How To Select The Right Health Insurance Policy
July 23rd, 2010 | 
Author: How To Select The Right Health Insurance Policy
A health insurance policy provides protection against high medical expenses and it is also an important taxsaving tool. Policyholders do not have to bear the cost up to the amount of the insurance cover taken and they can save their tax under Section 80D of the Income Tax Act 1961. Selecting a particular health policy requires checking out the various details from different insurance companies and then making a decision. Here are several factors that need attention while buying such a policy:
Coverage of Hospitals
One of the first things that have to be considered while selecting a particular insurance provider and its policy is the coverage of hospitals relevant to you. Just having a tieup with a large number of hospitals is not enough there has to be adequate hospitals that are present near your area of residence so that the required treatment can be taken. At the same time hospitals covering various areas of medical treatment also have to be included. This is the reason why the coverage of the hospitals with which the insurance company and its third party administrators have a tieup has to be checked. So figures like 3000 plus hospitals covered and so on are meaningless till the actual spread and quality are considered.
At the same time the overall coverage across the country also has to be checked because sometimes there might be a situation where there has to be an admission to a hospital elsewhere and this should also be possible. Usually an insurance company reimburses money when the necessary treatment in an emergency has to be taken at a hospital that is not a part of its tieup list but any conditions about exclusions here also need to be checked.
Exclusion in Policy
Most people pay attention to only the amount of the health insurance policy and the premium to be paid but another factor that plays a very important role in the entire issue is that of the exclusions in the policy. Exclusions refer to the conditions that will not be covered by the policy. This is known only after reading the fine print of the policy but once again very few people even ask about this point. There are several important diseases that are excluded from the policy some of which include HIV cancer and so on. At the same time most policies for females also exclude costs related to pregnancy. All these details have to be known before any decision about the purchase of a policy is taken. This is necessary to ensure that the insurance company does not disallow some of the expenses.
In several cases a health insurance policy says that if there are already existing diseases and these are intimated to the company then they will be covered after a specific number of years say 2 years or 3 years. There are also conditions where some diseases even if not intimated to the insurance company are covered after a certain period of existence of the insurance policy is complete. Clarity on these issues and a shorter time period for coverage of existing diseases are in the interest of the policyholders.
Cashless Facility
There has to be the facility of cashless insurance available at a large number of hospitals with a particular insurance policy. While most insurance companies will say that we offer cashless insurance there are often conditions under which the process is not followed and the reimbursement method has to be adopted. This has to be considered because the insurance company can very well say that for a particular hospital or area there is no cashless insurance as has happened in several cases.
This factor is important because suddenly you will be required to ensure that initially the amount of treatment will have to be paid by you and then the amount can be claimed back. This can also take a lot of time and there will also be conditions under which the amount is disallowed increasing your burden. The larger the coverage of the cashless facility the better it is for you.
Age Coverage and Premium
The age till which the insurance company provides you with the necessary health cover is essential. For a young person this might not seem to be important because every company seems to be rolling out the red carpet but the situation changes as the years pass by. The longer the age for coverage the better it is. Many insurance companies will cover you only till the age of 70. Others will continue to cover you if you remain with them even after passing the specific age. The longer the time period for which cover is available the better it is so that you are not denied the coverage when it is needed the most.
There are several companies that have raised the premium significantly for those who are either senior in age or who have made a claim. The rise is even 200300 per cent in a year. This creates a lot of pressure and problems in maintaining the policy and hence the premium policy of the company also calls for a careful perusal.
Other Factors
There are several other factors related to the health insurance process that needs attention. For example the number of days for which expenses will be provided pre hospitalisation and post hospitalisation needs to be considered. In this case too the longer the period the better it is for you. Another issue that has come up in recent times is that of sub limits where specific expenses are restricted to a specific sum. For example there are policies where there is a condition that every day you will be paid up to Rs 5000 for doctors fees and Rs 2000 of room rent and so on. This has to be considered carefully to see whether it is feasible because in such cases even if you remain within overall limits if your expense exceeds these figures a part of your claim will not be given. Some policies also cover the ambulance cost during a treatment.
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