You will not need any other advisor once you read the below !!
<aside>
Fact Box
Once an individual is diagnosed with any critical illness or accident; getting a good health insurance will be next to impossible.
You must buy a separate health insurance even if you have a company provided insurance, corporate policy will not serve you life long !
You save LOADING charges (30-40%) when you are healthy; make compounding your friend !!
Medical inflation is recorded at 10-14%, Getting good treatment is very expensive.
</aside>
<aside>
Waiting Periods
Most of the health insurance will have these waiting periods;
1️⃣ 30 Days initial waiting period: Only accidents covered
2️⃣ Two Year Waiting for Slow Growing Illness like Cataract, Kidney Stones …..
3️⃣ Three Year Waiting for pre existing diseases; can be reduced after paying money to the insurance company
</aside>
<aside>
Exclusions
Majority of the health insurer’s don't cover maternity cost, OPD expenses, dental, fertility treatments, weight loss procedures …….
Look for PERMANENT Exclusion in the policy wordings to get the complete list.**
</aside>
<aside>
Premiums
1️⃣ Premiums will increase with the change in age brackets or every year depending upon the insurance company.
If your Premium increases every year, expect an increase of 3-5%
If you premium increases with age brackets, expect an increase of 15-20%
2️⃣ Along with age related premium increase, Insurers will also increase premiums due to inflation.
3️⃣ If you have diseases while taking the policy, premiums can be increased 30-40% to accommodate the risk. These are known as LOADING CHARGES.
</aside>
<aside>
Premium Reduction
There are ways to reduce premiums up to 40% using the deductibles. Ping me if you wish to know more about the deductibles.
Using deductibles will not be recommended by big online aggregators as it affects their commissions!
</aside>
<aside>
Room Limit
Never select any plan that has a room rent limit; period !!
A room limit will stop you from accessing better services and insurer will recall the policy of “PROPORTIONATE DEDUCTION” during the claim.
Example, if You have opted a room rent limit of ₹1,500 per day but You go in for a room with a rent of ₹4,500 per day which is three times the allowed limit, when You claim, We will pay one-third of the Total bill amount and deduct the balance i.e. in the same proportion as it increased. This is because the other charges related to Your treatment like Doctor’s fees, also increase with the room type. This deduction will not be applicable for the cost of medicines and consumables.
</aside>
<aside>
Disease Limit
Avoid all the plans that have disease limits like 50K for Cataract; 100K for Knee Replacements; 250K for Cancer …..
Medical costs will always increase every year, you must not get restricted and get full benefits of the premium that you pay !!
</aside>
<aside>
Bonus
A good plan should have great bonus structure without any strings attached like “CLAWBACKS” or “ NO CLAIM” condition.
Usually you get 25% or 50% of the base cover as bonus from second year up to 100% or whatever is mentioned in the policy wording.
Most of the new age plans provide you bonus even if you make claims !!
Claw-back: The bonus that was provided by the insurer is taken back if you present any claims.
</aside>
<aside>
Restoration-Refill-Reset
Always purchase plans that have unlimited restoration or reset feature and avoid plans that have COMPLETE RESTORATION or DIFFERENT ILLNESS clause. If you want to know more about restoration, feel free to ping me.
Restoration is always done only on the base cover.
Let me explain you restoration with an example: Lets assume Mr. Rahul has a sum insured of 10 Lacs and he uses 7 lacs in a hospitalization, so technically for the next hospitalization only 3 lacs would be left. Now if your plan has RESTORATION feature, for the next hospitalization, you will have 10 lacs available instead of 3 Lacs. This feature is especially beneficial for a family floater plan.
</aside>
So these were some some of the basic features that you should know while purchasing a plan, below information is good to know !
<aside>
Co Payment
Avoid all plans that have co payment as much as possible if you are below 60; Co payment means that you will share a 10% or 20% of the final hospital bill.
</aside>
<aside>
Consumables
The cost of medical supplies such as syringes, gloves, bandages … are not covered in the health insurance plans, its a great addition if your plan covers consumables. This typically ranges between 5-10% of the final medical bill.
</aside>
<aside>
Lifelong Renewal
You should be able to renew your health insurance for lifelong, some of the plans from various platforms and banks are group health insurance.
The premiums may look attractive in group plans but features can change or plans can be withdrawn at short notice . Always ask for a retail health insurance plan.
</aside>
<aside>
Pre-Post Hospitalization
Usually health plans have benefits of 60 days pre and 180 post hospitalization. All the expenses leading to the admission and post discharge procedures related to the same illness will be covered under PRE-POST hospitalization.
You can only claim incase of admission deemed necessary, if you get admitted to hospital as a precaution, the expenses will not be covered.
Incase of planned treatments; always get pre authorization from the insurance company.
</aside>
<aside>
Day Care Procedures
Most of the health insurers cover day care treatments, for example cataract, dialysis, chemotherapy.
Check if there is any approved list for day care treatments, your plan should cover all day care treatments and not a restricted list.
</aside>
<aside>
Reasonable & Customary Clause
Insurer follows a policy to check the STANDARD cost of treatments in a particular geographical area, if the insurer feels that the cost of treatments are inflated or unnecessary, Only a part of the claim amount may be paid. There are doctors who work in the insurers team that approves the claim.
</aside>