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Healthcare costs in the country have risen sharply in recent years, in tandem with global trends. Many families have seen their financial planning going haywire due to the unexpected costs incurred on hospitalisation of a family member.
On the positive side, awareness about medical insurance has risen sharply, too. Still, people, particularly the first time mediclaim buyers, are stuck with one basic question - which is the cheapest policy going?
But price should not be the only concern while seeking a mediclaim cover. One needs to evaluate policies on various other parameters as well and avoid making a wrong choice based purely on price. For example, if you have diabetes, you might want to buy a mediclaim policy that is a little more expensive, but which will immediately cover the hospitalisation expenses incurred on complications linked to this disease (heart problems, kidney or eye problems associated with diabetes) without considering them as complications arising from a pre-existing disease. Or would you go in for a comparatively cheaper policy that treats all such diseases as pre-existing and hence not immediately coverable? Pre-existing diseases.
Coverage of pre-existing disease is probably the most important parameter for selecting a mediclaim policy, because if a disease is treated as pre-existing, the policy normally provides no coverage or very restricted coverage for expenditure incurred on treating complications arising out of that disease in the immediate future.
Pre-existing disease coverage encompasses the following:Most policies provide that any disease that was present at any time in the past (including any disease, which the insured person may not have been aware of) is treated as pre-existing. But some have a narrower definition, which may extend to only diseases for which the insured person had sought consultation or was treated, or of which he was aware during say the last four years (narrower the definition, the better it is for consumers).
* Cooling-off period:This is the stipulated period earmarked by the company, which denotes after how many years of continuous coverage the pre-existing disease will get covered. This is important, as after the expiry of the cooling off period, even pre-existing diseases get covered. You would do well to find out if the insurance company you are considering allows your track record of continuous coverage from another insurance company for the purpose of calculating this cooling-off period or insists only on continuous coverage with itself for this purpose.
* Special dispensation for diabetes/ hypertension:Diabetes and hypertension have acquired epidemic status in India. A host of illnesses/ diseases such as heart disease, kidney failure, paralysis, stroke and eye problems can trace their root cause to either diabetes or hypertension, or both. Since the definition of pre-existing illness includes any complication arising there from, this has been a major reason for disputes between the mediclaim providers and the consumers in the past. Hence, any policy that provides a special dispensation for complications arising out of diabetes/ hypertension is relevant for a person suffering from either.
There are several other vital parameters for selecting mediclaim policies, besides coverage of pre-existing disease. Among others:Here, the overall coverage is broken down into the maximum payable for a particular kind of expense. For example, a few insurance companies now provide that room rent cannot exceed 1% of the covered amount or that doctors' or consultants' fees cannot exceed 20-25% of the covered amount.
* Co-pay requirementsQuite a few companies now require that the insured bear a certain percentage of the eligible expenses either unconditionally or under certain conditions. Some companies provide a discount in premium if you agree to co-pay. Others might want a co-pay if you choose to get treated in a non-network hospital or others may have a co-pay for choosing a single air-conditioned room or for getting treated in a hospital in a higher cost city. The co-pay feature is built in to ensure that the insured chooses the appropriate hospital/ room/ doctor level relevant to his economic status and also watches the reasonableness of the charges levied by the hospital to ensure that there is no overspend or overcharge just because of the existence of the mediclaim policy.
* Specific exclusionsAlmost all policies have general exclusions such as costs incurred for AIDS or sexually transmitted diseases, or congenital diseases, etc. Watch out for exclusions if it affects you.
* Maximum coverage amountThis is important, as a particular policy that suits you may not be available for the coverage you seek.
* Maximum age at entryThis parameter is particularly relevant for senior citizens as quite a few policies may not be available to them.
* Age till which renewal is allowedThis is relevant for both senior citizens as well as people in their 50s, since they need to be able to enjoy the benefit of their track record.Weigh the policies available based on these parameters to be able to arrive at the policy that you need. It may or may not be the cheapest mediclaim policy going, but it's the best you can have.
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