Parameters of Health Insurance Plan

1) Maximum Renewal Age: The maximum renewal age is the age till which an individual can be offered the insurance cover. This parameter is the most important of the deciding factors since the need for health insurance is most felt as age increases, so you should look for the plan which offers the longest policy renewal period.

2) Sub limits: The sub limits are limits imposed on the different sections of expenses involved in the cover. It puts a maximum limit to which the insurer would pay for a particular expense incurred during a treatment. E.g. some insurance companies put an upper limit to the room rent it would reimburse. So in such cases if the expense incurred by you exceeds the limit mentioned by the insurer, than the remaining amount needs to be paid by you. There would be other sub limits like doctor’s consultation,

3) Maximum coverage amount: This is the maximum amount for which an individual is entitled to get the cover. Each insurance company has its own policy for the sum assured offered. The selection of the cover depends on our needs and premium paying capability. The sum assured ranges from 2 lakhs to 50 lakhs depending on the insurer.

4) Pre and Post hospitalization Expenses: This implies the cost of medical tests, medicines, scans etc occurred during the defined time frame before and after hospitalization are covered. Depending on the insurer the time covered could be 30 days before the hospitalization and maximum of 180 days post hospitalization.

5) Pre existing diseases: Some insurance companies cover pre existing diseases after a defined waiting period of continuous renewals. E.g. a policy holder suffering from diabetics would be covered depending on his age and plan opted after a waiting period of 3 or 4 years. We must choose the insurance plan which has the least waiting period.

6) Day Care treatments: There are certain diseases or treatments which are covered even though it does not require 24 hour hospitalization which in general is a mandatory clause. This could be due to the change in technology resulting in less time for treatment. E.g Cataract surgery.

7) Ambulance Charges: In case the policyholder needs hospitalization then insurance companies reimburse the cost of transportation by ambulance. Each company has a fixed amount allotted as ambulance charges.

8) Medical Tests: Companies have a list of predefined medical tests which an individual is required to undergo if the individual is above age 45 or sum assured asked for exceeds a certain amount. The requirement to undergo tests varies. Also these tests are completely paid by the insurer.

9) No claim bonus: If the policyholder does not claim in the previous year than he is entitled to the ‘no claim bonus’ either by premium reduction or increase in the sum assured at the existing premium amount.

10) Tax Benefit: The amount paid as premium is entitled for income tax deduction under section 80 ( C ).

11) Non allopathic treatments: Some insurance companies provide cover for treatments under ayurved, unnani and homeopathy.

12) Cosmetic and other surgeries: In most cases insurers do not provide cover for cosmetic surgeries, dental implants or any weight loss treatments or surgeries.

13) Network Hospitals: These are hospitals which have a tie up with insurance companies to provide cashless treatment. On the basis of the health card provided by the TPA ( third Party Administrator) you are eligible to get treated without any payment.

14) Domiciliary Treatment: In many cases the patient needs to be treated at home and cannot be taken to the hospital. In such cases many insurance companies provide reimbursement for the cost of treatment incurred.

15) Co payment: This means there is a division of expenses paid between the policyholder and the insurance company. If a particular company defines the co pay option as 10% on all claims made then in this case you are required pay 10% of the expenses and the insurer pays the 90%.

16) Claims Loading: Each premium following a year where claim has been made it loaded with extra charges. These charges depend on the percentage of cover claimed. The premium loading could be very high in certain cases so you should always check the extra premium charges specified by the companies.

17) Exclusions: There are certain diseases which the insurers do not consider at all. Such exclusions are permanent exclusions such as AIDS, mental disorder, drug abuse etc. Whereas, there are certain exclusions which are considered after certain conditions.

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