Health Insurance Guide - Everything You Need to Know

Ultimate Guide to Selecting the Right Health Insurance Plan

In the era of modern, busy, and sedentary lifestyles, having health insurance for you and your family becomes crucial, considering the rapid increase in medical treatment costs in India. But buying one can be challenging, especially if you are not very aware of the pros and cons of medical insurance. You may not understand multiple key points and what to check in a policy. By keeping these aspects in mind, we at Star Health have created a brief guide regarding how to buy the right health insurance plan, which can help you make the best choice.

A Comprehensive Guide to Purchase the Right Health Insurance Plan

Understand the following checklist for health insurance that can guide you to buy the right health insurance plan:

• Budget-friendly Waiting Periods: A waiting period is the time duration you must complete before you become eligible to raise a claim with your insurance provider. So, before buying health insurance, always check how long the waiting periods are applicable to pre-existing diseases (PED), critical illness cover and other treatments. However, the waiting period associated with PED generally ranges between 3 and 4 years, and coverage for critical illness generally comes with a waiting period of up to 90 days, subject to the policy terms and conditions. One should always opt for a health plan with a shorter waiting period, especially for PEDs.
• No Co-payment: Prefer buying a mediclaim policy with no co-payment clause, as it increases your overall out-of-pocket expenses, in which you are required to pay a fixed percentage of the claim amount whenever you raise a claim. However, having a co-payment clause lowers your premiums, but it is a wise decision to avoid them to keep your expenses minimal during unforeseen circumstances.
• OPT Plan with  Outpatient Coverage: If you have older people in your family who need to visit a doctor's clinic frequently, you must select outpatient coverage benefits in your health insurance policy. OPD coverage helps cover expenses of consultation fees, diagnostic tests, pharmacy, and treatments available on an OPD basis. However, some specific health plans may offer OPD coverage as default coverage, while others may offer it for an additional premium.
• Without limitation on Room Rent: Always check with your selected health plan whether it has any limits on the hospital room rent. Most health policies come with a cap on room rent limits. If you opt for a higher room rent limit, you must have to pay proportionally more for every care service availed during hospitalisation, which ultimately leads to high out-of-pocket expenses. Therefore, prefer a health policy without limitation on room rent.
• Select a Wider Coverage for Pre- and Post-Hospitalisation Expenses: Before selecting a policy, check how many days your insurer covers for pre- and post-hospitalisation expenses. However, it differs by plans in which pre-hospitalisation expenses cover incurred costs before hospitalisation, such as diagnostics, medicines and doctor consultations. In contrast, post-hospitalisation expenses cover the cost of prescribed medications, follow-up doctor visits, physiotherapy, etc., availed after discharge. You should prefer plans that cover at least 30 days of pre-hospitalisation expenses and 45-90 days of post-hospitalisation expenses.
• No Claim Bonus: When purchasing medical insurance, check whether the no-claim bonus or cumulative bonus applies to the plan. Prefer a policy that offers a high no-claim bonus for every year which is claim-free. Such a bonus increases your sum insured amount for no increase in premiums if you did not file a claim in a policy year.
• Select Restoration Benefit: Go for plans that have an unlimited restoration benefit, as with this benefit, the sum insured of your policy will be restored unlimited times a policy year before renewal. The restore benefit ensures increased coverage during the policy year without paying additional premium.
• Check for Annual Health Check-ups: Opt for a plan that comes with annual health check-ups. Regular health screenings are essential to diagnose a medical condition at an early stage. To encourage wellness, ideal insurers offer a preventive health screening benefit every year at the network hospitals.
• Select Consumables Coverage: Prefer a health policy that covers the cost of consumables during hospitalisation. Consumables or non-medical expenses generally include gloves, cotton, syringes, bandages, etc., which are usually not covered by all insurers.
• Review Policy Exclusion: Before purchasing a health policy, always check its associated exclusions. Doing so helps you to avoid confusion regarding which diseases and procedures are covered and to what extent it is covered. This further prevents future rejection of claims, and you should prefer the policy with minimal exclusions.
• OPT for Plan Cover for Daycare Procedure: Generally, insurers cover hospitalisation expenses if your hospitalisation exceeds 24 hours. But always select the plan that provides coverage for any claim for less than 24 hours of hospitalisation under a daycare procedure.
• Prefer Plan with Maternity Benefit: If you are going to marry soon, are newly married or planning to start a family soon, you must purchase a healthcare plan with maternity benefit. It will provide coverage for maternity expenses incurred during pregnancy and childbirth, including delivery charges and pre- and post-natal expenses, covering vaccination costs of the newborn baby.
• Select Coverage for Home Care Treatment:  Make sure to purchase a healthcare plan that covers home care treatment. With in-home care treatment, your insurer will pay for the medical treatment at home in case you cannot be transferred to a hospital or no hospital bed is available. However, you need to get a doctor’s approval for this domiciliary treatment, in which a minimum of 3 days of treatment should be received to activate the particular cover.
• Check For Sub-limits: Check whether your selected policy comes with any sub-limits on particular treatment and medical procedures. Generally, insurers levy a sub-limit or a maximum coverage limit for a particular ailment to keep the premiums lower. This restricts the amount your insurer pays for that treatment/procedure and increases your upfront payment. Hence, you must avoid plans that come with any sub-limits.
• Get Coverage For AYUSH Treatments: Choose comprehensive plans that cover AYUSH (Ayurveda, Unani, Siddha, Homoeopathy, and Yoga) treatment.