Mediclaim Insurance Factors

Factors to consider when comparing mediclaim insurance in India

• Choosing the Right ‘Sum Insured’
  It is important to ensure adequate coverage while buying Indian mediclaim insurance. With every increasing medical treatment costs, having an optimum coverage amount is very important. A person living in a metro city may require a higher sum insured than one residing in a smaller town, an older person should opt to have a higher coverage than a younger person. Also if one is opting for a Family Floater, having sufficient coverage for all members of the family is critical.
• Cashless Hospital Network of the Insurance Company
  This pertains to the number of hospitals that the insurance company has tied up for cashless treatment, ie. where the insured need not pay the treatment expenses at the time of discharge from hospital. The larger the network of hospitals, the better. Also see if the larger and better known hospitals are covered in the city of the insured’s residence.
• Waiting Periods
  Waiting Period is the period during which the insurance company is not liable to pay any claims to the insured for specific coverages. Most health insurance plans offer different waiting periods for different covers, one needs to review and compare them before opting for a particular plan.
• Exclusions Under the policy
  One must go through the detailed list of exclusions before opting for a particular Indian mediclaim insurance plan…these are essentially the benefits/features that are not covered under the chosen policy and the list of exclusions vary from insurer to insurer. Also once the policy is received, kindly go through the terms and conditions since there is a free look period for all policies, during which time the policy can be cancelled if the insured is not happy with the selected plan.
• Lifetime Renewability
  Renewability means the maximum age till the insured can have their Indian medical insurance policy renewed while continuing to enjoy the same coverage. Most health insurance policies today offer lifelong renewability, but the insured needs to confirm the same prior to opting for a plan. One must understand that buying a policy for the first time at a young age will help in having a lower premium, and one can enjoy accumulated bonus coverage for claim free years, but the policy will normally be required when the insured is at an advanced age.
• Co-payment Terms
  Co-payment is the insured’s contribution to a particular claim – it is normally a defined percentage of the claim amount payable by the insured while the rest will be settled by the insurance company. For example, if there is 15 % co-payment in a health policy, the insurance company will pay only 85% of the covered expenses and the insured individual will have to bear the remaining 15% of the hospitalisation/treatment charges. It is important to note that lower premium could sometimes mean higher co-payment terms, so the insured needs to be wary of the same while finalising their plan.
• Claim Settlement TAT / Ratio
  The Claim settlement turnaround time (TAT) and settlement ratio of the insurance company should also be evaluated while finalising the insurance plan and provider. A good insurance company is one with shortest claim settlement TAT and highest claim settlement ratio. Most insurance companies also work with Third Party Administrators (known as TPAs) for claims management, while some manage the claims directly. It is important to know who one has to deal with at the time of a claim.
• Other Important Clauses
  It is equally important for the insured to evaluate clauses like Day Care procedures (the number of them vary from insurer to insurer), Pre/Post Hospitalisation timelines, Coverage or Pre Existing Conditions, specific Sub Limits for certain coverages are also factors to be considered while finalising on the optimum Indian medical insurance policy.