Choosing the right health insurance plan is crucial for ensuring complete protection and peace of mind. It’s important to review the plan's coverage to confirm it meets your needs, minimizes unforeseen expenses, and offers financial security in case of accidents, illnesses, or other covered situations.
By considering aspects like hospitalisation, critical illness coverage, maternity benefits, and outpatient services, you can make an informed choice tailored to your healthcare needs. This guide highlights 12 essential covers to consider when buying health insurance to get optimal value and protection for yourself or your family.
Here are 12 essential covers that your health insurance policy should include:
Covers medical treatments requiring hospital admission for at least 24 hours, including room and board, nursing care, diagnostic tests, medications, and surgeries.
Health policies often offer preventive checkups, tests, and vaccinations, starting either at policy inception or after 2-4 claim-free years. These are usually available at network hospitals, or reimbursed if done at non-network hospitals.
Covers expenses incurred on Air Ambulance in the event of a life-threatening emergencies of the Insured Person, where road transport is not feasible. Coverage limits, geographic restrictions, and prior authorization may apply.
This feature allows for the restoration of the sum insured after its base Sum Insured is completely exhausted or insufficient due to previous claim made in the policy year, ensuring continuous coverage even after claims deplete the initial amount.
Covers treatments and surgeries that don't require 24-hour hospitalisation, such as cataract surgery, and dialysis.
Provides coverage for treatment received at home (including doctor visits, medications, and necessary medical equipment) when hospital admission isn’t possible due to the patient’s condition or lack of hospital beds. However, the coverage details, such as duration and specific situations, can vary between policies.
Covers regular check-ups, ultrasounds, delivery costs, and postnatal visits. It also includes newborn care, such as health assessments, vaccinations, and initial
Covers Modern Advanced treatments like immunotherapy, robotic surgery, and also provides coverage for HIV/AIDS and sexually transmitted diseases (STDs).
Offers a lump sum payment if the insured is diagnosed with a specified serious illness, such as cancer, heart disease, kidney failure, etc., helping to cover treatment costs and financial burdens during recovery
It covers the medical expenses related to the organ donation process, including hospital stays, surgical procedures. Depending on the plan's terms, it ensures financial support for both the donor and recipient.
Covers alternative treatments like Ayurveda, Yoga, Unani, Siddha, and Homeopathy,ensuring comprehensive care beyond conventional medicine.
Provides coverage for mental health treatments, including therapy, counselling, and psychiatric services, addressing conditions like anxiety and depression.
Aside from ensuring adequate coverage, there are a few more things to know before
buying health insurance. It's essential to consider the following factors before settling
on a health insurance plan for yourself:
Pre-hospitalisation covers medical expenses (like medical tests and reports)
incurred before hospitalisation, typically for 30 to 60 days. On the other hand, post-
hospitalisation covers medical expenses (like diagnostic tests, consultation,
Pharmacy medicine etc.) incurred after discharge from the hospital, usually for 45
to 90 days.
A waiting period in health insurance refers to the duration an insured individual must
wait before certain benefits are accessible. This period typically spans 24 to 48
months, depending on the insurer and selected plan. It may encompass conditions
such as hypertension, diabetes, and cataracts etc. Choosing a plan with the shortest
waiting period is essential to facilitate timely claims in emergencies.
A no-claim bonus in health insurance is a reward given by insurers to policyholders
who don't file any claims during a policy year. This bonus can be in the form of a
discount on the premium for the next year or an increase in the sum insured at no
extra cost.
Some insurance companies require co-payments, while others offer them as an option.
Selecting a lower co-pay result in higher premiums but lowers the claim amount.
Conversely, a higher co-pay decreases the premium but raises the claim amount. It is
prudent to choose a co-payment only if you can cover the remaining claims.
Cashless health insurance allows policyholders to receive medical treatment at network
hospitals without paying upfront. The insurer directly settles the bills with the hospital,
simplifying the process and reducing the financial burden on the insured.
Room rent capping in health insurance denotes the highest amount an insurance policy
will reimburse for daily hospital room expenses. Should the actual rent surpass this cap,
the policyholder must cover the excess costs personally, potentially increasing overall
medical expenses. However, some policies can extend your room rent cap, and others
don't have a limit at all.
When selecting medical insurance, reviewing the policy coverage and limitations is
crucial. It's important to note that most insurers typically do not cover the following:
When picking a health insurance plan, it's crucial to thoroughly investigate the insurer's
claim settlement history. A quick claim settlement means the insurer efficiently
processes and pays out claims. Checking the claim settlement ratio and customer
reviews online is critical to gauge this.
Some policies provide additional protection and financial security beyond the basic
coverage. These add-ons can include benefits like enhanced maternity coverage, critical
illness protection, or extended hospital stay benefits, which can be vital for managing
unforeseen health expenses. You can customise your insurance to fit your unique
needs, providing extensive coverage to reduce costs and bring peace of mind in health
situations.
Now you know what to consider while buying health insurance and how the coverage and benefits can help you get the best medical services in a time of need. ManipalCigna Health Insurance, too, understands this, and that's why its health insurance plans are thoughtfully crafted so that the insured gets all the essential coverage.