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Health Insurance: 4 things to look for while opting for a critical illness cover

Priyadarshini Maji

Health insurance, insurance cover, things to keep in mind while buying a health insurance policy His application was then rejected by the insurer following the results, as he was considered unfit for a basic health insurance plan.

Rajdeep Awasthi was 47 when he got diagnosed with diabetes. He then decided to get himself a health insurance cover. However, his health insurance proposal got rejected. "Before offering me a policy, I was told to get a series of tests done," says Awasthi. His application was then rejected by the insurer following the results, as he was considered unfit for a basic health insurance plan.

Generally, people like Awasthi are rejected by insurers for getting a health insurance cover given their high-risk conditions, old age and illness like diabetes. This is where people go wrong. They try to get a policy after getting an illness when it’s too late. Many people face the same problem as they don’t realize that buying health insurance becomes tougher and policyholders end up paying more as premium once they have been diagnosed with a disease.

However, catering to such cases and people, there are disease-specific plans. For instance, policies especially for diabetes and cancer. These plans offer cover even to those individuals who have been diagnosed with a critical illness. However, they come at extra cost.

Things to look out for while opting for a critical illness cover;

Inflated premium rates
The premium of disease-specific plans is very high. Hence, it is advised to policyholders to go for a basic health insurance policy first. The premium for theses policies are comparatively low. Also, after opting for a normal policy that comes with a waiting period, it covers everything after a waiting period of usually four years. However, if an illness is out of control, then one should buy an illness-specific plan.

Co-Payment and sub-limits
It is commonly seen insurance policies to have these clauses, sub-limits, and co-payments. Co-payment is the percentage of the expenses that the policyholder needs to share with the insurer, in case a claim is raised. The policyholder have to pay the percentage allotted to him while buying the policy from his/her own pocket. The rest of the share is paid by the insurer. Sub-limit, on the other hand, is the limit up to which the insurer pays for some of the expenses included in the policy.

Waiting period
For disease-specific policies, there is no such thing as a waiting period. For instance, a cancer policy will cover the illness from the first day, and other diseases such as dengue, a minimum waiting period of 15 days are applicable. However, normal health insurance policies include waiting periods ranging from 2-4 years depending on the type of illness.

Certain Treatment limits
There are cap amounts that the policyholder can claim up to for a particular surgery. With this clause, even if your sum insured is a huge amount, for a particular surgery or illness you will be restricted to only a certain amount with such caps. Try to find out about such clauses it is better to ask the insurer while buying the policy which illnesses are excluded in the policy.