As per a NITI Aayog report in March 2021, Indians spent a staggering $45 billion on medical expenses in 2015–2016, paid from savings or borrowings. By 2020, this number had jumped to an even more significant $72 billion. The rising cost of healthcare, especially since the onset of the pandemic, has made it crucial for each of us to consider health insurance.
Here are 10 essential points to keep in mind before you decide on a health insurance policy:
- Checking Claim Settlement Ratio (CSR):
- The CSR is the ratio of settled claims to the total claims filed during a financial year. Look for an insurance company with a CSR above 85%—a good sign of efficient claim processing.
- Websites like policybazaar.com and Digit provide CSR information.
- Waiting Period:
- New policies typically have a 30-day waiting period during which hospitalization charges are not covered.
- Be aware of specific waiting periods for pre-existing diseases (e.g., thyroid, blood pressure, diabetes) that can extend up to 48 months.
- Exclusions:
- Understand what medical expenses are not covered by your health insurance. Common exclusions include cataract, hernia, congenital internal diseases, and certain treatments.
- Exclusions may vary across products and companies.
- Cashless Hospitalization Coverage:
- Check if your insurance company has tie-ups with network hospitals. If you receive treatment at a network hospital, you won’t need to pay hospital bills directly.
- Verify the list of partner hospitals before purchasing insurance.
- Capped Expenses:
- Some policies have a maximum limit on the number of claims you can avail within a year.
- Review expense capping for room rent, ICU charges, ambulance fees, etc.
- Co-payment Clause:
- Co-payment is the percentage of the claim amount borne by the policyholder during a claim.
- Consider the trade-off: higher co-pay lowers premiums but increases out-of-pocket expenses during claims.
- Add-ons:
- Add-ons enhance your policy. Options include room rent waivers, maternity coverage, AYUSH treatment, and critical illness cover.
- The total premium for add-ons cannot exceed 30% of the original premium.
- Family Floater Policy:
- A family floater covers the entire family’s hospitalization expenses under one sum insured.
- It’s often more cost-effective than individual policies for family members.
- No Claim Bonus (NCB):
- NCB rewards claim-free years by increasing the sum insured.
- Check the policy wordings for NCB details.
- Grievance Resolution:
- If you’re dissatisfied with services, escalate grievances to the Integrated Grievance Management System (IGMS) by accessing www.igms.irda.gov.in.
- You can also register complaints via email or phone with the Insurance Regulatory and Development Authority (IRDA).
Remember, choosing the right health insurance ensures financial security during medical emergencies. Stay informed and protect yourself and your loved ones!