Efficiency of claims process
Look for an Insurer who has higher claim settlement ratio with lesser or reasonable Turn Around Time (TAT) towards Claims settlement when compared with Market. Higher the settlement ratio and better TAT means the insurer is doing a good job with genuine claims.
Co-payment
It’s a pre-defined percentage of the claim amount that will borne by the policyholder of each and every claim.
Day-care procedures
These are the medical procedures where 24 hours hospitalization is not required due to technological advancements. A glance through the list before one finalizes on the Health Insurance plan is advisable
Network hospitals
The number of network hospital city wise decides on the reach of the insurer to the Health Insurance market. This list is subject to changes owing to procedure of hot listing & addition of new hospitals in the network. Before the health insurance is purchased, one should check with the list of hospitals in the area where the policy holder resides. This will smoothen the claiming process.
Pre/Post Hospitalization
This is a continuous period in days immediately Prior to or Post Hospitalization for a particular illness/disease. Generally the coverage period allowed is 30 days and 60 days respectively. However now a days the insurers are extending these period as a differentiating feature. However its not so important for majority of small illnesses/diseases where the symptoms are acute and doesnot require more follow up with doctor after discharge.
No claim bonus
Its a kind of loyalty and reward to the policyholder which is offered as % of the Basic Sum Insured for a Claim Free Continuous Year. Majority of the Insurer allow it to accumulate upto 50% of Basic Sum Insured however now a days you can see policies with maximum Accumulation upto 100% also. The Sum Insured so earned can be utilized only when the Basic Sum Insured Exhausts.
Maternity Benefits
It means the expenses earned towards the Normal Or Sergical Delivery of a Female policy holder. This cover generally has got a Continuous waiting period of 48 or 72 months with the same insurer to get a claim paid under the policy
Free medical checkup
Its again a reward to policy holder for few consecutive claim Free years. It ranges from 1% to 2% of the sum insured subject to maximum of Rs. 1000/- to Rs. 2000/- respectively. The Actual expenses incurred are reimbursed subject to the limit mentioned in the policy as aforesaid.
Lifetime Renewal
This means the insurer should allow renewal of the policy till the policy holder is alive. The Renewal is at the wish of the policy holder. This is a very important condition for the senior citizens.
Waiting Period for Pre-Existing Diseases
Traditionally, the waiting period for covering the pre-exisiting disease which are declared at the time of proposal, use to be 4 consecutive break free policy periods. However now a days insurers are bringing new products reducing this waiting period to 3 years. This is an important point for those who have declared few Pre-existing diseases.
Our Recommendations
Barring 2 points viz. Life time renewal & Efficiency on Claim settlement, rest all other points are coverage related. Cost effectiveness sometimes knowingly or unknowingly makes you to compromise on the quality of Insurance Coverage, at the same time costly products does not always guarantee the customer satisfaction.
Hence, we opine that definition of a suitable and good product varies from person to person as per their age, health conditions & Income. You may contact or write to the undersigned in case any advice is required on Health Insurance Policy.
Warm Regards,
Laxminarayan Shanbhag
