5 questions to answer before buying a health insurance cover

Here are five questions you should answer before buying a health insurance plan.

How much cover is enough?

Buying a health insurance policy that is unable to cover your medical expenses effectively is useless. Till a few years ago, a cover of Rs 1-2 lakh was considered enough by most but that is not the case anymore. Experts suggest that individuals should take a sum insured of at least Rs 5 lakh.

However, if you are taking a family floater policy, which covers all the members of the family, you should go for a much higher cover. Like we have seen during Covid times, it is possible that multiple members of a family can fall ill at the same time; the expenses would then be multiplied by as many times in case the illness is serious and requires hospitalisation.

Additional Read: When is the Right Time to Buy Health Insurance?

How much is the deductible?

Deductible is the amount that the insurance company deducts from the claim amount before settling the claim. For instance, if the deductible is Rs 5 lakh and the claim amount is Rs 6 lakh, the insurer will settle only Rs 1 lakh. If the claim is less than Rs 5 lakh, the insurer will not pay at all.

Deductibles usually come with top-up or super top-up policies that are relative cheaper than basic health insurance policies. If you do not have a base policy that can cover the deductible amount, avoid taking these. These policies are meant to increase your sum insured at a lower cost. So in the above example, if your base policy covers the claim amount of Rs 5 lakh, the top-up or super top-up policy can be used to cover Rs 6 lakh. This will ensure that you do not spend anything from your own pocket.

How much is the sub-limit on the room rent?

Most hospitals bill the patient based on the room rent. If the room rent is high, the charge for other procedures and facilities such as a surgery will be higher and vice-versa. For instance, the room rent of a private ward may be higher than for a bed in the public ward which has multiple patients. Accordingly, the cost of the procedures and treatments will be higher for the patient in the private ward. Moreover, the room rent also varies from hospital to hospital.

Most health insurance policies mention the room rent covered. Ensure that it is a reasonable amount and will cover the cost of the room or hospital you prefer. Check the room rent in the network hospitals that are linked to the policy.

Exclusions usually refer to the procedures or conditions that the policy will not pay for. These may include maternity treatment and pre-existing diseases. Each health insurance policy may have a different set of exclusions, which you should check before buying.

For instance, if you are a woman who may plan for a child in another year or so and would want a cover for maternity treatment, you should choose a cover accordingly.

Similarly, if you have a pre-existing disease such as diabetes or hypertension, you should check whether the policy will cover it after a specified period or not at all.

Additional Read: What Does Health Insurance Not Cover?

What’s the coverage?

Apart from assessing what the policy does not cover, it is also essential to understand what it does and its scope.

For instance, if you live in a Tier II or Tier III city, you must check whether some of the network hospitals linked to the insurance policy are there in your city or not, or you may never be able to use the cover.

Similarly, you should look at the scope of coverage. Check how many diseases it covers and to what extent.

You must also check whether a policy only covers hospitalisation or home treatment, including doctors’ visits and tele consultations. The need for home treatment was widespread during the spread of Covid in the country. There are policies that may even pay for fitness and wellness routines.

A significant aspect to check is whether the policy offers cashless facility or not. This aspect can reduce a lot of running around for you, especially if you are old and do not have carers living with you.