Medical Inflation a cause of concern for Health Insurance in India

Medical inflation is a cause of concern for each one of us today. India lags behind its global counterparts in offering a state sponsored health insurance system to a large section of the population. As a result, it has one of the highest out-of-pocket spends at 61 per cent, putting a lot of stress on family budgets in case of a medical treatment.

 

Given the uncertainty associated with medical emergencies, it is best to be prepared by availing a health insurance policy. Choosing the correct health insurance plan is a very perplexing process for several people given that there are so many products available today. Also, each policy offers different options, add-ons which tend to further complicate the purchase process.

Before you zero in on a policy, you need to be clear about your requirements as well as your existing medical history and your family’s. Having zeroed in on a policy, it is very critical to thoroughly understand the same including the caveats.

The following factors will help you choose a health insurance policy in line with your needs:

Adequate sum insured

It is essential to take sufficient cover which protects you and your entire family. It is important to choose the right amount of sum insured depending on the past medical history of the elderly family members as they would require higher health insurance coverage. Similarly, the location where you reside should be taken into consideration. A person staying in a tier I city would require a higher sum insured compared to a person who lives in a small town since the hospitalisation costs are higher in metros.

Cashless mediclaim

Most health insurers provide cashless facility to insured individuals. It is necessary to check the list of network hospitals that are offered to the policy holder. Cashless facility offers convenience to the insured as it avoids the hassle of making payments and then claiming reimbursement. Some of the companies have their own claims processing unit which makes direct payment to the customers.

Age limits

It is essential to understand the maximum acceptable age limit offered by the health insurance company. The possibility of falling sick is much higher at an older age. Hence, it is important that one is covered by a comprehensive health insurance plan even after retirement. Also, you should choose a policy that can be renewed after the age of 65 because at an older age it is difficult to purchase a new insurance policy.

Value added services

Most of the health insurance plans in the market offer features that are competitive. An emerging aspect is the additional value-add perks offered along with the policy.

Health insurance firms now offer various additional value add services like free health check-up, online chat with doctors, dietician and nutrition e-consultation, physiotherapy, speech and audiologist consultation. Opting for these value-added services can result in a substantial saving for the insured individual. In addition to the haves in a policy, you need to know the have-nots as well to avoid negative surprises later. Given below are a few factors which are typically not under the covered expenses.

Limited services

Some plans have a limit on certain services. For e.g. ten doctors visits per year, in this case, the policy holder will have to pay full cost of any visits above that limit as they would not be considered as part of covered expenses.

Co-pay and sub limits

Insurance companies have introduced the co-pay and sub-limits wherein the insured individual agrees to share some of the expenses incurred. In this case, the insured benefits from a lower premium amount compared to a regular policy with no sub-limits.

It is essential that you conduct a thorough research and make an informed choice while choosing a comprehensive policy. Preventive care helps and it prolongs the need for insurance but it is wise to keep ones family protected with a good health insurance cover.

The author is VP (Health Underwriting & Claims), ICICI Lombard GIC Ltd.

Checklist

Choose a policy that can be renewed after the age of 65 because at an older age it is difficult to purchase a new insurance policy

Insurers have introduced co-pay and sub-limits wherein the insured individual agrees to share some of the expenses incurred. In this case, the insured benefits from a lower premium amount

The location where you reside should be taken into consideration. A person staying in a tier I city would require a higher sum insured than someone from a tier II city

Good hospitals may be few and far between, so it is necessary to check the list of network hospitals that are offered to the policy holder.

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