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Last Updated : Sep 11, 2018 11:51 AM IST | Source: Moneycontrol.com

Important clauses you should read when buying a health insurance policy

Many policyholders are not aware of the features of the health insurance plan they have opted for, nor do they fully utilise the benefits.

Navneet Dubey

Many of us buy health insurance policy only to save tax and often fail to update ourselves on the various features of the plan being purchased. Choosing a health policy for you and your family is a serious decision and it requires you to be fully aware of the policy and its benefits.

Here are few important features you should know before buying a health policy:

-- Deductibles: It is the amount of money customers will have to pay in an insurance claim before the insurance coverage starts paying. “Deductibles vary for different conditions, illnesses, and medical procedures. Though high deductible health plans have the advantage of smaller premiums, customers may end up paying much more out-of-pocket. To avoid this, customers can opt out & select the better plans without deductibles or opt for low deductibles insurance policies,” said Vikas Mathur, Head – Health, Universal Sompo General Insurance.


-- Co-pay: This clause allows customers to take some share of his/her medical expenses. Under this clause the insured has to bear a certain predefined percentage of the claim amount. One should always have a look at the co-pay clause while planning to buy a health insurance policy. Health insurance policies of few insurers have the co-pay clause compulsory, usually for the age group above 55 yrs.  Customers have the option to look for other policies without co-pay condition if they do not want hassles of this part payment. Also, customers should consider their health and fitness conditions before deciding to opt for a health insurance policy with Co-pay.

-- Restore benefit (Automatic restoration): Many health insurance policies available in the market provides inbuilt restore benefit. In case the sum insured is exhausted towards the treatment of illness, the insurance company restores it without any additional premium. “Customers should be well aware of this to get the benefit of this coverage when they need it the most. To deal with it, the insured should be aware of the conditions. These could include benefits that can be used for claims made in respect of inpatient treatment or to bear the expenses of any other illness that is dissimilar to the one for which claims has been made earlier,” said Mathur.

-- Pre and Post Hospitalisation Expenses: Many are not aware of Pre and Post Hospitalisation benefits that an insurance company offers to their policyholders. As per pre-hospitalisation expenses, the insurance company reimburses all the expenses before hospitalisation. Post hospitalisation expense covers all expenses incurred by the insured after the discharge from the hospital. Customers get reimbursed for the expenses like, consultations, diagnostic tests, medicines etc. incurred before & after hospitalisation for which legitimate claim has been made. The number of days that fall within the ambit of pre & post hospitalisation may vary from insurer to insurer.

-- Waiting Periods: The “waiting period” clause may affect the possibility of receiving benefits from day one of the insurance policy. Mathur said pre-existing conditions are usually covered after a waiting period of 4 years. However, some insurance policies provide the coverage for these conditions after a waiting period of 2-3 years. Coverage for certain surgical conditions is provided after waiting period of 1-2 years. “It is advisable that customers should read the policy terms & conditions carefully before purchasing the policy & avoid hurdles during claims,” he said.

-- Room Charges Restrictions: Some Health Insurance Policies come with this clause which has capping or sub-limit on room rent. In such cases, all the expenses incurred for the room rent are not reimbursed. Hence, to avoid paying extra, insured should be well aware of the room rent restrictions while selecting the type of room during their stay in hospital which would also avoid hassles during discharge at the hospital.

-- Attendant allowance: “Nowadays, many health insurance policies offer inbuilt coverage as an attendant allowance. This allowance is provided as benefit amount or allowance for accompanying children usually up to 12 years of age, during their stay in hospital as an inpatient. In most cases, the number of days is prefixed, and the amount is predefined. Customers should not forget to claim this amount from insurer & get benefited from this inbuilt coverage,” said Mathur.

The policy benefits might vary depending on the health insurance plan bought by the insured. All these benefits may or may not be available in their health insurance policies. Customers are advised to check their policy document to ensure they are fully aware of all features and benefits.
First Published on Sep 11, 2018 11:51 am