Medical Insurance
A comprehensive medical insurance is an important safeguard to ensure a financial cover in case you need to avail medical care. Some working professionals only use the corporate medical plan that is offered by their employers. However, it is always prudent to have a personal plan as well which comes in handy post retirement. Also, you might need medical insurance for your dependent parents who are retired. We are sharing 5 important clauses in the insurance plans that you need to be aware of and tips on how to select the best medical insurance plan suitable for you.
1. Co-payment : Medical insurance plans in India have a Co-payment clause. This clause means you have to foot a percentage of the invoice amount. Depending on the policy, co-pay could be 10%, 20% or more which means that you will have to pay that percentage of the total bill even if you have enough coverage in your policy. It is best to avoid policy with co-payment terms.
2. Room Rate Cap: Some insurance policies have a cap on the allowable room tariff that can be claimed. If you exceed this limit, the additional amount will be borne by you. However, the catch here is that all in-room services claimed will also be proportionally deducted.
Eg) If your policy has a cap of Rs. 3000/- and you opt for a room of Rs. 4000/- (exceeding by 25%), this 25% penalty will be applied on all in-room service expenses. You might feel that upgrading the room for a small amount of Rs. 1000/- is sensible, however, be prepared for a hefty deduction from claimed amount. Avoiding room rate capping is a good way how to select medical insurance plan.
3. Pre and Post Hospitalization Expenses: You generally will not plan to get sick. You will do some tests, diagnosis which will lead to your hospitalization, surgery, etc. After discharge and during your recovery, you have to deal with medications, followup tests. Often, the cost before and after hospitalization is substantial. Best medical insurance plans cover these pre and post hospitalization expenses.
Tip: Always keep ALL medical receipts, prescriptions and reports for at least 1 year. Do not throw these away. It will help to have the receipts if you want to claim prehospitalization expenses.
4. Waiting Period: If you have a pre-existing illness (diabetes, heart issues, cardio-vascular issues, chronic issues, etc) then you will have to go through a waiting period before you can start to claim expenses incurred from these illnesses. Better pick a policy which has a less waiting period so you don’t have to wait too long. The waiting period duration is an important criterion of how to select a good health insurance plan.
Tip: Always disclose such conditions. Do not try to hide or misrepresent facts.
5. Restoration Benefit: In some policies your cover amount is restored once a claim is made. Imagine you are hospitalized, and your complete policy sum insured runs out and later you or a member of your family falls ill. Without restoration benefit you would have had to foot the bill completely for the second hospitalization. Multiple restorations might not be offered by most policies but you can get at least one in a year which can come handy.
All these rules might bump up your premium a bit, but help you immensely if, god forbid, you or your loved ones need hospitalization. The whole thing about insurance is that it is your safety net and you need to make it as strong as possible. Always remember you might think - “I will never need this feature so no sense in unnecessary inflated premiums”, but if you are lucky enough the need one of the features that you excluded in your insurance, you will repent later.
A comprehensive medical insurance is an important safeguard to ensure a financial cover in case you need to avail medical care. Some working professionals only use the corporate medical plan that is offered by their employers. However, it is always prudent to have a personal plan as well which comes in handy post retirement. Also, you might need medical insurance for your dependent parents who are retired. We are sharing 5 important clauses in the insurance plans that you need to be aware of and tips on how to select the best medical insurance plan suitable for you.
1. Co-payment : Medical insurance plans in India have a Co-payment clause. This clause means you have to foot a percentage of the invoice amount. Depending on the policy, co-pay could be 10%, 20% or more which means that you will have to pay that percentage of the total bill even if you have enough coverage in your policy. It is best to avoid policy with co-payment terms.
2. Room Rate Cap: Some insurance policies have a cap on the allowable room tariff that can be claimed. If you exceed this limit, the additional amount will be borne by you. However, the catch here is that all in-room services claimed will also be proportionally deducted.
Eg) If your policy has a cap of Rs. 3000/- and you opt for a room of Rs. 4000/- (exceeding by 25%), this 25% penalty will be applied on all in-room service expenses. You might feel that upgrading the room for a small amount of Rs. 1000/- is sensible, however, be prepared for a hefty deduction from claimed amount. Avoiding room rate capping is a good way how to select medical insurance plan.
3. Pre and Post Hospitalization Expenses: You generally will not plan to get sick. You will do some tests, diagnosis which will lead to your hospitalization, surgery, etc. After discharge and during your recovery, you have to deal with medications, followup tests. Often, the cost before and after hospitalization is substantial. Best medical insurance plans cover these pre and post hospitalization expenses.
Tip: Always keep ALL medical receipts, prescriptions and reports for at least 1 year. Do not throw these away. It will help to have the receipts if you want to claim prehospitalization expenses.
4. Waiting Period: If you have a pre-existing illness (diabetes, heart issues, cardio-vascular issues, chronic issues, etc) then you will have to go through a waiting period before you can start to claim expenses incurred from these illnesses. Better pick a policy which has a less waiting period so you don’t have to wait too long. The waiting period duration is an important criterion of how to select a good health insurance plan.
Tip: Always disclose such conditions. Do not try to hide or misrepresent facts.
5. Restoration Benefit: In some policies your cover amount is restored once a claim is made. Imagine you are hospitalized, and your complete policy sum insured runs out and later you or a member of your family falls ill. Without restoration benefit you would have had to foot the bill completely for the second hospitalization. Multiple restorations might not be offered by most policies but you can get at least one in a year which can come handy.
All these rules might bump up your premium a bit, but help you immensely if, god forbid, you or your loved ones need hospitalization. The whole thing about insurance is that it is your safety net and you need to make it as strong as possible. Always remember you might think - “I will never need this feature so no sense in unnecessary inflated premiums”, but if you are lucky enough the need one of the features that you excluded in your insurance, you will repent later.
Comments
Post a Comment