Choosing the Right Health Plan

Are you caring for any dependents? Do you have any pre-existing conditions? How comprehensive do you want your plan to be? Do you need dental and vision plans? Do you have a chronic illness that requires monthly treatment? What are your month-to-month medical expenses, like prescription drugs? What could happen should you require surgery? What if you were injured in an accident? How much preventative care do you want?

Given the plethora of questions and options in the health insurance space, it is difficult to make a rational choice. One person who can rationally help you find the right health insurance plan is your insurance broker since he would be aware of the latest health insurance products in the market and he has your best interest in mind. It is finally up to you to make an informed decision based on his suggestions.

With insurance going online, getting health insurance quotes has become even simpler. No longer do you need to call up several insurance companies or fill out various different applications for getting health insurance quotes. On sites like healthandinsurance.in, all that you need to do is – enter in your requirements and you will be easily able to compare benefits and costs from different insurers.

Selecting a health plan is a matter of balancing the cost of a plan with the amount of coverage you need, the degree of choice you want and the trade-offs you are willing to make. Fueled by the skyrocketing costs of health care, revolutionary changes have been taking place in the design of health plans to reduce costs while maintaining quality care. There can thus be no dispute over the need for health insurance. Some points that specially needs to be noted are -

 

Cashless & reimbursement plans
There are two options available. The first is the cashless policy where you don’t need to pay while getting the medical treatment done.The payments are generally done by hospitals through their tie-ups with third party administrators (TPAs). Then there are reimbursement plans where you have to pay at the time of getting the treatment done and then are supposed to apply for reimbursement from the insurance company.

Difference in premium
How much health insurance will cost you depends on your age, the condition of your health, where in the country you live, your income, your job status and the like. When comparing policies, make sure you are comparing the same benefits and coverage. Also check the co-pays or coinsurance, deductibles and waiting period.
The deductible is the amount you must pay out-of-pocket before any medical charges are eligible for reimbursement. Plans with the highest premiums usually have low deductibles. When you choose a plan with a higher deductible, the premiums are usually lower.
Co-insurance is the percentage of covered expenses that you will pay. For example, co-insurance on office visits may be 70/30. This means the insurance company will pay 70% after the deductible, and you will pay 30%.
You will have to serve a waiting period when you start a new health insurance policy or increase your level of cover. There are also waiting periods for particular diseases.

Tenure of the cover
The mediclaim has to be renewed annually and within the specified time.


Size Matters
You should look at the annual limit of your health insurance policy. According to experts, if you hail from a small- or mid-sized town you should look at a cover of Rs 2-3 lakh. If you reside in a metro, then you should not look at covers less than Rs 4-5 lakh.

Clause On Sub-Limits
There are sub limits in mediclaim policies, the most common of them being room rents, doctors’ fees and diagnostics. If you have a sum insured of Rs 1 lakh and the insurer has capped your room rent at 1-1.5% of the sum insured then your room rent cannot exceed Rs 1,000. If it exceeds the specified amount, then you have to pay the balance from your pocket.

Other Clauses

There are mediclaim covers which do not cover pre-existing diseases for four years whereas some which do not cover it for three years. Similarly, ensure there is no ambiguity in the renewal clause of the policy. Another clause is the limit on Pre-Post i.e.expenses which include commuting to the hospital, buying medicines post hospitalisation and so on.

Other Information

Go through the list of hospitals and other facilities you would be able to use under the insurance plan. Equally important is to understand the plan’s procedures for handling claims and complaints.

The Ideal Choice

Keep in mind that there is no one-size-fits-all health insurance plan. The needs of a healthy 20something are vastly different from the needs of a family of four, which are vastly different from a baby boomer entering retirement. Right health insurance can save you from multiple expenses when it comes to paying for emergency or long term health services. Once you’ve settled on a plan, it is imperative to thoroughly understand it and follow its guidelines. And don’t forget you always have the option of claiming a tax benefit of up to Rs 15,000 under Section 80D.