Top Things to Know Before Buying a Health Insurance Policy in India

At the time of purchasing a health insurance policy in India, prioritise a sufficient sum insured, verify the cashless hospital network in your locality and understand the waiting period for pre-existing health conditions.

Life is full of surprises, and not all of them turn out to be good, especially if it's related to our health. In the time and age we are living in, it has become important to have a health insurance policy in place. However, with a plethora of health insurance plans available in the market, sometimes one may find themselves being confused as to which medical insurance plan to go with.

Read on to learn things to know before buying health insurance, the benefits of such a plan, and common mistakes to avoid.

Things to Know Before Buying Health Insurance

If you are on the verge of getting health insurance cover and are wondering, “What things should I know before buying health insurance?”

Here’s a quick rundown of the factors that should be considered by any individual planning to buy mediclaim insurance for themselves or their family:

Waiting Period

It refers to the period during which the insured cannot raise any claim against the medical insurance. This is usually applied to any pre-existing diseases or ailments. The duration for it varies from insurer to insurer and also as per the plan chosen. Before one chooses the plan, ensure to check the waiting period on the health insurance plan.

Co-payment

It refers to the claim amount percentage that will be borne by the policyholder during a health insurance claim. This implies that the insured and insurer will split the medical bills, wherein the insurer will pay a higher sum. The smaller part will be settled by the insured. For instance, if the insured has a 20% co-pay, the insurance company will bear the remaining 80% of the claim amount. A co-pay enables policyholders to lower the premium.

Also Read: Open Enrollment for Health Insurance: A Complete Guide

Pre/Post Hospitalisation Cover

It encompasses any tests, doctor visits, treatment, and so forth that are conducted either before or after the insured is hospitalised. The terms and conditions will vary as per the insurance company and plan chosen. Generally, health insurance plans offer coverage for the expenses incurred during hospitalisation. However, check with the insurer and go with a plan that offers cover for both pre- and post-hospitalisation expenses.

Day Care Procedures

There are specified treatments that can be completed within the day itself. Those medical procedures require hospitalisation, but for less than 24 hours. So while buying the policy, ensure that such treatments are covered within the plan. These procedures could be tonsillectomy, nasal sinus aspiration, cataract surgery, and much more.

Room Rent Capping

When hospitalised, the hospital may charge a room rent for the time till the patient is admitted. In a hospital, there are different types of rooms. Right from a general ward, semi-private rooms, private rooms, and so forth, with different rent for each.

Insurance companies, at times, set a maximum room rent limit within an insurance plan, including a cap on the ICU rent rooms, too. It means if the insured chooses a hospital room with a higher rent, then the amount needs to be paid out of their pocket.

Cover for New-age Treatment

Compared to conventional treatment, there are advanced medical treatment options that are accurate and give better results. Check with the health insurer whether they offer coverage for modern treatment methods. Some of the new-age treatments include stem cell therapy, robotic surgery, etc.

Add-on Cover Option

The health insurance add-ons help to enhance the base plan. It's also important to understand how to choose only those health insurance add-ons that you need and customise the plan accordingly. Every add-on cover comes with an additional premium amount that is added to the base policy premium.

Claim Process

When choosing a health insurance plan, also research the company’s claim settlement process. A hassle-free health insurance claim process is crucial. Read customer reviews online, and do not forget to check the company’s claim settlement ratio.

What are the Benefits of Health Insurance Plans?

Health insurance policies provide a variety of advantages.

1. Financial security: Protects against major medical bills such as hospitalisation, surgery, tests, and medications, thus lowering financial difficulties

2. Peace of mind: Knowing you're insured helps you to focus on getting better rather than stressing about medical bills.

3. Easier access to care: Some plans provide cashless hospitalisation at network hospitals, which simplifies the whole process.

4. Tax benefits: Health insurance? Premiums can qualify for deductions in taxes, offering more financial comfort.

Investing in health insurance guarantees your well-being and financial security.

Also Read: Does Your Health Insurance Cover Robotic Surgery?

How Much Health Insurance Coverage Do You Need?

One of the most common mistakes people make when buying health insurance is choosing a sum insured based solely on affordability rather than actual healthcare needs. While a lower sum insured may reduce premiums, it may not be sufficient to cover rising medical costs.

The ideal coverage amount depends on factors such as your age, city of residence, family size, lifestyle, and existing medical conditions. For example, a young individual living in a tier-2 city may have different healthcare requirements than a family residing in a metropolitan area where hospitalisation costs are generally higher.

When evaluating coverage, consider:

1. Current healthcare inflation and future medical expenses

2. Family medical history and hereditary health risks

3. The cost of treatments at preferred hospitals

4. Whether the policy covers all family members or only an individual

Choosing an adequate sum insured today from Bajaj General Insurance can help avoid financial strain during medical emergencies in the future.

Also Read: Health Insurance for People Below the Poverty Line

Common Mistakes to Avoid When Buying Health Insurance

To make an informed decision while purchasing health insurance, avoid these common mistakes:

1. Purchasing a policy solely based on the lowest premium.

2. Ignoring waiting periods for pre-existing diseases.

3. Overlooking policy exclusions and sub-limits.

4. Choosing inadequate coverage amounts.

5. Not reviewing the network hospital list.

6. Delaying the purchase of health insurance until health issues arise.

Buying health insurance early in life can help you access broader coverage options, lower premiums, and shorter waiting periods compared to purchasing a policy.

Wrapping it Up

Now that you are aware of the things to know before buying health insurance, never hide any critical information from the insurer.

In case you are buying health insurance for senior citizens, declare their medical history. Go through the policy wording carefully, and in case of any queries, get them cleared. Last but not least, choose a health insurance plan that fits your budget and fulfils the requirements. If you have an existing policy, ensure to renew health insurance on time.

If you are looking for a trustworthy health insurance provider, choose Bajaj General Insurance’s comprehensive cover. The policies we offer ensure maximum benefits at an affordable premium. 

Frequently Asked Questions

1. What things should you know before buying health insurance?

Before buying a health insurance policy, you should check the sum insured, waiting period, co-payment clause, network hospitals, exclusions, claim settlement process, and coverage for pre/post-hospitalisation and day care treatments. Comparing different health insurance quotes can also help you choose a suitable plan.

2. How much health insurance coverage should I choose?

The ideal coverage amount depends on your age, medical history, family size, lifestyle, and city of residence. Considering rising healthcare costs, it is advisable to choose a sum insured that can adequately cover major medical emergencies and hospitalisation expenses.

3. Why is the waiting period important in health insurance?

The waiting period is the duration during which you cannot make claims for certain illnesses or pre-existing diseases. Different insurers have different waiting periods, so it is important to review this carefully before purchasing a policy.

4. What is cashless hospitalisation in health insurance?

Cashless hospitalisation allows policyholders to receive treatment at network hospitals without paying the entire medical bill upfront. The insurer directly settles eligible expenses with the hospital as per the policy terms and conditions.

5. Can I reduce my health insurance premium?

Yes, you can lower your premium by opting for a higher co-payment, choosing only the required add-on covers, maintaining a healthy lifestyle, and buying health insurance at a younger age. Comparing health insurance quotes from different insurers can also help you find cost-effective options.

*Standard T&C apply. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

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