With advancements in the healthcare sector over the last few years, the costs of medical treatments have also skyrocketed and continue to increase steadily, causing financial difficulties for many families. Recently, there has been a gradual increase in awareness of the need for medical insurance cover. The health insurance industry in India is just a few decades old. However, it has seen significant progress with the emergence of private insurers and the introduction of various health insurance plans, such as family floater plans, senior citizen health insurance, and critical illness covers, catering to the diverse needs.
The structure and features of these plans have become comprehensive and customer-friendly with new features added to them. One should check for these features, as discussed below, for getting the best coverage in any health insurance plan in India.
1. Cashless Hospitalization
Earlier, health insurance began as medical coverage for the insured, wherein the insurer reimbursed the expenses. In recent years, the cashless claim facility has become a prominent feature in health insurance plans. Leading hospitals have tie-ups with the insurers for offering medical treatment on a cashless basis. The insured has to get treatment at any of these network hospitals empanelled with the insurer to avail the facility. In this feature, the insurer settles the hospital bills directly with the hospital; thus, the insured need not pay the bills from their pocket.
Network hospital is one of the crucial factors to check before choosing any health cover. The broader the network, the easier it will be to access cashless treatment near one’s location. For instance, Care Health Insurance has over 11000+ cashless healthcare providers in India so that you can easily find a suitable network hospital in your vicinity for hassle-free treatment.
2. Lifelong Renewability
The Insurance Regulatory and Development Authority of India (IRDAI), in its recent regulations, have mandated insurers to offer health insurance for an entry age of up to 65 years. Private insurers mostly do not have age-limits in the health policies they offer. Also, all the health policies include the feature of lifelong renewability.
Getting a health cover becomes challenging with increasing age, so the feature of lifelong renewability ensures the insured persons get continued coverage as they grow older. Timely renewal of the insurance policy is essential so that a policyholder does not lose the benefits, such as no claim bonus, cover for pre-existing ailments, etc.
3. Cover for Pre-existing Diseases
Many health policies now cover pre-existing diseases after the waiting period. The waiting period depends on the insurer, which is usually 48 months. When individuals decide to buy a health insurance plan, they should always check the waiting period. Moreover, when purchasing a policy, they must be honest and disclose complete information, including any pre-existing ailment. It will ensure they do not face any claim rejection or hassles later on.
Another thing to note is that many insurers are now offering customized health plans for people with pre-existing diseases, like diabetes and heart diseases. These plans give the insured the much-required financial cushion to meet the high hospitalization costs and related medical expenses involved during the treatment of these ailments.
4. Day Care Treatment and OPD Cover
The healthcare system in India is advancing. Many medical and surgical procedures do not require an extended stay in the hospital. These procedures, performed in less than 24 hours, are known as day care procedures. Some examples of day care treatments include cataract surgery, chemotherapy, and injury-related dental surgeries, etc. Nowadays, day care treatment cover has become a noteworthy feature in many health policies and is available through reimbursement or cashless facility.
Simultaneously, many health policies now come with OPD treatment as an add-on cover wherein the insurer would reimburse the OPD expenses of the policyholder.
There is a significant difference between the day care treatment and OPD cover. While hospitalization of minimum duration is mandatory to get coverage for day care treatment, the insured person can avail of OPD treatment without hospitalization. Also, day care treatment is usually available up to the sum insured, whereas OPD expenses are covered up to a specific limit.
5. Alternative Treatment
The popularity of alternative medicine in curing chronic conditions, like diabetes and hypertension, is growing in India and worldwide. Earlier, health insurance plans would cover only allopathic treatment; however, most insurance companies have now started including alternative treatment cover among the key features in their policies. In 2013, IRDAI introduced guidelines asking health insurance companies to offer cover for treatments availed under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH). AYUSH treatment is considered to be safe and has been effective in treating various lifestyle diseases.
However, to avail of the coverage, the insured person must get treatment at a government-recognized institute/ hospital or an institute accredited by the Quality Council of India/National Accreditation Board on Health (NABH). The feature is useful for individuals as it saves them from spending huge sum of money from their savings on their medical treatment.
6. Annual Health Check-ups
Most medical insurance policies now cover expenses related to preventive healthcare services, including annual health check-ups and screening tests. Annual health check-up is a prominent feature as it helps the policyholder undertake regular medical check-ups without worrying about the hefty medical bills. Timely health check-ups are essential for detecting ailments at an early stage or knowing the medical treatment required at that stage.
Ailments are on the rise, owing to hereditary and lifestyle-related factors. So, getting a health cover is a valuable investment decision to make as it will protect a family from facing any financial hardships due to medical emergencies.
Choosing the right health cover involves planning and proper research. If you buy a health insurance plan with the features mentioned above, you can rest assured that your medical treatment expenses will no longer be a financial burden for you. It is always advisable to pick a health cover with a high sum insured at an affordable premium. So, comparing the plans and their premium is also necessary.
Additionally, there are many other factors to consider when selecting a policy, such as the inclusions, exclusions, sub-limits, co-payment, etc. Besides, knowing the claim settlement ratio will help you make an informed decision that will keep you worry-free when filing a claim. The higher the claim settlement ratio is, the better the chances of getting a claim.