National Health Accounts estimates that in India, 61% of the healthcare services are financed out-of-pocket. This expenditure has driven 55 million Indians into poverty in 2017, a number higher than the entire population of Spain, South Korea, and Kenya. The situation presses the need to relook at the state of healthcare services in India.
The continuous pressure of a stressful lifestyle, environmental pollution, and food contamination exposes you to a variety of health-related threats. As a protective measure, buying a health insurance policy comes second only to leading an active and disciplined lifestyle. While it can’t defer the inevitable, a health insurance policy provides a financial cushion to combat medical contingencies.
But before you get into a contract with your health insurer, you should consider:
The size of the cover
The cost of removing a cataract can cost you around Rs. 70,000 for each eye and the expenses for heart surgery can be around Rs. 4-5 lakh in India. You should go to an insurance plan that offers maximum coverage. It is also crucial to factor in medical inflation.
While calculating the sum insured, consider your age and marital status. The risks to your health tend to go up with age, and you may begin to be prone to various lifestyle diseases like hypertension, diabetes, kidney-related ailments, etc. The protection of your health plan should be extended to your spouse as well.
Today, insurers provide online calculators to precisely determine the coverage amount and the premium payable for the same. They require the input of a few necessary information.
Entitlement for No Claim Bonus
Check whether your plan offers no claim bonus. NCB is a discount that you can avail in case you have not registered any claim against your health insurance policy. Depending on your insurer, the no claim bonus may increase your sum insured or decrease your premium or both.
The spectrum of coverage
Health insurance policies with pre/post-hospitalization facilities take care of the expenses incurred both before and after hospitalization, for the treatment of a particular disease. It may include consultancy charges, cost of medicines, investigations, and follow up procedures.
For example, in the case of knee surgery, your plan with pre/post-hospitalization facility may cover the consultancy charges of an orthopedic and the cost of surgical procedure. Post-operative physiotherapy and medication may also be financed.
Availability of network hospitals
Ease of access to healthcare is essential. Check whether the hospitals that you usually visit are under the network coverage offered by your health insurance policy. With the option for cashless facilities available, network hospitals enable you to avail of quality healthcare across India.
The protection needs of your family
By ensuring all the family members under a single umbrella, a family floater plan eliminates the need for individual policies. You can avail complete health coverage for your family at a reduced premium, and higher sum insured.
Waiting period for a pre-existing illness
Insurers lay down certain conditions for the treatment of an ailment existing before availing the health insurance policy. Generally, you have to wait for 2-4 years before you can register such a claim. It is advisable to choose a plan with a minimum waiting period.
Mind the list of exclusions
It is essential to understand the medical conditions that are not covered by your health insurance policy. Diseases and procedures like Hernia, Gastric, and dental treatment may be excluded.
Addition of riders
For an extra premium, the riders for critical illness or accidental death significantly augments the scope of your health insurance policy. Such riders extend your plan to offer protection against a list of life-threatening ailments such as cancer and heart attack.