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Tips for buying best mediclaim insurance

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Health Insurance is probably the most important insurance cover that every individual should ensure they have Every individual should buy health insurance and for themselves and members of their family, based on their requirements. Know more »

Tips for buying best mediclaim insurance in India

Buying health insurance protects individuals from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into their hard earned savings. Healthcare is also becoming increasingly expensive in India, with technological advancements, new procedures and more effective medicines that have driven up the costs. While these high treatment expenses may be beyond the reach of many, taking out a health insurance policy is much more affordable and makes economic sense to any individual. Some of the important tips to buying the Right Health Insurance in India plan include:
  • Choosing the Optimum Sum Insured
    every individual should first decide on the sum insured / coverage that they need given their affordability, risk appetite, family history and the exposure they currently have.
  • Evaluate the Exclusions and Waiting Periods under the Plan
    these are important features to be considered while choosing the right plan. One should end up understanding what is covered and after what period of waiting they can make a claim while also understanding what is not covered under the policy.These are important features to be considered while choosing the right plan. In order to purchase a plan with a low premium, the waiting period and exclusions could be higher than most plans in the market.
  • Choose the Right Insurance Partner
    the insured should opt for an insurance partner whose policy is transparent and clear on the terms and condition, as well as their claim settlement capabilities and their claims settlement ratio. One must also ensure the insurance company has a reasonable strong cashless network across India.
  • Lifetime Renewability
    almost all insurance plans today offer a lifelong renewability, the insured can continuously renew the policy every year as long as they are alive. But the same needs to be confirmed by going through the policy coverage, terms and conditions.
  • Day Care Procedures / Pre & Post Hospitalisation
    these are also a few important features that must be present in the proposed plan. Day Care procedures are those surgeries and medical interventions that don’t require hospitalisation.
  • Truthfully Declare existing medical conditions
    while this may seem tricky to inform the insurance company upfront about a pre existing condition, since this may result in an increased premium or even denial of coverage in extreme cases, it is recommended that the individual makes a transparent declaration so that they do not face an issues at the time of a claim.
  • Coverage / Benefits under the Plan
    This is an important factor deciding the premium. If one considers only premium, the coverage could be reduced significantly which may cause financial stress at the time of a claim.
  • Co Payment by the insured
    Since the premium is low, the plan could have a higher co pay, which is the % of the claim expense payable by the insured. So whatever the insured is saving on premium will need to be paid as part of the co pay at the time of a claim.
  • Strong and Large Cashless Network
    One must also ensure the insurance company has a reasonable strong cashless network across India because the insured could be hospitalised anywhere in India.

Yes, there is nothing against multiple insurance policies paying for a single treatment. There are however certain conditions to be followed and which the insured should keep in mind. In fact, one must be aware of the fact that while taking health insurance, one is required to fill up proposal forms, wherein the insurer asks the insured to disclose any existing policy. The main purpose of asking this is because there is a contribution clause in most policies. The contribution clause means that for the same treatment if there is more than one policy, then for such a claim situation all the policies will contribute in equal proportion to the proportionate sum insured.

Also one needs to inform about the existing policy or policies to the other insurer(s) while buying a policy or making a claim simply because if you do not disclose this fact, they are violating the terms and conditions of the health insurance contract and in case of investigation this could be termed as mis-representation. Let us look at two possible scenarios.

  • Scenario 1 - Assuming that an insured has two policies with Sum Insureds of ₹2 lacs and ₹3 lacs and the insured is admitted to a hospital for some treatment and the expenses incurred are ₹ 1.5 lacs. In such a scenario, the insured has to make a decision to claim under either one of the policies. Since original bills have to be submitted while seeking reimbursement of a claim, the insured cannot use the same set of original bills to claim with multiple insurers.
  • Scenario 2 - Assuming that an insured has two policies with Sum Insureds of ₹2 lacs and ₹3 lacs respectively and the insured is admitted to a hospital for some treatment and the expenses incurred are ₹ 3 lacs. Here the contribution clause will apply and based on the SI contribution, the first policy will take 40% (2 lacs/5 lacs) of the claim of ₹3 lacs and hence will pay ₹1.2 lacs. The second policy will take 60% (3 lacs/5 lacs) of the claim of ₹3 lacs and hence will pay ₹1.8 lacs.

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