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What are the Key Features of good health insurance plans?

Some of the key features that most good mediclaim health insurance plans have include:
  • Cashless Hospitalization
    This is the primary reason that Cashless India health insurance plans are bought by customer. They offer cashless hospitalization due to a sickness or accident and where the insured can get admitted to a network hospital and be treated without having to pay for the same from their pocket. The treatment expenses will be settled directly between the insurance company & medical facility.
  • Pre and Post Hospitalisation
    There are additional expenses for diagnostics, consultation fees, medicines, vaccines before or after hospitalization of the insured and these expenses also get covered under the Health insurance policy. Typically coverage period is 60 days pre hospitalisation and 90 days post hospitalisation.
  • Pre-existing Diseases Coverage
    Almost all India health insurance plans cover pre-existing diseases, though there is a waiting period in all cases which varies between 36-48 months of continuous coverage of the insured before the said illness gets covered. It varies from plan to plan and from insurer to insurer.
  • Day Care Procedures
    As everyone is aware for a claim to be paid, the minimum period for which the insured needs to be hospitalised is 24 hours…but there are some treatment procedures like cataract, chemotherapy/ radiation for cancer treatment, dialysis, coronary angiography etc may not require 24 hours of hospitalization, and these are called day care procedures. For named/listed daycare proceducres, the insurance company offers coverage for treatment of the same much like a cashless claim. Every insurance company provides the list of covered day care procedures covered under their plan, and this document is part of the policy kit provided to the insured.
  • OPD / Maternity Benefits
    Some insurance companies offer comprehensive health insurance plans for maternity which also cover Outpatient (OPD) treatment like consultation, diagnostics & pharmacy expenses like medicines, vaccines etc. One can also purchase a cover for Maternity Expenses to include delivery charges and post-delivery expenses too, subject to terms of the plan.
  • Restoration of Benefits
    Considering the rising health-care costs, it is quite possible that the entire sum insured gets exhausted in a single hospitalisation and this is when ‘restore benefit’ in a health insurance feature comes in. Restoration benefit is a feature that reinstates the total sum assured if it is used up in any given policy year. Quite common amongst the family floater plans, restoration benefit covers all the members insured in a health insurance policy. Though the data shows that the probability of people opting for restoration benefit is quite low – less than even 0.5% (according to an article in Financial Express) – the feature still remains very important. Moreover, most comprehensive India medical Insurance plans come with a built-in restoration feature. It is important however to verify with one’s insurance carrier whether the restored sum insured can be used for the same illness the second time around. Some insurance companies restrict the usage to a different ailment/treatment that the first incident.
  • No Claim Bonus (NCB)
    If the insured doesn’t file a claim in a given policy year, in the subsequent policy year the insured can enjoy a no claim bonus (NCB) or cumulative bonus (CB) which means that the sum insured is enhanced by a % over the previous year. Depending on the health insurance plan and insurer, the NCB can start at from 5% increase and go up to a maximum of 100% of the sum insured based on continuous claim free years.
  • Riders / Add Ons
    Health insurance plans also come with options for the individual to enhance the coverage of their plan through opting for add-on or riders, which can be purchased at additional premium. Some of the common riders include Critical Illness, Accidental Dismemberment & Disability, Hospital and Surgical Cash, Broken Bones, Burns cover etc. Most of these riders are benefit plans, which mean the full sum insured is paid out on the occurrence of the incident and not based on the expenses incurred. (Let us look specifically at the Critical Illness (CI) rider – The rider offers coverage against Critical illness like cancer, paralysis, kidney disorders, heart-related complications and the entire sum insured is paid at the time of diagnosis of such diseases, irrespective of the expenses…which means if one has a policy of ₹1 lac, but incurs ₹50,000 for treatment of the CI, the policy will still pay out ₹1 lac)
  • Wellness Programmes
    Insurance companies offer wellness programmes as part of the overall health insurance offering to ensure customers learn more about their health, engage with experts through chats and avail various discounts across wellness stores. Customer can then redeem their earned points (for using these services) and avail the discount in the premium at the time of renewal. The intention is to focus on prevention of claims rather than paying the claims later during the policy period, hoping that a health focussed customers will file less claims.
  • Annual Health Check-ups
    Many insurers offer free annual health check-ups (on successful completion of a certain number of claim free years) to retain their customers. This check up is conducted at an approved diagnostic centre and the insurer pays the expenses to the centre directly for the same. The objective is that the annual check up encourages the insured to keep in reasonably healthy condition during the duration of the policy and it also provides the insurer valuable insights into the health of the insured.
  • Life Time Renewal
    It is a guarantee that one’s health insurance policy will be renewed, no matter your age or health conditions of the insured, subject to the payment of renewal premiums in a timely manner.
  • AYUSH Treatment
    There are many health insurance companies that offer coverage for AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) treatment. Most of the AYUSH coverage offered by insurers are reimbursement-based claims and AYUSH treatment has a specific sub-limit in most health insurance plans. Most insurers allocate a specific percentage of the sum insured for alternate treatments. There are also plans with a fixed amount as sub-limit for AYUSH treatment. AYUSH coverage is offered only under a regular health insurance plan and it is not possible to buy a health insurance cover dedicated exclusively for AYUSH treatment. In most cases, any claims related to AYUSH treatment is approved only if the patient is hospitalised at least for a few days.

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