How To Buy a Health Insurance Plan?
To have a best health insurance policy is not as easy as buying regular things or even big consumer items such as refrigerators and washing machines. This decision totally depends on substantial degree of analysis and the needful consideration of various factors, including what the health insurance requirement we have, the sum insured and the amount you can opt out on health insurance premiums.
How you can get health insurance in a systematic manner:-
By Understanding what the Health Insurance Requirements is:
Buying a suitable health insurance plan is a thorough assessment of your health insurance requirements and the sum insured you need. If you want to buy health insurance for yourself, you can opt for an individual health insurance plan, whereas if you wish to get medical insurance coverage for your family members, you can consider a family health insurance plan.
After deciding who you want to bring under the coverage of the intended health insurance plan, you must decide on the type and extent of said coverage. In this context, you must take into account your age, medical history, pre-existing illnesses, if any, etc. before determining the sum insured and plan. You can opt for a critical illness cover to enhance the scope of your health insurance.
Before buying health insurance policy must Check Policy Benefits
After deciding the health insurance plans the next step is to assess and compare health insurance plan to select the best for yourself and/or your family. It is advisable to choose a medical insurance plan that allows you to remove room rent limits, offers relevant benefits such as a maternity cover and a critical illness cover.
Do all the needful Research about the Insurers
You would not purchase anything that is even remotely important without adequate research, now, would you? Then why make an exception for something as critical as health insurance?! It is important to compare various health insurance providers and check their key result areas, including but not limited to their claim settlement ratio, the ease of the claims process, hospital networks, customer feedback and reviews, and customer support mechanism.
Eligibility Criteria for a Health Insurance Policy in India
Health insurance plans are meant to protect you and your family against the rising medical costs resulting from unfortunate medical emergencies. While you may think that anyone can avail of health insurance plans, you are only partly right. There are eligibility criteria that need to be met if you are looking to purchase health insurance. For most health insurance plans, these are the eligibility criteria that need to be met –
Age Criteria
While adults over the age of 18 years and within the age limit of 65 years can purchase health insurance plans, the age criterion for dependent children is between 90 days to 25 years. Beyond the age of 25 years, it is best to have health insurance for yourself so that you can avail of a low health insurance premium rate.
- The age criteria for dependent children marks the entry age between 90 days to 25 years of age.
- The age criteria for adults marks the entry age at 18 years to 65 years of age.
- The pre-existing disease waiting period is 2 – 4 years.
- The pre-medical screening applies to policy buyers aged 45 years, 55 years or 60 years.
Pre-medical Screening
A pre-medical test or examination is necessary mostly for policy buyers above the age of 45 or 55 years. In the case of most, a pre-medical test is compulsory and will influence the policy issuance. However, it is best to buy health insurance when you’re young so that you can benefit from a low health insurance premium cost.
Pre-existing Diseases
There is a waiting period of 2-4 years for pre-existing diseases during which you cannot receive the full benefits of your health insurance coverage. It is also a wise idea to let your insurance provider know if you have a medical history or about your smoking habits.
By revealing genuine information to us about your health conditions and lifestyle habits, you can save yourself from the hassle of a delayed or rejected claim.
Factors To Consider While Buying Health Insurance
Whilst it is critical to buy health insurance as early as possible in your life, it is even more important to engage in thorough research before selecting a health insurance plan, finalising the sum insured and the amount of applicable premium. Here are some of the main factors you must consider while choosing a suitable health insurance plan for yourself:
The Sum Insured
For instance, if you have a pre-existing illness, say, diabetes, or have a family history of said ailment, you must choose a plan that covers it. With the cost of medical treatment rising faster than a stock market ticker on a bullish day, you simply must not settle for less than the optimal sum insured for your health insurance plan.
Waiting Periods for health insurance
Whilst some health insurance benefits get activated instantly, some others have a waiting period during which they stay mere words on your policy document. First things first, there is the initial waiting period of one month during which you cannot file any claims other than accidental claims. Secondly, the waiting period for the pre-existing illness cover to get activated lasts anywhere between two to five years, depending on your policy and the specific illness. Thirdly, the waiting period for the maternity cover part of your policy to get activated is usually four years.
Network Hospitals
The larger the cashless hospital network of your health insurance provider, the higher is the degree of convenience and flexibility you enjoy with regard to cashless claims. With a network of more than 10,000 hospitals, Tata AIG health insurance has you covered for cashless treatment across the country.
The Add-Ons & Riders Available
If a health insurance plan has the flexibility for the addition of an add-on rider, it is usually considered a green light as far as the value of the plan is considered. With the inclusion of the required health insurance add-ons, you can significantly enhance the coverage of your health insurance plan with minimal addition to your health insurance premium. It’s a win-win situation for you if ever there could be one.
The Claim Settlement Ratio
You must always get insured with a health insurance provider with a high claim settlement ratio over the preceding few financial years. Since this ratio is one of the key markers of the customer-centricity and claims efficiency of an insurer, a higher ratio indicates a massive go-ahead sign for you.
What Is Waiting Period In Health Insurance?
Typically, there are three types of waiting periods in health insurance.
Initial Waiting Period
This waiting period usually lasts between 15 to 90 days, varying from one health insurance plan to another. If you were to add any newborn children to your existing health insurance plan, this waiting period clause shall apply to them as well.
Waiting Period for Pre-existing Illnesses
There are different waiting periods for different medical conditions and ailments, such as diabetes, hypertension, and thyroid. You must, therefore, check the selected plan to ascertain this waiting period before you make the purchase decision.
Waiting Period for Specific Diseases
The waiting period for specific critical diseases also varies depending on the health insurance plan you select. For instance, the waiting period for cancer shall be different from that for renal failure. Therefore, it is pivotal to carefully peruse the policy wordings.
Waiting Period For Maternity Cover
The waiting period for maternity cover in a health insurance plan is usually four years. Therefore, it is prudent to buy a health insurance plan well in advance of your plans to start a family.
Documents Required for Health Insurance Claim
Medical emergencies can only be covered if you either file a reimbursement claim or choose to undergo treatment at your closest network hospital. And for that, you should have all of your documents in place so that we can help you with a seamless claim settlement.
In health insurance plans, the documents needed for filing a claim are –
- In-patient hospitalisation bills attested by the insured under the medical insurance.
- The discharge card signed by the authority at the hospital/network hospital.
- Claim form containing the insured’s signature.
- A valid medical investigation report.
- The medical store receipts and the doctor’s prescription.
- List of hospital consumables prescribed by the doctor with all details.
- The present year’s copy of the third-party administrator’s (TPA) ID card.
- Copies of the health insurance policy from the previous year.
- Any other document as required by TPA.
- Bills and receipts of doctor’s consultation.