pays for your hospital bills for diagnostics, surgery etc.
When buying Health Insurance you need to understand that no two health plans are identical. To pin down the right health plan for your needs, you need to confirm the following important aspects with your agent.
This is perhaps the most fundamental aspect about buying a health plan. The Sum Assured defines the upper limit of expenses that will be covered by the insurance company in case the Insured is hospitalized. But this is just the upper limit and you need to dig into the details before you finalize a health plan.
While the health insurance Policy may be offering you a very high sum assured but you need to be cautious about specific terms which cap the amount of expense you can make for a particular item like room rentals. This restriction on the amount you can spend on the room rent has significant implications. If your policy caps the amount of rent you can pay for the hospital room, the ramifications of this extend beyond just the room rent.
The pricing mechanism in most hospitals is such that the cost of treatment also goes up in proportion to the room rent. Like if you undergo a heart surgery the cost of treatment excluding the room rent would depend on the type of room you stay. The cost of treatment excluding the room cost is higher for a Single AC room than for a twin sharing or general ward. So if according to the policy terms you are eligible for a twin sharing room the treatment cost that would be reimbursed by the insurance company would only be as much as the hospital would charge for a similar room.
Health plans exclude coverage of pre-existing disease and some specific diseases for a pre-specified duration from the date you buy your first health insurance policy. This pre-specified duration for which you are not allowed coverage may vary from one plan to another and you need to be aware of the same.
Cashless coverage is granted by insurance companies for taking treatment in a hospital that is included within the network of the insurance company. Hence it makes sense to buy a policy from a company that has a much wider hospital network.
Some policies require the insured to make a copayment which is typically 20 to 30 percent of the treatment cost. So even if the total expenses are well below the sum assured limit you will still have to bear the copayment cost.
Some health insurance policies may apply Claim related loadings. If you make a claim in any given year your health insurance Premium for the next year will go up. Some policies have a provision to hike the premium amount by as much as 200 percent in case of a claim.