Insurance Plan: Buy What Suits Your Need

Written on Wednesday, December 9, 2015
By Sanjeev Puri

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Insurance Plans are common while few are unique to each of them. Understanding them will make buying the right plan suited for your needs. It’s a well-known fact that the terms and conditions in health insurance plans have been standardized. This should help someone looking to buy a health cover for self and family. However, differences in features exist and hence, buying just about any plan would not help. Let’s see what features are common among most plans and also certain features that are not common and even touching upon the unique features that many insurers have in-built into their plans, knowing them helps to buy the better plan out of the lot.


Common Ground


All health plans offers 24 hour hospitalization while the claim can either be cashless or on reimbursement basis. Number of hospitals offering cashless may vary among insurers, but generally most have such tie-ups with nearly 4000 hospitals and above. Importantly, check such network hospitals in your city. All plans under the new guidelines would offer lifetime renewability, hence, don’t fall for such sales pitch anymore. Further, there is a no-claim bonus in most plans. Typically, there is a 5 percent renewal discount every year that goes to a maximum of 25 percent or upto 50 percent as per insurer. Pre and post hospitalization domiciliary treatment and availing ambulance service are common to all too. Remember, to avail a family discount of 10 percent, if 2 or more members of a family have to be covered under the same IHP policy. The most important common feature among all is about the non-coverage. In all health plans, any treatment within first 30 days of cover except any accidental injury is not covered. Further, there are certain ailments which are not covered for initial 24 months in addition any pre-existing conditions will not be covered for first 36/48 months.


Not-So Common


While evaluating plans, see how much of coverage is allowed. Some have a cap on sum insured of Rs 5 lakh while others  might offer upto Rs. 15 lakh or even higher. Knowing this is essential, if one is contemplating to increase coverage in future. An important differentiation among plans is in terms of sub-limits on hospital expenses. Most expenses like, room rent or the cost of consultant may be capped in most plans. These restrictions would largely pinch in low sum insured polices.


Therefore, not only choosing the right sum insured is important but also zeroing on plan with less or no sub-limits is helpful. Remember, this features is most crucial while fixing room rent. If one doesn’t stick to applicable room rent and chooses a higher room-rent, all other hospital expenses attached to that room might see a proportional cut during claim. Few insurers offer unlimited room rent on some of their health plans.


Once admitted, the claims can either be processed by the in-house claim processing team of the insurer or there could be a third-party administrator (TPA) for such processing. However, as a buyer one has no option between the two and depends on the route the insurer takes. Find out the insurer’s claims settlement process and assurances from its policy document available on websites including the time taken to pay claims. Another differentiation could be on the plans offering day care treatment where 24 hours of hospitalization is not required for treatments like dialysis, chemotherapy, eye surgery, lithotripsy among others. Check if the plan you are contemplating to buy includes them. Plans offering them usually include up to 140 of such treatments.


Unique Features


Once you have zeroed on to a plan, check if it is available online as it is easier and saves time. Most online plans do not ask for medical tests up to the age of 45. Buying them online, however, might not lower the premiums.  An important, differentiation could be about critical illness (CI). Not all plans would allow attaching a CI cover, which one may consider buying especially, around age 40. Remember, CI coverage would normally cease by age 65/70 years, even while the basic plan continues lifetime.  Some allows CI to be added while others may offer it as a separate plan. A Family Floater covering all members and allowing CI to be added along can provide wholesome health protection.

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