Buying health insurance for the first time can be quite challenging. With a range of health plans available, choosing the right one is a tough ask. However, it’s an exercise ought to be done with utmost care to avoid surprises later. If you are buying a health insurance policy for the first time, here are some essential things you need to know.
Factors affecting the premium amount
Premium refers to the amount you pay to your insurer to receive coverage. This amount depends on various factors including your age and lifestyle habits. Premiums are lower when you buy a policy early as you in a better health condition.
Also, lifestyle habits like smoking, which leads to various ailments, push up the premium amount as the insurer is covering greater risk for you.
The concept of the sum insured
Sum insured is one of the fundamental aspects of buying a health insurance plan. It’s the maximum amount of coverage offered by your insurer and depends on various factors including the premium amount.
The sum insured varies across insurers and the higher the amount, the greater is the applicable premium. You must opt for an optimum sum insured to reduce out-of-pocket expenses during a medical crisis.
The network of hospitals covered
Before buying home insurance & health insurance, check out its network of hospitals. Every health insurer has a tie-up with hospitals where you can avail cashless treatment. Make sure the hospitals covered have state-of-the-art treatment facilities and are close to your home.
In case you need treatment in a hospital not in the insurer’s list, find out how you can get reimbursement of the expenses incurred.
Co-pay and sub-limit clauses
Generally, health plans have co-pay and sub-limit clauses. These clauses are there to prevent policyholders from making unnecessary claims and encourage judicious and honest use of their policy. Co-pay refers to a fixed percentage of the billable amount, up to the sum insured, which you need to pay from your own pocket. For instance, if the amount is Rs.1 lakh with a co-pay clause of 10%, you need to pay Rs.10,000 from your own.
On the other hand, a sub-limit clause caps the monetary claim you can make on your policy and is generally put on room rent, ambulance charges, doctor’s consultation fee, etc. For example, if the sub-limit on room rent is Rs.1,000 per day and you stay in a room whose rent is Rs.1,500, you need to pay the extra Rs.500 from your pocket. Buying a policy with lower co-pay and higher sub-limit attracts a higher premium and vice versa.
It refers to the period within which you can’t avail of the benefits of your health insurance policy. The waiting period varies across insurers and can range from 30-45 days. However, there’s a special waiting period for pre-existing ailments.
These are those ailments which you already have while buying the policy. The waiting period for pre-existing diseases can range from 2-4 years. So, even if you overcome the general waiting period, in case of hospitalization due to pre-existing ailments, you won’t get any monetary benefits from your policy.
While filling up the proposal form, make sure to furnish all the correct information related to your health and lifestyle habits. Any wrong data can lead to a claim rejection, thereby defeating the purpose of health insurance. Also, while buying the best Insurance Policy in India, do compare various policies to make the right choice.