Medical costs and the complexity of diseases keep increasing by the day. A minor surgery can cost you anywhere between Rs 30,000 and Rs 60,000, while a cardiac treatment can cost you Rs 5 lakh, depending on the city and hospital you choose. One way to handle this rising cost is by taking a medical insurance policy in your name. In India, there are more than 25 companies offering various medical insurance policies. However, most of these policies are complex in nature and one plan never fits all. Hence, it is very important to note that you have to understand your individual needs in order to choose the right insurance plan. Here are a few points that will help you do this.
- Company– There are 28 general insurance companies in India that offer health medical insurance plans. It is very important to know the company’s background, management, network of hospitals, claim process (in-house or third party) and claim settlement ratio before choosing the right plan. It is best to choose a general insurance company for your health insurance, rather than a company that offers life and general insurance. This is because the cost for health insurance policies is higher when life insurance companies offer them.
- Inclusions and Exclusions– It is very important to note that pre-existing diseases are not covered during the initial years of the policy. Also, there are a few medical procedures like dental surgery, hernia, etc. which are excluded in the first few years.
- Sublimit– To tackle the rise in health care costs, insurance companies have introduced sublimit clauses. The most common sub limits are room rent, doctor’s fees and diagnostics. For example, if you are taking a plan for a sum assured of Rs 2,00,000, the insurer may cap the room rent to the extent of 1%-1.5% of the sum assured, or Rs 2,000 per day, whichever is higher. If it exceeds the specified limit, then you have to pay the balance.
- Co-payment– Co-payment means the fixed percentage of the total bill which you have to pay in case of a claim. This percentage is already defined in the policy document. The co-payment clause is around 10% or 20% for such policies. For some policies, it can go as high as 40%.
- Renewal age– Most PSU companies and certain public insurance companies provide medical insurance policies with a renewal age of up to 70 or 80 years. It is to be noted that diseases may increase with old age and so, medical costs may be higher. Hence, it is important to have medical insurance at an older age.
- Coverage– If you are unmarried, it is better to take an individual policy. Health insurance policies offer a provision to add new family members at a later stage. If you are married with kids, then it is best to opt for a family floater policy that will cover you, your spouse and your kids. It is ideal to have a separate senior citizen policy for your parents, if they have crossed 60 years of age. This is because the cost of a family floater would be decided on the basis of the highest age of the person in the family and hence, taking such a policy with a senior citizen in it would skyrocket your cost
- Cost– Ideally, the cost of the policy should be given least importance while buying medical insurance. If the policy provides you all the benefits and if the cost is a little higher, it is ideal to look at the cost benefit analysis and to take the same as it is worthwhile to pay the cost for the benefit you get.