What factors to consider when taking a health insurance?

What factors to consider when taking a health insurance?

The following are the factors that need to be considered when taking a mediclaim or health insurance.

Pre and post expenses: The policies usually have a time frame under which the expenses are covered. You should see for how many days prior to diagnosis of illness and for how many days post diagnosis the expenses are covered. A good policy will cover 30 days pre-illness to around 90 days post illness expenses for a claim.

Premium: There are many companies that offer these insurance policies, however you will notice that the premiums for the same sum assured will vary from company to company. Therefore, you should do a prior research about the premiums and then look for where you can save money.

Bed or per day room charges: There are policies that will mention that we cover the hospitalisation expenses only if you use the general ward, however, better services are provided to people with private rooms. So, read the documents carefully whether the policy covers the expenses, if you get admitted to a private room or ward.

Claim settlement: This is the percentage of claims that the insurance company has fulfilled i.e. they have paid the sum assured to the insured. The higher the claim settlement percentage, the better it is. So try to buy the policy which has higher claim settlement because it's no point paying a little lower premium to save money but then the claim settlement ratio is also less. In that case, the lower premium paid also goes into vain. 

Tie up with hospitals: You should aim for policies that have tie-up with hospitals that are preferable by you. This is because, the insurance company will directly pay the expenses as per the bill to the hospital and you don't have to pay anything prior from your pocket. This is called the cashless facility. In reimbursement facility, you will have to incur charges on your own, then submit all documents to insurance company and then wait for reimbursement, which is a lengthier process (sometimes 2 to 3 months).

In house claim settlement: There are many insurance companies that sell their policies, however, the part of the business where verification is done in case of hospitalisation i.e. claims settlement process may be outsourced to some third party. In that case, the customers get very irritated by all the questioning and also, these third party agencies take a lot of time to prepare the right report and it makes it difficult for the insured to get a claim settled faster. Therefore, it is recommended that you go with a company which has an in house claims settlement department, so that the process is done in the right manner and at a faster pace.

So, the above were the factors you should consider when taking a health insurance, however, when you go out for taking a health related insurance, you will come across the two terms, mediclaim and health insurance. The question that comes to the mind is whether mediclaim and health insurance are the same thing or different.

 So, let me tell you that both are different. Read below to find out the difference between the two.

A mediclaim policy is limited to the hospitalisation expenses whereas health insurance is comprehensive i.e. along with hospitalisation expenses it covers many other things such as critical illness policy wherein a lump sum payment is made to the insured on detection of critical illness, treatment or surgery cost for a specific disease,  compensation of loss of income, ambulance cost, cost of preventive health checkup etc.

In order to avail a mediclaim policy, it is mandatory to be hospitalised whereas the same is not the case for health insurance. In a mediclaim policy, you can claim multiple times till the sum assured gets exhausted, however, you can claim under health insurance for any critical illness only once.

A mediclaim policy is a reimbursement policy wherein the money spent on treatment is reimbursed to either the hospital if you have a cashless policy or to the insured if you have opted for self reimbursement. On the other hand, a health insurance policy not only includes reimbursement but also lump sum payment under critical illness policy or cancer illness policy or a policy covering any specific surgery or treatment.

These insurance policies also give a tax exemption to individuals which can be claimed under section 80D.

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