11/13/2015

HowtobuyhealthinsuranceValueResearch:TheCompleteGuidetoMutualFunds

Insurance

Howtobuyhealthinsurance
Followthiscomprehensiveroadmapifyouareplanningtobuyahealthinsurancepolicyforyourfamily
ByResearchDesk|Nov10,2015
InMarchNoidabasedinteriordesignerSeemaSinghhadtoundergoasurgicalprocedurecalleduterinearterialembolisation.She
wasflabbergastedtolearnthatalthoughshewouldberequiredtospendonlyonenightatoneofDelhi'stophospitals,nonethelessthe
procedurewouldcostherR70,000.Thensherememberedthataboutsixmonthsagoherbrother,acertifiedfinancialplanner,had
badgeredherintopurchasingahealthinsurancepolicy.Shelookedaroundforthepolicyandtheaccompanyingidentitycard.These
shedepositedwiththethirdpartyadministrator(TPA)atthehospital.Shewasfloodedwithreliefwhenacoupleofdayslatershe
learntfromtheTPAthattheinsurancecompanyhadconsentedtofootherentirebill.
Inthesetimesofescalatinghealthcarecosts,buyinghealthinsurancehasbecomeoneofthemostimportantelementsofone's
financialplanning.Ahealthinsurancepolicyprovidesprotectionagainstexpensesarisingoutofmedicalemergenciesandensuresthat
youdonothavetodipintoyoursavingstopayforunforeseenmedicalexpenses.
However,withsomanyhealthinsuranceschemesavailableinthemarket,choosingtherightpolicyhasbecomeachallenge.Policies
fromdifferentinsurershavedifferentfeatures,ridersandpremium,andtopicktherightonethatsuitsbothyourneedsandyour
budgethasbecomeacomplicatedexercise.Butpayingheedtoafewcriticalpointswillhelpyouzeroinontherightpolicywithease.
Adequatecoverage.Thefirstthingtoensureisthatthehealthinsurancepolicyyoubuyprovidesadequatecoveragetoyouandyour
family.SaysKaranChopra,headofretailbusiness,HDFCERGOGeneralInsurance:'Customersshouldensurethatallmembersofthe
familyarecoveredandthatadequatecoverage(suminsured)isoptedforconsideringthecurrenthighcostofqualityhealthcare.'
Donotsacrificecoverjusttosavemoneyonpremium.Forthesamesumassured,premiumsvaryacrossdifferentinsurance
companies.Insteadofsimplygoingforthecheapestplan,comparefeatures.Bypayingalittleextra,youmaybeabletogetgreater
benefits.
Preexistingdiseases.Everyhealthinsurancecompanyhasawaitingperiodbeforeitstartscoveringpreexistingdiseases.
AccordingtotheInsuranceRegulatoryandDevelopmentAuthority(IRDA),apreexistingdiseaseisanycondition,ailment,injuryor
relatedconditionforwhichonehadsignsorsymptoms,werediagnosed,orreceivedmedicaladviceortreatmentwithin48months
priortothepurchaseofthepolicy.Thewaitingperiodforcoveringpreexistingdiseasesdiffersfromoneinsurertoanotherandranges
fromtwotofouryears.Asisobvious,givepreferencetopoliciesthathavealowerwaitingperiod.
Alsorememberthatmosthealthpolicieswillnotreimburseyouforanytreatmentundergonewithin30daysofbuyingthepolicy.
Criticalillnessrider.Manyhealthinsurancepoliciesofferacriticalillness(alsocalleddreadeddisease)rideralongwiththebasic
policy.Itcoversalimitednumberofdiseasesforwhichusuallythecostoftreatmentisveryhigh.Closelyscrutinisethediseasesthat
arecoveredbytherider.Thosediseasesforwhichthereisahigherdegreeofsusceptibilityinyourfamily'smedicalhistoryshouldbe
included.
AccordingtoYashishDahiya,chiefexecutiveofficer,Policybazaar.com,'Whileselectingtherightcriticalillnesscover,askspecifically
whichdiseasesarecoveredandwhicharenot.Forexample,procedureslikeangioplastyarenotcoveredundercriticalillness.Also
rememberthatthewaitingperiodforcriticalillnessisusually90120daysandyoumustsurviveforatleastamonthafterthe
proceduretogettheclaim.'Acriticalillnessridermostlycoversexpensesarisingoutofcancer,kidneyfailure,organtransplant,
multiplesclerosisandcoronaryarterysurgery.
Cashlessfacility.Cashlessfacilityisthemostcriticalfeatureofahealthinsurancepolicy.Mosthealthinsurancecompaniesoffer
bothcashless(insurerreimbursesthehospitaldirectly)aswellasreimbursementfacility.Itisbettertogoforthecashlessfacilityas
thenyoudonothavetomakeanypaymentstothehospitaloutofyourownpocket.Italsoinvolveslesspaperworkandhasslethanthe
reimbursementfacility.
Checkthenetworkofhospitalsinyourcitywherethecashlessfacilityisavailable.KarthikJhaveri,acertifiedfinancialplanner,

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11/13/2015

HowtobuyhealthinsuranceValueResearch:TheCompleteGuidetoMutualFunds

Checkthenetworkofhospitalsinyourcitywherethecashlessfacilityisavailable.KarthikJhaveri,acertifiedfinancialplanner,
suggeststhatyoushouldcheckwhetherahospitalempanelledwiththeinsurerissituatednearyourresidence.
Annualbonus.Ifyouhavehadaclaimfreeyear,companiesoffera5percentbonusonsumassuredthefollowingyear.The
cumulativebonuscouldgoupto50percentofsumassured.Makesurethatyourinsureroffersyouthisbonus.
Hospitalroomrent.Mosthealthinsurancecompaniesplaceacaponthedailyhospitalroomrenttheywillpay.SaysDahiyaof
Policybazaar.com:'Insurancecompanieshaveacaponroomrentwhichisusually1percentofsumassuredperday.Thisfigurevaries
fromcompanytocompany.'RoyalSundaramGeneralInsurance,forinstance,reimbursesupto1.5percentofthesuminsuredperday
andIFFCOTokio,12percentunderitsbaseplan.StarHealthpaysuptoR1,500perday,dependingonthecity.Thus,whetheryou
willspendyourtimeinhospitalinthegeneralwardorintheprivacyandcomfortofasinglebedroomwillalsodependonhowhigh
yoursumassuredis.
Medicalexamination.Usuallypersonsagedabove45arerequiredtogothroughamedicalcheckupbeforetheinsurancecompany
agreestocoverthem.Ifyourmedicalreportisadverse,theinsurancecompanymayturnyoudown(whichiswhyyoushouldpurchase
ahealthinsurancepolicyatanearlyage).
Theagelimitatwhichamedicaltestbecomescompulsoryvariesfromcompanytocompany.Itis45yearsinthecaseofBajajAllianz
andRelianceGeneralInsurance,50yearsforRoyalSundaram,55yearsforICICILombard,and60yearsforStarHealth.
Healthcoverforseniorcitizens.Someinsurancecompanieshavedesignedpoliciestocatertotheneedsofseniorcitizens.These
policiestypicallycoverbothhospitalisationanddomiciliaryhospitalisation(criticalailmentswhereinthepatientisbedriddenbutnot
hospitalisedforcertainreasons).
Someinsurersofferpoliciesrenewableuptotheageof75years,providedtheinsuredhadboughtthepolicybeforetheageof55.The
longerperiodforwhichaseniorcitizencoverlasts,thebetter.
Exclusionclause.Carefullygothroughtheexclusionclausewhichisincludedinthebrochurethataccompaniesthepolicy(available
ontheinsurer'swebsite).Mostcompaniesexcludecertaincategoriesofdiseasesandexpensesfromtheircoveragelist.Theseinclude
anyinternalcongenitaldisease,nonallopathictreatment,pregnancyandchildbirthrelatedconditions,andcosmetic,aestheticand
obesityrelatedtreatments.ExpensesarisingfromHIVorAIDSandrelateddiseases,misuseofliquor,intoxicatingsubstancesor
drugsaswellasintentionalselfinjuryarenotcoveredbyhealthinsurancepolicies.Diseasesortreatmentsarisingoutofwars,riots,
strikes,actsofterrorism,andnuclearweaponsarealsonotcovered.
Thelistofdo'sanddon'tsmentionedaboveforbuyinghealthinsurancemaylookdaunting.However,mostofthepointsmentioned
abovecanbecheckedoutbygoingthroughthebrochureavailableontheinsurancecompany'swebsite.Whenitcomestoone'shealth,
itisalwaysbettertobesaferatherthansorry.

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