The Common, Uncommon Features Of Health Insurance Plans

Companies especially in private sector are launching health plans with high coverage limit of around a crore. The market is also witnessing innovative and more customer friendly top-up features thus averaging the cost outgo for policyholder. But, as market develops and more and more options and features are made available to the buyers, the complexities increase and the decision making becomes difficult.

Still, getting a health insurance helps, as medical emergency may strike anytime and to any family member. Studies point out that nearly 75 per cent of medical costs are still borne by people as out-of-pocket expenses.

When choosing a health plan, there are several features which are common to most as much of the terms and conditions have been standardized as per regulations. Therefore understanding unique features of a plan is important to weigh its need, urgency and probability of occurrence. It will help you keep the premium low too.

Here's a low-down on common and uncommon features of a health plan.

Common Ground
All health plans offers 24 hour hospitalisation while the claim can either be cashless or on reimbursement basis. Number of hospitals offering cashless may vary among insurers but generally most have such tie-ups with nearly 4000 hospitals and above. Importantly, check such network hospitals in your city.

All plans would under the new guidelines offer lifetime renewability, hence don't fall for such sales pitch anymore. Further, there is a no-claim bonus in most plans. Typically, there is a 5 percent renewal discount every year that goes to a maximum up to 25 percent or up to 50 percent as per insurer. Pre and post hospitalization domiciliary treatment and availing ambulance service are common to all too. Remember, to avail a family discount of 10 percent, if 2 or more members of a family have to be covered under the same IHP policy.

The most important common feature among all is about the non-coverage. In all health plans, any treatment within first 30 days of cover except any accidental injury is not covered. Further, there are certain ailments which are not covered for initial 24 months in addition any pre-existing conditions will not be covered for first 36/48 months.

Not-So Common
An important differentiation among plans is in terms of sub-limits on hospital expenses. Most expenses like room rent or the cost of consultant may be capped in most plans. These restrictions would largely pinch in low sum insured polices.

Therefore, not only choosing the right sum insured is important but also zeroing on plan with less or no sub-limits is helpful. Remember, this features is most crucial while fixing room rent. If one doesn't stick to applicable room rent and chooses a higher room-rent, all other hospital expenses attached to that room might see a proportional cut during claim. Few insurers offers unlimited room rent on some of their health plans.

Once admitted, the claims can either be processed by the in-house claim processing team of the insurer or there could be a third-party administrator (TPA) for such processing. However, as a buyer one has no option between the two and depends on the route the insurer takes. Find out the insurer's claims settlement process and assurances from its policy document available on websites including the time taken to pay claims.

While evaluating plans, see how much of coverage is allowed. Some have a cap on sum insured of Rs 5 lakh while others might offer up to Rs 15 lakh or even higher. Knowing this is essential if one is contemplating to increase coverage in future.

Another differentiation could be on the plans offering day care treatment where 24 hours of hospitalization is not required for treatments like dialysis, chemotherapy, eye surgery, lithotripsy among others. Check if the plan you are contemplating to buy includes them. Plans offering them usually include up to 140 of such treatments.

Unique Features
Once you have zeroed on to a plan, check if it is available online as it is easier and saves time. Most such online plans do not ask for medical tests up to age 45. Buying them online, however, might not lower the premiums. An important, differentiation could be about critical illness (CI). Not all plans would allow attaching a CI cover which one may consider buying especially around age 40. Remember, CI coverage would normally cease by age 65/70 years, even while the basic plan continues lifetime. Some allows CI to be added while others may offer it as a separate plan. A Family Floater covering all members and allowing CI to be added to the basic plan, can provide wholesome health protection.