It is common knowledge that most of us are getting prone to lifestyle diseases. Blame it on genetics, unhealthy eating habits or work-life pressures, our bodies are taking the toll more than ever before. And, on top of it, hospitalization costs are increasing with medical inflation being more than double than general inflation. To guard against rising medical expenses, having a health insurance policy is increasingly becoming inevitable.
A health insurance policy is an indemnity plan in which the insured need not have to pay the hospital bill on discharge from the hospital as the insurer is supposed to reimburse the bill up to the amount of bill or the sum insured, whichever is lower. To ensure this, one has to buy a health insurance policy by paying a certain premium each year.
While buying a health cover is easy and simple, choosing the right health insurance plan is important. IRDAI approved portal – PolicyX.com is offering a wide range of health insurance plans to choose from. However, below are a few important things to look at to ensure you end up buying the right plan.
1. Claim settlement process
Knowing the claim settlement process goes a long way in the settlement of the claim smoothly, especially when one is busy in the discharge of the family member at the hospital.
Cashless in-network hospitals: If it is a cashless claim, as a policyholder, one need not pay any amount to the hospital. In case of cashless hospitalization, hospital bills are directly re-reimbursed by the insurance company up to a maximum of the sum insured or the amount of medical bill, whichever is lower. Such a cashless mode of insurance is generally available only in-network hospitals that are in the empanelled list of the insurer.
Non-network hospitals: In case of a non-network hospital, the insured has to initially pay the cost of hospitalization from one’s own pocket and later on get it re-reimbursed from the insurer.
In-house or TPA: Some insurers may have their own in-house claim settlement department while others could be using the services of a Third Party Administrator (TPA). Documentation plays an important part in the claim settlement process, whether it’s in-house or a TPA which is handling your claim.
Pre-authorisation Form: Whether it is a network or a non-network hospital, make sure you inform your insurer directly or through the TPA about the hospitalization. Subsequently, make sure to fill the Pre-authorisation Form available at the hospital or the TPA by submitting your policy ID, etc.
Discharge: While getting discharge from the hospital, make sure you have the original hospital bills, medical reports etc with you. You may need them while filing for reimbursement claims later on.
2. Day-care procedures
Unlike in the past, when the health insurance claim used to get paid only if there was a hospitalisation of at least 24 hours, nowadays insurers do not insist for any such time-limit. With technological advancements, there are several treatments that require surgeries that can be completed within 24 hours. Such treatments are known as day-care procedures and most insurers cover them in their health insurance policies. The type and nature of procedures and surgeries that can get the coverage vary among insurers.
3. Pre and post hospitalization expenses
All health insurance plans re-reimburse medical expenses incurred during hospitalisation. In addition, expenses incurred by the insured before and after getting discharged from the hospital are also covered as pre-hospitalisation and post-hospitalization expenses, respectively. The coverage, however, is subject to the conditions that the expenses are directly related to the same condition for which the insured was hospitalized. Also, most health insurance plans cover pre-hospitalisation expenses for up to 60 days before hospitalization while for post-hospitalization expenses, after discharge from the hospital, the coverage is for up to 90 days or even higher.
4. Medical checkups
Having bought a health insurance policy gives you mental peace about incurring medical expenses in the future. However, leading a healthy life is all the more important in the present. Keeping a watch on your health conditions should be a regular feature. Many health insurance plans offer a health check-up feature. The insured can get a health check-up from a hospital or a medical test center and get the amount reimbursed from the insurer. Such a feature is generally available in the policy after 4 policy years and is not treated as a claim by the insurer.
5. Other benefits
In addition, there are certain other benefits and features that one needs to keep an eye on while choosing the right health insurance plan. Most plans have a sub-limit on various hospital charges such as room rent or doctor fees, etc. The room rent in such a plan may be capped at 1 percent of the sum insured.
Further, most health insurance plans have more than one version of the same plan wherein one gets coverage even for expenses incurred on the ambulance, organ donor, etc. In addition, while most plans cover pre-existing diseases after 48 months, a few plans may cover them even after 36 months. Also, some plans may have a co-payment feature wherein a portion of the claim is met by the insured and the premium is lesser compared to a regular plan.
Now that you know what it takes for a claim to be settled smoothly, look for plans and the insurers that give you the right features. To choose the right insurance plan, make sure you buy a health insurance plan that has the most comprehensive coverage for self, spouse, and children.