And this is because, first, under a family floater health plan, the premium of the policy is always calculated considering the age of the eldest member. Thus, covering your parents within your family floater plan may cost you more.

4. Specific treatments and diseases

Medical insurance plans list some specific illnesses and treatments for which coverage is available after a specified duration. For instance, in many plans, coverage for piles, fistula, hernia, etc., is available only after the first 2 policy years. These ailments are called specific diseases. Reach out to the insurance company if you are unsure about this coverage being offered.

5. Network of Hospitals

The network of hospitals allows you to avail yourself of cashless treatment. Under the cashless feature, you can take treatment during hospitalization at any of the network hospitals without having to pay anything from your own pocket. However, if you do not take treatment at a network hospital, you will have to first pay for the hospitalization expenses from your own pocket and later the bills have to be submitted with the insurer to get reimbursement which then becomes a lengthy process.

In addition, arranging for a hefty amount while suffering from hospitalization crises can prove to be a major challenge for most families. To avoid such a situation, always make sure to buy a health insurance plan with the maximum network of hospitals within your city of its proximity.

6. Claim settlement ratios

The reason we buy health insurance is to ensure that the insurance company comes to our aid when we need treatment. You don’t want to be in a position where the insurer rejects your claim or only approves a small amount of the claim. You need a policy wherein you can get maximum coverage.

An excellent way to check the legitimacy of an insurance provider is through their claim settlement ratios. You can find the details of the claim settlement ratios on the insurance provider’s website. You can even see the number of claims settled the number of days taken to settle a claim and check the pending claims.

7. Right Time to Buy

Insurance premiums are calculated mainly based on age. Therefore, the earlier you start, the more you save in your annual cash outflows. If you have started earning, you must consider buying insurance first. If you are a homemaker looking for medical insurance you can be a part of the family health plan that most insurers offer. These family plans are good bargains and money savers.

If you are a senior citizen exploring senior citizen insurance plans, choices may not be vast, but you must act quickly. Youngsters should not delay buying insurance because as you age you risk falling ill and paying a higher premium for the same coverage. Preventive health checks are important at all ages and some policies bundle annual health check-ups as part of their offering.

8. Maternity benefits

With medical expenses on the rise, pregnancy costs have skyrocketed as well. It is vital for women to buy a health insurance plan that offers maternity benefits. For maternity benefits, one should look into the waiting period applicable for claiming maternity expenses and consider the sub-limit. The policy should also cover outpatient expenses and check for exclusions related to the policy.

9. Co-pay clause

This clause is, usually, applicable in health plans if coverage is granted for an individual aged 60 years and above. The clause represents a portion of the claim which is payable by the policyholder himself. The insurance company settles the remainder of the claim only.

For instance, if a policy has a 10% co-pay ratio, 10% of every claim would be borne by you and the company would pay for only 90% of the amount. Co-payment is applicable in each and every instance of claim and so you should be careful. If you are buying a policy for senior citizen parents or if you yourself are more than 60 years of age, the co-payment clause might be applicable in the policy. Find out the co-pay rate. The lower the rate the better it would be for you.

10. The waiting period

The waiting period is the time when you cannot raise a claim against the health insurance plan. It is usually applicable to pre-existing diseases and maternity benefits. It can stretch from 9 months to a few years, depending upon the insurance company and the plan that you are looking to purchase. Do check the applicable waiting period on your health insurance plan before buying.

Conclusion: While buying health insurance, you must ensure that you get your money’s worth. After all, insurance premiums are high, and you may not need to file an insurance claim for many years. As such, it is essential to consider all the points mentioned above and make an informed decision while buying health insurance.