9 Important Pillars of Health Insurance everyone must consider

People today are quite aware of the importance of having health insurance for the entire family. But, how can you find out the health plan that best suits your needs? Knowing some important points related to health insurance can point you in the right direction.The increasing pressure on the public healthcare infrastructure often compels people to look over private healthcare alternatives. However, the medical expenses of a good-quality private hospital can be out of reach for you unless you have adequate coverage under a health insurance plan.However, you may feel overwhelmed by the sheer number of options available while choosing a health plan. Therefore, it is important to know the important pillars of health insurance before you decide to buy one.

• Are there any hidden clauses that limit the coverage amount?
• What are the deductibles mentioned in the policy document?
• Are you supposed to pay a portion of the expenses while filing a claim? If yes, how much?

• How many network hospitals are in your vicinity?
• If you have a transferable job, find out whether the insurer has a pan India network of partner hospitals.
• Check sub-limits of the policy.

• You are young, healthy, and don't have any serious illness or hospitalization history.
• You want to lower your premium amount.

1. Age Criteria Age is one of the most important factors when purchasing health insurance. Age becomes an even more crucial factor when you consider a family floater policy covering all your family members. The insurance premium amount can significantly vary depending upon the age of all the covered members.Additionally, also consider the age limit of every family member to be included in the plan. While the entry age limit can start from just 91 days, which comfortably covers a newborn baby, the maximum age limit can be anywhere between 55 to 65 years.Therefore, you need to check your parents' age before considering a family floater. If your parents have already crossed the maximum permissible age limit, you can consider taking a separate plan for them as some senior citizens health plans can have a maximum age limit of 75 years. In fact, some insurers allow the maximum entry age as high as 80 years too.
2. Premium & Coverage When selecting the premium amount, people usually like to go with the lowest premium payment. However, the low premium can inadvertently result in lower and inadequate insurance coverage. Besides, there can be other reasons that can affect the premium cost.Therefore, it is wise to do your research and find out the reasons behind the low premium amount by checking out the following questions.
3. Never compromise on benefits in the lure of affordable premiums. On the contrary, you can include some additional riders such as accidental death, disability benefit, critical illness, etc., along with your original health plan.While you may have to shell out more money in premium, such plans offer you peace of mind by including such important riders.
4. Cashless Treatment Benefits Cashless treatment can be a great relief in an emergency as the insured person need not have to worry about arranging cash for hospitalization. Reputed health insurance service providers have nationwide tie-ups with a network of hospitals.In case of any emergency, the insured person can simply approach any network hospitals and start receiving treatment without going through numerous paperwork. The insurance firm directly pays the hospital for the treatment (as per the policy terms).You should check the following points to determine the worth of the cashless benefit offered by the insurer-
5. Hospitalization Coverage The definition of hospitalization coverage can vary with different health insurance plans. Most health plans cover the medical expenses from the period when the insured person is admitted to a hospital until the date of discharge.However, many insurance service providers offer health plans that cover pre-hospitalization and post-hospitalization cover, which ensures maximum coverage. Such plans can help you save money on doctor's consultancy fees, medical diagnostic tests, post-hospitalization expenses like medicine, physiotherapy, ambulance charges, etc.
6. Maternity Expenses As the cost of maternity and child delivery continuously rises exponentially, ignoring the coverage for maternity expenses can prove to be a financial blunder. Therefore, it would be wise to select health insurance that covers maternity care and delivery costs. Some plans also cover the expenses of the newborn baby up to 90 days after the child is born.However, it may to noted that the waiting period to claim maternity expenses can be anywhere between 2 to 4 years. Therefore, would-be parents should carefully plan the arrival of the new member accordingly to avail of this benefit.
7. No Claim Bonus The insurance company offers a discount to the insured person for the number of years passed without any claim since purchasing the health plan. This discount is called the No Claim Bonus. However, the bonus is not offered in the form of a reduced premium amount. Instead, the insurance coverage is proportionately increased at the time of the policy renewal for the duration that went without any claim.No claim bonus is usually capped up to a maximum of 50% of the insurance coverage amount.
8. Co-Payment Clause The co-payment is an arrangement where the insured persons agree to pay a certain portion of the claim amount out of their pocket, and the rest of the claim amount is settled by the insurance service provider.Consider the following example to understand the co-payment clause better:Suppose; you purchased a health plan with a 10% co-payment clause. Now, assuming you raised a claim of Rs 1,00,000 against this plan that comes under the plan's coverage. This is what your claim will look like-While the presence or absence of the co-payment clause does not solely determine the quality of the health plan, you should carefully consider this clause depending upon your medical history.For instance, You can consider having a certain percentage of co-payment, if-
9. Alternatively, you might not want a co-payment clause or keep it as low as possible if you expect hospitalization for your aged parents in the near future.
10. Preventive Health Check-up facility A preventive health check-up is necessary as you age for the early detection of critical illnesses such as cancer or heart-related ailments. However, the cost of such preventive health check-ups like lipid profile, ultra sonography, or MRI can cost you a fortune.Therefore, you may want to consider a health plan that can provide a certain level of coverage for such preventive health check-ups.
11. Claim Settlement Process What good is a health insurance plan if it does not settle the claim quickly? This is why the claim settlement process is perhaps one of the key pillars of health insurance that a policyholder should be aware of.Apart from looking for a health plan with a high claim settlement ratio, you should also check whether the health plan has a smooth and customer-friendly mechanism to settle claims in a hassle-free manner.

Purchasing health insurance should not be a spontaneous or quick decision as it may save you a fortune in future. On the flip side, a wrong plan can prove to be futile when you actually need it. Besides, the health cost of your loved ones can directly depend on the health plan you purchase.Therefore, understand these pillars of health insurance in detail and weigh your options carefully before making the final call.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.