How to select the APT health cover?

We all believe in the age old saying that ‘health is wealth’. However, with increasing medical costs it is becoming increasingly difficult for the common man to deal with emergency medical expenses. In comparison with its global counterparts, India today has one of the highest out of pocket spends at 61% which is a clear indication of the humongous stress on one’s budget and savings. To add to the woes of inflation going northwards, lifestyle changes and other environmental factors are adding to the rise in medical disorders and acute diseases. Taking note of the above mentioned factors and uncertainty associated with medical emergencies, it is prudent of everyone to be prepared in advance to deal with the uncalled for expenditure and avail a suitable health insurance policy.

The Indian insurance market today is offering host of health insurance products with various features to its customers. With such an enormous choice it has become increasingly difficult for people to opt for the most suitable health insurance plan.

Each health insurance plan today has various features, provides different options, variable add-ons which tend to further complicate the process of buying. Therefore, before one decides to buy a policy or selects one, first one needs to be very clear regarding the specific requirements followed by the existing medical history of self and family. Post zeroing on a policy, it is very crucial to understand the particular needs including the caveats. One can follow the below mentioned factors to help select the right health insurance for self and family:

1) Sufficient sum insured
Foremost, one need to be adequately covered to deal with any future medical emergency. Sufficient coverage is required to protect oneself and the entire family. For this, one should select the right amount of sum insured taking into the consideration the medical history of the elderly family members who would need higher health insurance coverage. Also one should take into account the location of residence as one residing in a a tier I city would require higher sum insured compared to a person who lives in a smaller town since the hospitalisation costs are higher in metros.

2) Availing cashless mediclaim
Cashless Mediclaim allows customers the ease of hassle free payments upon sudden hospitalisation. Today most health insurers offer the ease of cashless Mediclaim to its customers. Before choosing the health insurance plan or the provider on this basis, one should always check the list of network hospitals offered. In such a case the insurance company either directly pays the hospital or uses its TPA to pay the amount to the network hospitals provided all the conditions laid by the company are adhered to.

3) Age limits
One should always take into cognisance the maximum acceptable age limit offered by the health insurance company. The chances of taking ill is much higher at an older age. Therefore, it is required that one gets covered under a comprehensive health insurance plan at an early age which provides cover even after retirement. Also, one should select a policy that which can be renewed after the age of 65 as at an older age it becomes difficult for one to avail a new health insurance policy.

4) Co-pay and sub limits
Co-pay and sub-limit clauses have been introduced by health insurance companies wherein the insured individual agrees and partly pays some of the expenses incurred. In this case, the benefit is of a lower premium amount that the insured gets, in case of a co-pay policy as compared to a regular policy with no sub-limits.

5) Value added services:
Health insurance companies are fast taking the preventive approach while offering products to the customers. An emerging aspect is the additional value-add perks offered along with the policy along with features that are competitive. These additional value added services like free health check-up, online chat with doctors, dieticians and nutrition e-consultation, physiotherapy, speech and audiologist consultation allows customers to have benefits beyond just the expenditure part.. Opting for these value-add services can result in a substantial saving for the insured.

In addition to the haves in a policy, one needs to know the have-not as well to avoid negative surprises later. Below mentioned are factors which are typically not covered by the health insurance plan.

1) Limited services
Certain medical expenditure are not covered by health plans in totality as they have a limit on some services. For e.g. ten doctors visits per year, in this case, the policy holder has to pay the entire cost of the visit above that limit as they would not be considered as part of covered expenses.

2) Non-covered services
Some insurance policies may not cover specific types of treatments e.g. over-the-counter medications or cosmetic surgery. The insured individual has to pay the full cost of the services in such a case. It is therefore extremely essential that one conducts a thorough research before selecting a comprehensive policy. Wellness and preventive care helps and it prolongs the need for insurance but in today’s date it is wise to keep ones family protected with a good health insurance cover too.


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