5 Points to Check in a Health Insurance cover

The COVID-19 pandemic has put a spotlight on protection. The death and destruction caused by COVID-19 have triggered even the skeptics and fence-sitters the need to buy the inevitable. But with so many options available, it can get confusing to find the perfect health plan for yourself and your family. Do not worry though, we have made it easier! Here is a quick checklist of the 5 things that you can consider when buying your health plan:

Premium and coverage 

Sum insured is the maximum coverage offered by a policy. Premium is the amount paid either monthly or yearly to avail of that coverage. It is essential to choose this with the utmost care, as medical inflation has pushed up the healthcare cost significantly. You should buy a policy that offers adequate coverage, without compromising on the benefits and at a premium that you can afford. Check if there is an additional clause of co-payment, deductibles, and sub-limits, and if it is then you would actually end up paying more at the time of claim. 

Network of hospitals and pre/post coverage

Health insurance companies usually have a tie-up with network hospitals where the members can avail of cashless treatment in case of a medical emergency. This is helpful because it saves people from the tedious paperwork required at the time of admission and claim. Thereby saving you from having to arrange funds first and then filing for its reimbursement. When comparing health insurance plans, make sure to find one that covers medical costs incurred regardless of whether it is before or after your stay in the hospital. You’ll save money if you opt for a plan that covers the expenses from ambulance rides, diagnostic tests, prescriptions, and doctor’s visits without requiring you to pay anything at all.

Claim settlement ratio

This is the most critical factor to look for while sorting out the insurance company. Claim settlement ratio (CSR) is the % of claims that an insurance provider settles in a year out of the total claims. It acts as an indicator of their credibility. The higher the ratio, the greater the chances of your claim being settled. All the insurers publicise this ratio on their websites. But it is advisable to recheck it from IRDAI publishing.

Co-payment clause

Another important metric to look at is the co-payment clause. It refers to the amount you need to pay from your pocket, with the insurer settling the remaining for you. For instance, if your health policy has a 10% co-pay and the bill amounts to Rs. 10,000, then you have to pay Rs. 1,000 from your pocket, while the insurer will pay the rest Rs. 9,000. There are also some sub-limits of payment under the clause. Read thoroughly before you sign for it.

Claim process and waiting period clause

When searching for a healthcare provider it’s important to ensure that there’s a good understanding of all the policies relating to payment and reimbursements, particularly if they vary from other organizations. So, you can compare and choose a plan that comes with a minimum waiting period to be able to claim the benefits in case of a health emergency. It makes sense to take some time to read online reviews, talk directly with the health providers involved and hire professionals who are known for conducting their business in a professional way.

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