Life is a packaged deal of good and bad surprises, worries and challenges.Sudden illness, accidents and injuries can be a huge setback if you are not fully- equipped to deal with them.The rising hospitalization expense can drain you out financially and Emotionally, if you are not covered with a good health insurance plan. A good health insurance policy, apart from giving you extensive health coverage, also provides emotional peace and a complete sense of security.
What does a good health insurance policy should include?
There are lots of benefits which are offered under a health insurance policy. It is important to understand those benefits before buying a product. Let us look at the most important benefits which are required while choosing the right product:
- Pre & post hospitalization: You policy needs to cover pre & post hospitalization. Generally, most of the companies cover a 30 days Pre hospitalization expenses (i.E. Before the insured gets hospitalized if there are any expenses related to the diseases like doctors expenses, medical bills, pathology reports, etc. Are covered) & 60 days post hospitalization expenses (i.E. After the insured is discharged from the hospital if there are any expenses related to the diseases like medicines, physiotherapy, doctors expenses, pathology reports, etc are covered)
- Cashless hospitalization - every insurance company has a list of network hospitals which provide cashless facility when the insured is hospitalized. It is important to check the list in advance.
- No claim bonus - in case you do not claim for the current year then the insured shall provide you a no claim bonus which will either increase you sum insured every year or give you a discount on the premium.
- No capping - your health insurance policy should not have any limits on room rent, doctor expenses, opd charges, icu, etc.
Types of health insurance cover available in the market:
- Individual health insurance cover: policy applicable For single individuals.
- Family floater health insurance cover: policy is beneficial for immediate family members Like, spouse, dependent children, dependent parents, etc
- Senior citizen health insurance cover: this policy helps to cover individuals who are senior citizens or more than 60yrs of age.
- Extended family health insurance cover: this policy helps to cover up to 15 family members under one policy.
- Specialized health insurance cover: Following cover helps to take care of expense for specified illness like diabetes, hiv, etc.
Exclusions and waiting period under health insurance cover:
Every health insurance products have certain exclusions and waiting period which Are not covered under the policy. Let us list down few:-
- Initial waiting period of 30 days to 90 days
- Pre-existing conditions (it varies from 12months to 48 months waiting period)
- Maternity waiting period or waiting period for pregnancy (it varies between 24months to 6yrs)
- Specified diseases (eg, hernia, cataract, joint replacement surgery, etc) waiting period (it varies between 12months to 48months)
- Circumcision unless for treatment of a disease
- Cost of specs, contact lenses, hearing aids) dental treatment / surgery unless requiring hospitalization
- Convalescence, general debility, congenital external defects, v.D., intentional self-injury, use of intoxicating drugs / alcohol, aids, expenses for diagnosis, x-ray or lab tests not consistent with the disease requiring hospitalization.
- Any condition directly or indirectly caused or associated with any sexually transmitted disease
- Any treatment arising from or traceable to pregnancy, miscarriage, maternity, abortion or complications of any of these.
- Any treatment related to sleep disorder etc.
- Treatment of mental illness, Stress , psychiatric or psychological disorders
- Non allopathic treatments
- Any Out patient treatment
- Treatment received outside india (unless it's part of the policy)
- Act of self-destruction or self-inflicted Injury , attempted suicide
- Any hospitalization primarily for investigation or diagnosis purpose
How much cover is required?
The amount of coverage required by any individual depends on certain factors. Let us look at those factors:-
- Demographics - the city in which you live and your lifestyle that you are living.
- Family size - total number of family members & their age whom you would like to cover in the policy
- Medical history - past and current medical history of you and your family members whom you are taking insurance for
- Annual family income and expenditure
- Affordability of the premium - it is important to buy a cover keeping in mind whether you will be able to afford the premium or not, as it has to be paid on yearly basis.
One golden rule which needs to follow while buying a health insurance:-
100% of the annual income = ideal health insurance cover
Let us understand with an example:
Mr. Suresh singh annual income is rs. 15 lakhs. The ideal health insurance cover which he needs to buy is rs. 15 lakhs. In case of any emergency he will be adequately insured and does not needs to dig into his savings to pay off the medical bills.
A health cover less than 50% of your annual income is considered like a low coverage. If the annual income is on the higher side, let's say 30 or 40 Lacs, then 50% or lesser coverage will be sufficient.