Understand finer points in health insurance

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Buying health insurance policies in current times is essential. We don’t know when one might need them. But while buying health cover we should also look at he fine print of the policy. But normal policies use such complicated and difficult words that it becomes impossible to understand. But here are some points which can be looked at.

Health insurance expert Bhakti Rasal says that it is crucial to check for coverage details, premiums, policy limits, claims process, and renewal/termination clauses in the policy. A good starting point is to read the key definition section, which explains all the terms used in the document. Thereafter, read these sections to better understand your health insurance.

First comes coverage details. Pay close attention to the diseases covered and waiting periods, since you won’t be covered by your insurer right away. There are 3 types of waiting periods. First is a standard, 30-day period. Except for claims related to a road accident, no other claims will be accepted.

Second comes the waiting period for pre-existing diseases. Say you have been suffering from diabetes since before buying the policy. So, any claims related to diabetes will be accepted by your insurer only after this time has passed. As per IRDAI, this duration cannot exceed 48 months.

Thirdly, there’s a waiting period for specific diseases and procedures. For instance, some policies come with a 3-year waiting period for joint replacement surgery, 2-years for operating cataract and covering kidney failure, which requires dialysis. All insurers specify the waiting period and the specific diseases they will begin covering only after this period has lapsed.

Next, check what are the inclusions and exclusions offered by your policy. Inclusions tell you what will be covered, while exclusions list what will not be covered. Some common exclusions include injuries sustained during adventure sports, cosmetic, weight-loss surgeries.

Another important section is that of policy limits. In this section, you will find the maximum amount the insurance company will pay for a particular service or treatment. This is important because, if ignored, these limits can drain your pockets. These are generally applicable on room rent, ambulance cover, pre and post hospitalization expenses.

Also check the clauses related to Premium and Co-payment. Take note of the frequency of premium payment, whether it needs to be paid annually, monthly, etc. Check for provisions for a no-claim bonus, due dates and consequences of defaulting on premium payment.

Additionally, take special note of whether or not your policy has a copayment clause. Co-payment means that the insurer only agrees to pay some percentage of the total  cost incurred, and not the entire amount. For example, if your make a claim of Rs 2,00,000, and your policy has a co-payment clause of 10%, the insurer will only be liable to pay Rs 1,80,000. The remaining Rs 20,000 will have to be borne by you.

Next, check for the procedure, documentation and timeline that is to be followed while filing a claim. Understanding this will help you navigate through it smoothly and ensure you receive the benefits you are entitled to.

In case you want to cancel your policy, check the timeline and the premium you will be refunded. In most cases, no amount is refunded in case you do not intimate the company within 180 days. You can get back up to 50% of your premium if you inform the insurer within 3 months of policy’s inception. Also note the duration of the free-look period. If you decide to cancel the policy within this period, you can get back the entire premium amount.