A guide to choosing the health insurance you need

However, many policyholders believe that insurers should cover all their claims. It is not. Insurers only pay out claims based on what is written in the insurance policy. In addition, they follow the guidelines already established by the General Insurance Council (GIC) of India for settling such claims.

Here are some ways to help you get more money from your health plan.

Basic health tips: Most health insurance plans come with a deductible, known as super-up plans. In such plans, there are limits (deductibles) on premiums. Before your health plan can fully cover your medical expenses, you must reach that limit.

Depending on your plan, your annual deductible can be several thousand or lakhs of rupees. In other words, the cost-sharing strategy often works on cost-sharing. It means that the process does not have a full cost; only that portion is covered based on your deductible.

However, the health plan covers all types of medical expenses without any deductible. It covers a lot of medical expenses, including the cost of hospitalization, etc., without the owners having to pay the expenses out of their own pockets.

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A multi-year health plan: When you purchase a multi-year health policy, the premiums remain the same throughout the term of the policy. This way, you are protected from any changes in the insurance policy during the period the policy is in effect. In most cases, policyholders have to pay premiums for up to three years at a time. Therefore, the increase in the cost of insurance will not affect you for three years.

Prawal Kalita, managing director, Marsh India, said healthcare costs are on the rise. One of the advantages that a multi-year contract offers is the lock-in that one gets when making such policy decisions. “However, you have to weigh the financial benefits and the long-term policy benefits when choosing,” said Kalita.

Terms and Conditions: The insurance documents provide a detailed explanation of the terms and conditions of the policy that can be on several pages, regardless of whether it was purchased online or offline. Many policyholders avoid going through the documents because they are too wordy, and this can be very expensive at the time of appeal.

Decision to rent rooms: Some expenses are unavoidable if you are hospitalized and these include fees paid to surgeons, consultants, medical expenses and medical fees, etc. Most of these are fully covered by your health plan, except for your co-pays. to the ward or room you are admitted to. Insurance policies limit the amount that can be paid for this. If the insured person lives in a room with a higher rent than what is mentioned in the insurance policy, it may result in a deduction from the price.

Ankit Agarwal, CEO and co-founder of InsuranceDekho, said that many insurers often allow basic or private rooms under health insurance. “You should always choose a room for rent that meets the limits set by the insurance company. Otherwise, you can opt for a policy without having to rent a smaller room or choose to go for additional cover at an additional cost. It is important to ensure rent limits in health insurance,” said Agarwal.

Co-payment decision: This refers to a clause in which the insurer agrees to pay a fixed percentage of the premiums because most health insurance policies do not provide additional fees.

Agarwal said, “you should choose a health insurance that does not have a co-pay section. Besides, health insurance usually does not cover maternity, dental, and eye care or treatment. It also does not cover medical treatment caused by drinking alcoholic beverages, voluntary organ donation, etc. In some cases, it is better to choose additional covers. For example, you can add maternity cover to your policy to cover expenses related to maternity.

Loan repayment schedule: No insurance can fulfill its purpose until it provides the right amount of compensation to the policyholders. Indraneel Chatterjee, co-founder of Renewbuy said, “There is a big question mark on the branch-driven mindset even today. It is better to move to a fee-free environment.”

“Most of the time, insurers tie up with network hospitals. Because of this partnership, they can often discount drug prices for policyholders if they provide non-cash payments. Insurers and network hospitals only offer discounts on non-cash services because this helps them deal with the funds they need for several planned surgeries,” said Abhishek Bondia, CEO and Managing Director, SecureNow.in.

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