10 Common health insurance distresses you must know

Health insurance, though has become popular among many, is often bought without careful consideration. Whether it is lack of time, lack of understanding or simple ignorance, people invest in a health insurance plan hurriedly. They don’t do much research before buying. Are you one among them?

A health insurance plan should be bought only after you have understood the plan completely and are sure that the plan matches your requirements. Buying a plan ignorantly would result in common problems and cause a distress. So, when you are buying a plan for yourself and your family, avoid these common health insurance distresses –

Coverage limits

While many of you consider the coverage features, the underlying limits are often ignored. Don’t do this. Check whether the plan has any sub-limits or restrictions on the coverage features. If it does, you should ensure that your claims are within the sub-limits so that you don’t have to pay any excess from your own pockets. For instance, the sub-limits on room rents under many plans can be 1% of the sum insured. If the sum insured is Rs.5 lakhs, you are allowed a room rent limit of Rs.5000 per day of hospitalisation. If the actual room rent is higher than the allowed limit, the overall hospitalisation claim is reduced. So, if the actual room rent is Rs.10, 000 and the medical bills amount to Rs.50, 000, claim would be paid for only Rs.25, 000.

Ignorance of the claim process

Health insurance claims require you to follow a protocol. You should, therefore, check the terms and conditions of making a claim. Check the claim intimation timelines, the documents required and the claim process beforehand to avoid a distress at the time of actual claim.

(Here are the reasons why your claim might get rejected)

Waiting periods

Health insurance plans have different types of waiting period. Pre-existing illnesses are covered only after a waiting period. This period differs across different plans. It starts from 12 months and goes up to 48 months. So, if you or any family member is suffering from a pre-existing illness, check the waiting period to know when the plan would allow coverage for the illness. Just like there is a waiting period for pre-existing illnesses, there is also a waiting period for specific illnesses and treatments. Treatments like piles, fistula, hernia, cataract, etc. are covered after 2 to 4 years. So, you should know this waiting period too when buying a health plan.

Age-based premium increase

Health insurance plans can be taken for one, two or three years. However, the premium might not remain the same. Companies have age-based premium rates. So, when buying a health plan, know that your premium would increase when you move to another age bracket.

Facing out-of-pocket expenses

Every health insurance plan has a list of excluded coverage features. This list constitutes the plan’s exclusions. Many often than not, most of you ignore this exclusion list. When you make a claim you find out that the coverage is excluded and end up paying the expenses yourself. Avoid this dilemma. Know the plan’s exclusions when you are buying it so that you can avoid the excluded claims

Did you know India spends 90% of its healthcare costs from its own pocket?

Co-pay ratio and deductibles, if applicable

Co-pay is applicable if individuals aged 61 years and above are covered under the plan. So, if you cover your senior citizen dependent parents or buy senior citizen health plan co-pay would be applicable. Co-pay ratio indicates the portion of claim which you have to pay. So, if your plan states a co-pay of 20%, 20% of the claim amount would be payable by you. So, check for the applicable co-pay ratio before buying the plan. There is also a concept of deductibles in some health plans. Deductibles also represent the portion of claim payable by you. Claims up to the deductible limits are not paid by the health plan. Only if the claim exceeds the deductible limit, the excess is paid. For instance, if there is a deductible of Rs.10, 000 and the claim amounts to Rs.12, 000, the health plan would pay only Rs.2000 as claim. The first Rs.10, 000 would have to be borne by you.

Read more about Dejargonizing health insurance terms

Pre-entrance medical check-ups

Pre-entrance medical check-ups are medical tests which are conducted before the company issues the policy. Requirement of these tests depends on your age and the sum insured you have chosen. Usually, if your age is up to 45 years and the sum insured is up to Rs.5 lakhs, pre-entrance check-ups are not required.

The coverage features

This is the most important factor which you should consider when buying your health insurance plan. The coverage features of the plan influence the coverage you get. Higher the features, the more comprehensive would be your health insurance coverage. So, look at the coverage features of a health insurance plan and opt for a plan with the highest features.

Age restrictions in a floater plan

A family floater plan covers your family members too. Dependent children and parents are covered under the plan besides yourself and your spouse. However, coverage for dependent members is limited up to a specified age. Dependent children are, usually, covered till they attain 21-25 years. Similarly, there might be a restricting age for dependent parents too. So, understand these age restrictions of your floater plan to know for how long can your family members be covered.

If you exercise caution with these pointers and choose a health plan with care, you wouldn’t have to face any distresses. So, be wise when you are buying a health plan.

Renewals and Grace Period

Health insurance plans come with a fixed tenure. This tenure can be one, two or three years. After the selected term of the plan comes to an end, the plan should be renewed if you want to enjoy uninterrupted coverage. If the plan is not renewed within the due date, the policy lapses and the coverage under the plan stops. You lose all renewal benefits when the plan lapses. However, there is a concept of grace period under health plans. Grace period is an additional period which is allowed after the policy due date for renewal. If the policy is renewed within the grace period, the renewal benefits continue. However, no coverage is available during the grace period.