Slowly but surely, insurance penetration in India is rising. Be it for the rise in medical cost, to save tax or just to stay safe, an increasing number of people are opting for health insurance policies. With plenty of health insurance policies available in the market, policyholders are most often spoiled for choice. It becomes a challenge to find the right policy, and most often insurance buyers need guidance with that.
There is also a large percentage of people who research policies online but want to buy their policy offline. Experts say these kinds of people feel safe talking to a company representative or an agent before signing off a policy.
Here is a list of questions you should get answered from your agent before opting for a policy:
Inclusions in a policy cover
The premium should not be the only look-out when buying a policy. Buyers need to check for coverage too. To find out how much coverage your policy offers, find out from your agent what type of policy it is, as different types of policies such as basic hospitalization plan, daily hospitalization plan, or critical illness plan have different types of coverage.
Additionally, ask about the extent of the coverage. For instance, a certain type of critical illness plan covers up to 37 illnesses whereas another might cover just 15 critical illnesses. Hence, the scope of coverage differs from company to company and policy to policy. Find out from your insurer or agent what all is covered in your policy before buying one.
Exclusions in a policy cover
As insurance policies vary, the exclusion list of every policy also varies. All policies come with exclusions. Find out from your agent before confirming a policy.
Exclusions are an important part of a policy. Know about it in advance so that you don’t get surprised later.
Under basic health insurance policies, note that claims cannot be made during the first 1-2 months from the date of buying the policy. Other than general exclusions some policies also have time-based exclusions. For instance, after the diagnosis of a critical illness, a policyholder has to survive for at least 30 days before the policy pays out.
Sub-limits in a policy
Sub-limits on a specific treatment means there is a cap on how much the policyholder can claim. It is a fixed amount that is paid out for a particular disease or it can also be a cap on room rent. Sub-limits are set on 2 expenses, the sum assured on a specific disease or on hospital room rent. In the case of room rent, a certain percentage of the total sum insured is the capping of room rent.
Hence, ask your agent about what expenses are capped, and the limit that is set for the policy. Health insurance policies come both with sub-limits and without sub-limits. Other than room rent, sub-limits are also set on doctor’s fees, OPD, etc. You can also ask your agent for a policy without sub-limits if you do not want expenses to be capped.
In most health insurance policies, pre-existing diseases are not covered. However, even if covered, it doesn’t get activated before 3-4 years. A few companies have come up with policies with a shorter waiting period, but find it out from your agent in advance.
Other than pre-existing diseases, policies come with a waiting period for other medical expenses also, such as arthritis, stone in the gall bladder, maternity coverage, cataract and eye ailments. Expences for these treatments might not be covered in the first 1-2 years. Hence, ask your agent details about the waiting period associated with your policy.
Mostly new policies cover features such as Ayurvedic treatments, treatments abroad, and maternity expenses even though with a waiting period. Find out from your agent if your policy includes any of these add-ons.
Depending on your lifestyle, some of these add-ons can be of help. Hence, ask your agent what all is included in your policy, and the premium you are being charged for it.