Five Elements You Should Not Ignore While Finalising The Health Plan For Your Family

An effective risk mitigating tool hedging you against rising healthcare expenses, a health insurance policy is a modern-day need. Financial advisors strongly advocate for health insurance as a medical emergency can arrive unannounced and wipe out your life’s savings. Today family floater plans you can cover all members of your family under a single policy. However, while finalising a health insurance plan for family, you mustn’t ignore these five essential elements. 1. The sum insured One of the primary things to consider before buying a family medical insurance policy is the sum insured. It’s the maximum amount of cover provided by your insurer. You must choose this amount carefully as healthcare costs in metros and tier-I cities are comparatively higher than rural areas and tier-II and tier-III cities. For a family of 5-6 members living in a metro, experts generally advise opting for a health insurance cover of a minimum of Rs.5-8 lakh. 2. Network of hospitals covered Every health insurer has a network of hospitals where you can avail cashless treatment. Though most insurers have tie-ups with leading hospitals, it’s essential to note its network of hospitals. Make sure the hospitals are close to your residence and have state-of-the-art treatment facilities.Note that in case you avail a treatment in a hospital which isn’t covered by your insurer, you need to provide the bills and relevant reports along with the claims form to receive reimbursement.
3. Co-pay and sub-limit clauses Co-pay and sub-limit clauses are two essential aspects of buying a health insurance policy. A co-pay clause entails payment of a certain percentage of the billable amount from your own pocket. For example, if your medical insurance policy has a co-pay of 20% and the bill amounts to Rs.1 lakh, you need to pay Rs.20,000 from your pocket. Your insurer would pay the remaining Rs.80,000. Sub-limit clauses put a cap on the health insurance claim and is generally placed on doctor’s consultation charges, room rent, etc. For instance, if your family medical insurance plan has a sub-limit of Rs.1,000 on room rent per day and you stay in a room costing Rs.1,500, you need to shell out the extra Rs.500 from your pocket. It’s financially prudent to opt for a plan with lower co-pay and higher sub-limit clauses. This may, however, push up the premium amount. 4. Waiting period for pre-existing ailments Waiting period refers to the time after which you receive coverage and the benefits of the policy. On most occasions, the waiting period of a health plan is 30 days. It means you are entitled to receive monetary benefits in case of hospitalisation after 30 days of the policy issuance. However, it is different in case of pre-existing ailments and can range from 2-4 years. Before finalising the policy, make sure to read the fine print and find out the waiting period for pre-existing ailments such as arthritis, diabetes, etc. 5. Provision of no claim bonus No claim bonus is an essential feature of a health insurance policy whereby the insurer increases the sum insured by a certain percentage for every no-claim year, by keeping the premium same. It’s crucial to note that no claim bonus helps you beat the effects of medical inflation to an extent. Before purchasing a policy, make sure to understand the provisions of no-claim bonus and it’s calculated. Apart from these essential points, note that the premium of a family health insurance depends on the age of the eldest member covered by it. There are various health insurance premium calculators available online that help you to calculate the payable premiums. Make sure to compare various policies before choosing. Comparison of health insurance plans in India is an easy process with the availability of various aggregator portals. The Bottom Line: While buying a health insurance policy for family opt for a high sum assured and watch out for the network of hospitals covered, co-pay and sub-limit clauses along with the waiting period of pre-existing ailments.