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Financial Planner - Answered on May 23, 2024

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Asked by Anonymous - May 09, 2024Hindi

I am totally confused as to which health insurance plan to buy for my family. What are the most important pointers I must know before buying a mediclaim? I want total cashless insurance. My friends tell me that many insurance companies don’t cover all the claims. How will I know about that?

Ans: Choosing the right health insurance plan for your family is crucial, and it's understandable to feel overwhelmed by the options. Here are some important pointers to consider before buying a mediclaim policy:

1. Coverage and Benefits:

• Inpatient Hospitalisation: Ensure the plan covers hospitalisation expenses, including room charges, doctor's fees, surgery, and nursing.
• Pre and Post-Hospitalisation: Look for coverage of medical expenses incurred before and after hospitalisation.
• Daycare Procedures: Check if the policy covers treatments that don't require 24-hour hospitalisation.
• Domiciliary Treatment: Verify if home treatment is covered if hospitalisation is not possible.
• Maternity and Newborn Benefits: If relevant, look for plans that cover maternity expenses and newborn care.

2. Network Hospitals:

• Cashless Facility: Ensure the insurer has a wide network of hospitals offering cashless treatment. This means the insurer pays the hospital directly, reducing your out-of-pocket expenses.
• Hospital Network Size: The larger the network, the better your chances of finding a network hospital near you.

3. Claim Settlement Ratio:

• Research: Check the insurer's claim settlement ratio, which indicates the percentage of claims settled against the total claims received. A higher ratio is preferable.
• Customer Reviews: Look for reviews and testimonials regarding the insurer's claim settlement process.

4. Exclusions and Waiting Periods:

• Pre-existing Diseases: Understand the waiting period for pre-existing conditions.
• Specific Treatments: Check for exclusions related to specific treatments or conditions.
• Waiting Periods: Be aware of initial waiting periods, disease-specific waiting periods, and maternity waiting periods.

5. Sum Insured and Sub-limits:

• Adequate Coverage: Choose a sum insured that adequately covers potential medical expenses.
• Sub-limits: Be cautious of sub-limits on room rent, specific treatments, or diseases, which can limit your claim amount.

6. Premiums and Deductibles:

• Affordable Premiums: Ensure the premiums fit your budget without compromising on coverage.
• Deductibles and Co-payment: Understand any deductibles or co-payment clauses which require you to pay a portion of the expenses.

7. Additional Benefits:

• No Claim Bonus: Some policies offer a bonus for each claim-free year, which can increase your sum insured.
• Free Health Check-ups: Look for plans offering periodic health check-ups.
• Restoration Benefits: Check if the policy offers sum insured restoration in case it gets exhausted during a policy year.

8. Portability and Renewability:

• Policy Portability: Ensure the policy is portable, allowing you to switch insurers without losing benefits.
• Lifetime Renewability: Opt for plans offering lifetime renewability to ensure coverage in older age.

9. Customer Service:

• 24/7 Support: Check if the insurer provides round-the-clock customer support.
• Ease of Process: Evaluate the ease of buying, renewing, and claiming processes.

10. Regulatory Compliance:

• IRDAI Approval: Ensure the insurer and the plan is approved by the Insurance Regulatory and Development Authority of India (IRDAI).

11. Steps to Verify Coverage and Claims:

• Policy Document: Read the policy document thoroughly for detailed coverage, exclusions, and terms.
• Brochures and Websites: Check the insurer’s official website and brochures for detailed information.
• Customer Service: Contact the insurer’s customer service for any specific queries.
• Independent Reviews: Look for independent reviews and ratings on insurance comparison websites.
• Friends and Family: Gather feedback from friends and family who have experience with the insurer.

By carefully evaluating these factors, you can make an informed decision about the best health insurance plan for your family that meets your needs and offers comprehensive coverage.

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.