Guide To Insurance

I am pretty sure most of us might end up in the hospital rather than die. At such times one shouldn’t dip from their savings.

Hence, a cover can help you protect your health, life and your savings too. The deal is simple, we pay the annual premium and when hospitalized they will pay our bills.

But the question is “what policy to buy?”. There are numerous companies out in the market offering the best of the best policies with an affordable premium. The complexity of products, their features and the fine print in policies is so large that it is impossible for an average person to know enough to buy a policy.

Especially in times like these, where a pandemic is taking over the world, with increasing hospital charges, a medical cover is of great importance.

The cheapest policy is not necessarily a good plan. Agreed that a low premium is good and an important factor in your choice of a policy, but it is not the only factor. Look at the policy as a three-way settlement. One, how does it perform on the metric of the price(the premium of medical cover increases as we age). Two, how does it perform on the metric of benefits(listed below). Three, how does it perform on the metric of claims.

I am pretty sure most know this, but today I want to discuss some important points that would definitely profit you. These insurance companies have the ability to set the game in such a way that you end losing it.

Also, the technicalities and the rules will keep changing, making it real tough for common people us to understand making us more vulnerable to fall into their trap.

Let me point out 8 such basic benefits which you must definitely ask for in your policy.

1. Ensuring there is co-pay:

We pay such huge sums of premium so that the insurance company would pay for us, hence search for the word co-pay in the documents provided. Ask your agent about the per cent which they would pay. And check online for any complaints against them regarding co-pay. For example, if the copay is 90:10 and your total bills worth is 2,00,000, then you need to pay just 20,000.

2. Check for ‘existing diseases’ clause:

Most companies do not provide insurance for existing diseases. Insurance rules allow a company to refuse to pay for any treatment related to any condition, ailment or injury for which you were diagnosed or had symptoms when you took the policy, for four years. It is a good idea to disclose your correct present and past medical history to the insurance company when you sign up for the policy. Else they will have a tool in their hands to refuse your claim. And, believe me, they use it to refuse claims on very flimsy grounds.

3. Check if the policy has a ‘disease waiting period’:

Many companies have a cool-off period of 30–90 days in which claims cannot be made. Ask the agent for a list of such diseases that are covered under this clause. Look for a policy with no waiting period.

4. Check for any ‘sub-limits’:

Many insurers have limitations like they might pay just 1000 per night for a room in the hospital. If you choose an extra deluxe room costing 3000 per night just because you have a 10lakh cover, they won’t pay for it. That wouldn’t add to it. Hence you must always make note of such limitations like the ambulance charges, room rent charges, also some insurers pay only if you are hospitalised for a certain period of time. Always choose a policy with no sub-limits, or at least with those which seem comfortable to you.

5. Check for exclusions:

As mentioned above, apart from existing diseases, many other diseases like dental treatment, cosmetic surgery, pregnancy are excluded in every policy. It always a good idea to get the list of such excluded diseases. What you can’t do much about is when the policy you buy excludes something at some future point in the policy.

6. Asking about the pre and post-hospital charges:

You can claim expenditures based on the doctor’s fee, medicines bought and diagnostic tests 3 months before being admitted, and 3 months post-discharge. For example, a knee replacement will have MRI costs before the surgery and physiotherapy costs post-surgery. Check if you can claim these costs. Check the exact amount and time your policy will cover.

7. Ask for a list of ‘day-care’ procedures:

Daycare procedures don’t need us to stay in hospitals for 24 hours any more. Procedures and treatment for cataract surgery are treated as daycare and are covered. Check the details of the day-care clause, what will be covered, how much will be paid and how long you have to stay to claim.

8. Look for ‘no claim’ bonus feature:

If you don’t make a claim in a year, you get rewarded by the company. It does by giving you a non -claim bonus (NCB). The usual way is, they raise your policy amount by 10% for the same premium. If your cover was Rs 15 lakhs, for a premium of Rs 25,000, when you have a claim-free year, you get a cover of Rs 16.5 lakhs for the same premium.

You need to find out if your policy gives at least these eight benefits. As said, the claims also play a major role in help choosing our policy. Always go for a company with the below claim reviews:

1. The claiming percentage should not be less than 95.
2. Look at the claim-complaints data and look for a policy that has less than thirty complaints on every 10,000 claims made.

In this pandemic, I am pretty sure most must have been thinking of buying a medical cover, as the prices of corona treatment are shooting up one must be prepared. With the fear of a second wave approaching, one should definitely invest in a medical cover.