5 Things To Check in Your Health Insurance Policy

When you avail of a health insurance policy, a lot rides on it since you will be financially reliant on the plan during times of dire health emergencies. So, you need to be sure that the policy you choose is suited to your medical and financial requirements. While a quick comparison of policies before the purchase can be a smart move, you can also use the free look period after the purchase of the plan to go through some important details in your Health Insurance Policy Document. This will help you determine if the plan you purchased suits you.

Here are 5 important things to check in your health insurance policy -

Proposer & Insurer’s Details - Irrespective of whether you have purchased an individual, group, or family health insurance plan, the first thing that you need to check is the name(s) of the policyholder(s), their gender, age and such other similar details. The address, contact details, and names have to be accurate to ensure that during claim filing, there are no confusions that could lead to delayed or rejected claims.

Policy Number - You can see an alphanumeric code in your policy document that is unique to the plan. This policy number needs to be provided to the respective authorities when you are raising a claim. So say you are in a hospital for a scheduled treatment/surgery. To have the cashless (if it’s a network hospital) perk kick in for your invoices, you will need to submit your health insurance policy number at the insurance desk in the hospital.

(P.S. It’s best to carry your health insurance card with you. This carries the policy number for your plan and makes way for a hassle-free claim filing process.)

Permanent Exclusions & Waiting Period - Each health insurance policy has a set of permanent exclusions and waiting periods that are mentioned in the document.

1. Permanent Exclusions: These are conditions pre-set by the health insurance provider as ones that will not be covered under any circumstances. This includes injuries caused by war, injuries caused by suicide attempts, intentional or self-inflicted injuries, substance abuse and addictions, cosmetic procedures, obesity/weight control treatments, etc.
2. Waiting Period: Once you have purchased a plan, the health insurer will request you to wait for a certain number of days/months/years to get coverage for certain ailments. This is called the waiting period and is categorised into - the initial waiting period (30 days from the commencement of the policy), the waiting period for pre-existing medical conditions (2 years to 4 years), the waiting period for specific ailments (2 years), and maternity waiting periods (9 months to 4 years).

Any Co-insurance/Deductible/Copayment Clause - These are optional conditions that distribute the payout risks for the health insurance provider and end up leading to a lower premium.

1. Co-Insurance: Co-insurance can come into place as a threshold % amount that you need to pay towards each of your invoices, after which the insurance coverage kicks in. However, co-insurance can only kick in if you have opted for a deductible on your health insurance plan.
2. Deductible: A pre-decided fixed amount that you need to pay off towards your invoices before the insurance coverage kicks in.
3. Copayment: A fixed amount or percentage of the billed amount that you need to pay, while your insurer covers the residual amount.

These options lead to out-of-pocket expenses, despite having a health insurance policy in place. It’s usually best to skip these conditions and opt for a health insurance policy that doesn’t make such shared payouts a mandate. However, if there are conditions involved (senior citizens or any complicated list of pre-existing medical issues), opting for these may be the only way to get a plan at all.

When checking the health insurance policy document, check if the copayment, deductible, and coinsurance terms and conditions are declared as per your discussion with the insurer. If you find a mention of these conditions despite saying explicitly that you don’t want them, make sure to immediately report it to your insurer.

Coverage details including Health Insurance Add-Ons - Look into the details regarding your coverage amount. Make sure that if you have opted for a Rs 10 lakh coverage, the same is mentioned, nothing more, nothing less. Moreover, health insurance providers, to promote customisation, offer a wide range of health insurance add-ons like consumable cost coverage, inflation shield, no claim bonus shield, unlimited restoration, daily hospital cash, etc. In case you have opted for any of these covers, take a look into the details regarding the same.

Conclusion

A quick health insurance policy check is your last stop to ensure that you have chosen the right health insurance plan that meets your financial and medical goals. In case you find some discrepancies in the documents,

you can rectify the same You can send queries to the insurer

-and subsequently, get the changes made, or get a different plan altogether. In case you follow up with these actions in the free look-up period, you don’t lose much financially.

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