Everyone is running at high speed to reach their goals because no matter how much you try, you can never beat time and all you can do is compromise with it. Thus, began an era of fast paced life where man needs work harder and faster in his respective field. If so many things can be done in jinks then how can medical science stay behind? Therefore, unlike few years back when treatment of cataract, gall bladder transplantation etc. used to take few days, can be now treated within 24 hours. However, does that mean the expense of these treatments has also reduced? Of course not. Like in every field technology is improving but service charges are increasing, similarly, getting medical treatment is a very costly business. Thus, day-care health insurance was introduced. What is Day-care Health Coverage? There are at times that patient is asked to do some disease diagnosed test where the treatment is not required say MRI Scan or some minor operation that does not require patient to stay in hospital and can be done in minimum 24 hours, so all the expense related to these stuffs will be paid by the insurance company under day-care rider. In other words, day-care health coverage looks after all the coverage that the insurer had to pay for diagnosis or treatment in hospital which can be taken care of within 24 hours. What is the Benefit of Day-Care Health Insurance? If you are wondering why to bother about day care procedure, I can bear a day expense of hospital, then let me tell you, you are making a grave mistake. Nowadays, the over the counter expenses like disease diagnosis test that do not need hospitalization or treatment as such can also burn your pocket. Few tests can cost you thousands. So, how can you simply ignore it? The biggest benefit of day-care procedure is that it will save your money. How to Choose Best Health Insurance in India on Basis of Day-Care Procedure? Nowadays, almost all health plans provide day-care procedure. However, the benefits of some indeed are better than others. So, whenever, you buy medical coverage on basis of day-care procedure, keep these points in mind- It usually happens that whenever a person see variety of treatments covered under day-care procedure, he becomes excited. However, it is advisable to see rather the treatments covered under the day-care procedure are broader in concept wise. For example, instead of give 200 names of all types of surgeries, the name of the 20-25 type of categories such as oncology, urology etc that might cover 300 surgeries will be more beneficial. Moreover, let’s be frank we are no expert nor doctor, so, it is obvious, we might not know all type of surgeries mentioned in the form nor we are free enough to Google everything, thus, it is better to go for the broader categories that we can at least guess. There is ODP (Out Department Patient) clause that not all insurance companies consist. It means that if the insurer didn’t get hospitalized for at least a day or has minor treatment not mentioned in day-care procedures, and then he/she will not be paid. Hence, be sure that your insurance actually has ODP so that even if your treatment or diagnosis is done within few hours still you get paid by your insurance company. For an example- a simple dental surgery, this might not be considered under general day-care procedure but is included in ODP. Though in India, very few insurance companies offer ODP because health sector here is much unorganized. [Source: http://www.policyx.com/blogs/what-all-day-care-procedures-are-covered-by-insurance/] So you have decided to go for a health insurance policy? That’s a great decision! But have you thoroughly assessed your health insurance needs before choosing a plan? It is important to understand the nitty-gritties of your health insurance plan even if you go for a large health cover. Many insurers operate on the model of sub-limits. What are sub-limits? Sub-limits are upper limits imposed on various aspects of hospitalization. Therefore, all costs lower than your sum assured may not be approved by your insurance company. Thus, resulting in unexpected outgo from your pocket.
Sub-limits are imposed to limit claims outgo and are restricted to some common ailments such as piles, hernia, cataract, kidney stones, etc. Of course, the list of ailments and sub-limit factors vary from insurer to insurer. While sub-limits are not largely prevalent for individual health insurance plans, group insurance policies have such limits. Sub-limits exist for many aspects such as room rent, ambulance charges, ICU expenses, oxygen, etc. Typically, room rent expenses as part of sub-limits are restricted to 1 – 1.5% of the sum assured per day. ICU charges are capped at 2 – 2.5% of the sum assured. Let’s look at some of these hospitalization costs and how insurers treat these in further detail: Sub-limits on room rent: Many health insurers cap the room rent per day to not exceed 1 – 1.5% of the sum assured i.e., if your sum assured is Rs.5 lakhs, the room rent cannot exceed Rs.7,500 on the higher side. Sub-limits on specific ailments: There are certain ailments which come under the sub-limits clause. Hence, you will need to check the list of ailments which come under the sub-limits clause of your insurance provider. While your sum assured could be high, you might still not get adequate insurance if the ailment for which you or a member of your family is undergoing treatment falls under the list of ailments that are restricted by sub-limit. For instance, if there is a sub-limit clause of 40% of sum assured for liver or kidney ailments, then regardless of whether your total sum assured is Rs.5 Lakh, you will be eligible for only Rs.2 Lakh due to the 40% sub-limit clause. Miscellaneous Expenses: Depending on your insurer, treatment costs such as ambulance charges, oxygen, etc. also fall under the sub-limit clause. While some of these costs might be small, if you have not done your homework adequately, these charges might add up to cost a considerable outgo from your pocket. Therefore, it is advisable to do a thorough review of what aspects of hospitalization fall under sub-limits, if any, for your Medical Insurance Policy. Factors to keep in mind: a. While the premium for policies with sub-limits could be slightly lower than policies that don’t have sub-limits, the risks are rather higher. Therefore, weigh the opportunity costs before choosing the plan. b. Assess the cost of hospitalization from time-to-time and evaluate whether your current insurance cover meets the escalating cost of medical treatment. If required, increase your insurance cover to meet the higher cost of medical treatment. c. It is advisable to take a health cover fairly early in life. This ensures your premium amount is lower and you stand protected against medical expenses as well. d. A higher coverage ensures your eligibility is higher in spite of a sub-limit. e. Identify a few hospitals in your neighborhoods, to be adequately prepared for emergencies. Also, ensure that the hospitals identified are part of the network hospitals list of your insurance provider. To ensure you are not in for any nasty surprise at the time of hospitalization or claim, make sure you go over your health insurance policy document carefully to understand the terms and clauses specified. If the policy contains sub-limit clauses, evaluate if there are other plan options that contain no such restrictions and at similar price-points. Compare health insurance plans for sub-limits before going for your purchase. [Source: http://www.policyboss.com/blog/health-insurance/what-are-sub-limits-in-health-insurance] Unaware of what your health insurance plan can provide you with? Never mind most of us fall into the same league. Most of us believe the said about health insurance policies. i.e they cover hospitalization charges, but there is much more to a health insurance than hospitalization charges. Unaware of what your health insurance plan can provide you with? Never mind, most of us fall into the same league. Most of us believe the said about health insurance policies. i.e they cover hospitalization charges, but there is much more to a health insurance than hospitalization charges. A traditional health insurance policy provides you with
11. To simplify things, here are some of the good, unique, known and not-so-known health insurance benefits offered by the insurance companies in the recent time: 1. Lifelong renewal
4. Second OpinionStandard health insurance policies would cover only one doctor's consultation fee but in the recent times specialized health insurance companies know the importance of getting second opinion from a specialized doctor and hence offer the benefit of second opinion from a medical practitioner for selected major illnesses. Eg. Religare offer the Second opinion coverage. 5. Vaccination coverPreviously mediclaim polices did not cover maternity expenses, but of late health insurance plans cover maternity expenses and also provide the vaccination expenses for the children. Please note, that this benefit is covered post waiting period for maternity ranging from 2 years to 4 years. Eg. Max Bupa, Star Health, Apollo. 6.Health Insurance covering OPD expenses 24 hour hospitalization for reimbursement was the traditional way , new health insurance providers cover outpatient department (OPD) expenses, like routine doctor consultations, medical checks, dentist consultation and treatment bills. The inclusion of OPD benefits means that the insured individual need not be hospitalized to seek insurance benefits. E.g. ICICI Complete health and Star Health Comprehensive offer health insurance with OPD benefits. 7.Take advantage of health and wellness toolsBeside from providing financial protection, many health insurance plans offer benefits, resources and incentives to help you and your family get and stay healthy. These may include coverage for annual check-ups and screenings, and discounts on exercise programs and alternative care treatments. Review your plan materials and take advantage of the programs offered. 8.Varied premium structuresEarlier the premium structures of the health insurance policies remained same all over India, but in the recent times some companies like Bharti AXA, Max Bupa, New India Assurance, Star Health, and L& T Insurance have introduced the concept of Zone based premiums for Metros and Smaller Towns. The pricing structure for the health insurance policies for smaller towns is lower than the pricing in metro cities mainly because the medical expenditure and cost of treatment is higher metro cities. 9.Daily hospital cash allowanceReally! did any of you know that all the food, commuting, family expenses, all are paid by the insurer! After all even these add up to substantial amount. Yes, the solution to this is your policy. Check for daily hospital cash allowance, in form of pre-fixed, per day cash handouts,this is usually provided without any produce of bills or documents. 10.Convalescence BenefitsIs your recovery not costly? Oh yes hospitalization charges apart some companies also take care of the recovery charges. Also termed as recuperating benefit, this feature promises a lump sum in case of a prolonged stay at the hospital. The duration of prolonged stay usually varies between 7 and 10 days among policies. In case of some policies, the post-hospitalization stage could be treated as the recuperating period. You need to be aware of the predefined benefit amount and period. [Source: https://healthinsurancepolicyblog.wordpress.com/2016/01/13/known-unknown-benefits-of-your-health-insurance/] Healthcare insurance is an essential aid in today’s world where medical care costs are rising steeply with every passing day. A medical crisis like accident, critical illness or sickness can result in extended hospital stay that can leave you in a serious financial setback unless you have a comprehensive healthcare policy which can take care of your medical expenses. So, what we need to find out is, “Which is the best healthcare insurance plan for you”? Today where so much of information is available and huge efforts are put in spreading awareness, there is an apprehensive approach when it comes to buying a health insurance. Prime cause of this is the insufficient knowledge about the prospects a good medical insurance policy can offer. There is also very little knowledge about the aspects that should be examines when buying a medical insurance plan and filing a medical claim successfully. Factors which should be considered to choose the best health care plan for your family in India are: 1. Number of members and their respective age 2. Look for the maximum amount of sum provided to cover family members in the policy. Select a sum considering your premium payment capacity as higher the coverage, more the premium payment. 3. Additional features like riders that you can add to your policy like accidental cover, critical illness rider. 4. Complete information regarding medical check-ups if one has reached a pre-defined age. 5. Information regarding filing of claims and the restraints that may prevent a successful filing. 6. Thorough research for the best health care insurer and their policies. Select a policy that can manages all your health needs. 7. Always claim your free year bonus that every healthcare insurer offers to its customers for claim free years. The bonus can either be an increase in the sum insured or a discount on the premium. [Source: https://www.maxbupa.com/health-articles/general-health/best-health-insurance.aspx] |
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