One development that can cause a serious setback to a family’s finances is the occurrence of a major or prolonged disease, or the requirement of a major surgical procedure. Increasing privatisation of healthcare has made healthcare more expensive. Advancements in medical technology mean that you can live longer, but high-end procedures also come with a huge price tag. The answer to the high and rising cost of healthcare (the rate of healthcare inflation in the country is about one-and-a-half to twice consumer inflation) lies in purchasing adequate health insurance for your family.
Hospitalization cost, operation theatre charges.
Surgeon/ medical practitioner fees and nursing expenses.
Medical tests expenses, drugs bills, chemotherapy, radiotherapy, and etc.
Hospitalisation plans: These are indemnity covers: they compensate you for the cost incurred on hospitalisation (you must be hospitalised for at least 24 hours). The maximum they pay out is determined by the sum assured of the policy. These are the most popular type of health insurance covers in the country.
Hospitalisation covers are of two types. In individual policies, the sum insured can only be utilised by the individual in whose name the policy has been issued. Family floater policies cover the entire family. The sum insured can be shared by the entire family during a year.
Basic hospitalisation covers only cover the cost of treatment when a person is hospitalised. But many companies now offer policies that have expanded the ambit of coverage to include cost of maternity, day care procedures, pre- and post-hospitalisation care, at-home care, and so on.
Top-up policies: These are meant to enhance your level of coverage. They reimburse you when your healthcare costs rise above a certain limit called the deductible. You need to pay out of your own pocket, or your base policy should cover you up to that limit. Once your costs cross that level, the top-up policy provides compensation.
Usually top-up policies are bought by people whose base policy, either self-purchased or employer-provided, has a small sum assured. People also buy them to keep pace with the rising cost of healthcare. These policies are cheaper than a basic mediclaim policy (due to the deductible clause).
Hospital daily cash benefit: Besides the cost of treatment, hospitalisation and illness entail many other costs. Cash benefit plans are meant to cover those expenses. They also provide a substitute for the loss of income during illness. These policies pay a pre-defined sum of money for each day of hospitalisation, and for a defined number of hospital days each year.
Critical illness plans: Some illnesses have a low incidence but can cause massive damage to a family’s finances because of the high cost of treatment. Critical illness plans pay out the sum assured to the beneficiary as soon as he is diagnosed as suffering from one of those diseases. Some of the diseases covered by these policies include heart attack, cancer, etc. The list of diseases covered varies from policy to policy. Treat them as a supplement, and not as a substitute, for basic mediclaim policies.
Some of the documents required at the time of buying a mediclaim policy include identity proof, age proof, and address proof.
However, a wide range of documents need to be submitted to the TPA (third-party administrator) to claim reimbursement. These are as follows:
Exclusions refer to diseases or conditions that are not covered by your health insurance policy. Before purchasing a health cover, read the fine print of the document to understand which diseases and conditions are not covered. While comparing policies, go for one whose list of exclusions is smaller. Often, people complain about having been cheated by the insurer when the latter doesn’t reimburse them for a particular treatment. But the fault could lie with them: they may not have read the fineprint of their policy document to understand the list of exclusions.
Exclusions may be divided into the following categories:
Permanent exclusions: These are conditions that are never covered by a health insurance policy. These include treatment of mental illness, sexually-transmitted diseases, AIDS, abortion, cosmetic surgery, self-inflicted injuries, and so on. The list of permanent exclusions varies from one policy to another.
Exclusions with waiting period: In case of many illnesses, the waiting period lasts for only a specified period and not forever. It usually ranges from 2 to 3 years. Some of the conditions for which health insurers impose a waiting period include cataract, hysterectomy, hernia, fistula, joint replacement, etc. Typically these are conditions for which treatment is not urgent. The waiting period is imposed to ensure that people don’t buy a health cover after they have contracted these conditions. When comparing policies, buy one that has a shorter waiting period.
Pre-existing illnesses: These refer to illnesses which a person already has at the time of buying the policy. Companies usually cover pre-existing illnesses after 2 to 4 years. Experts suggest that you buy a health cover as early as possible when you have fewer diseases and conditions. That way any ailment that arises after the policy has been in force for a few years will be covered, and the insurer will have no ground to reject your claim.
In case of senior citizens, pre-existing illnesses may not be covered for the rest of the life. This makes it essential that you buy health insurance for your parents before they turn 60. Nowadays, however, many companies offer health insurance for senior citizens with a limited waiting period for pre-existing diseases. Such policies often come with a high co-payment clause, requiring you to pay a part of the cost of treatment out of your own pocket.
There are a wide range of policies available in the market, as described above. You need to understand which policy is best suited for your life stage, family size, profession (employed or self-employed), etc.
Many policies come with sub-limits. This means that if a particular expense such as room rent or ICU expense rises beyond the level specified by the policy, the insurer won’t compensate you for the excess amount. You need to avoid such policies or buy those where the sub-limits are high.
You also need to buy a cover whose network of hospitals includes some of the bigger ones in your vicinity.
As mentioned earlier, policies also come with a wide variety of exclusions.
Including old parents in a floater policy may not be wise as the age of the oldest member of the family hikes the premium charged for a floater policy. So it may be wiser to buy a separate cover for your parents. When buying a senior citizens’ cover, it is important to keep in mind the co-payment requirement: the lower the better. Also make sure that the senior citizens’ policy offers lifelong coverage and doesn’t terminate at an arbitrary age.
Self-employed people should also buy a hospital daily cash benefit plan to supplement their basic mediclaim policy because unlike salaried individuals, they are not entitled to paid medical leave and need some compensation for loss of income.
If you already have a policy but it is not well-suited for you, we can hold your hand while you port to a better policy.
Given all the complexities of health insurance described above, you need guidance to help you select the right policy, which our experts at Credit Sudhaar can provide.