Key features to look for in a health insurance policy

Health insurance is part of financial planning. It can help you to reduce your burden of sudden medical expenses and make it easy to access quality healthcare services without any fear of high financial outflow. The challenge, however, is how to choose a good health policy from the available options. This complete guide will help you go through the best features to look for in a health insurance policy so that you remain conscious while deciding.

1. Coverage and Benefits

The very first important feature to be checked in a health insurance plan is indeed its coverage. One should opt for a policy covering medical expenses during hospitalization, pre and post-hospitalization treatment, day-care procedures, and also treatments taken as an outpatient. A good health insurance policy must also be able to provide considerable coverage for different kinds of illnesses and health conditions.

Sub-features to consider:

• In-patient Hospitalization: This relates to the room charges, ICU charges, doctor fees, operation theaters, pre and post-surgery expenses, and other miscellaneous expenses relating to hospitals and the care of the same.

• Pre and Post-Hospitalization: It covers the medical expenses incurred by the policyholder before and after hospitalization for some period of time.

• Day-care Procedures: It includes coverage for treatments that do not require a 24-hour hospital stay. Very few policies also cover OPD treatments.

• OPD Treatments: Some policies also bear consultations, diagnostic tests, and minor procedures that do not require hospitalization.

2. Sum Insured

This is the maximum amount payable by an insurance company in case of a claim. Therefore, one has to select a policy providing a sum insured for a sum in which possible medical expenses may arise. Age, health condition, family medical history, and the cost of quality health care where one resides are some important aspects that have to be considered for deciding an adequate sum insured.

Points to be considered:

• Individual vs Family Floater: You must take an individual plan or a family floater that covers a family under a single sum insured.

• No-claim Bonus: Prefer to get a policy that comes with a claim bonus feature that increases the sum insured for every claim-free year without any extra premium.

3. Network Hospitals

Network hospitals are those that are empaneled by the insurance company where you can avail of cashless treatment. Ensure that the policy you are choosing has a wide network of hospitals, which includes the reputed hospitals in your area.

 Why it matters:

 Cashless Treatment – You are able to get treatment without payment, and then having to claim a reimbursement. The insurance company settles the bill directly with the hospital.

4. Waiting Period

This is the time frame during which the insurer does not offer any insurance policies or pay any claims; this varies from one health insurance policy to another. Therefore, you must understand the Waiting Periods in your policy to avoid surprise policies during an emergency.

• Incurred Claim Ratio: The proportion of the total number of claims settled against the total number of claims reported for a given period of time. A Ratio of 70% and above.

• Initial Waiting Period: Typically 30 days from the start of the policy, during which all claims are not covered except for accidental injuries.

• Pre-existing Diseases: Mostly varies from 1-4 years depending on the insurer.

• Specific Ailments: Certain policies specify a certain amount of waiting periods for

Co-pay and deductibles are cost-sharing features wherein the policyholder bears part of the expenses on medical treatment. Though they help bring down the premium, they mean higher out-of-pocket expenditure during a claim.

5. Understanding the terms

• Co-payment: A fixed percentage of the amount claimed to be paid by the policyholder.

• Deductible: A fixed amount that the policyholder must pay before the insurance company begins paying.

6. Benefits for maternity

This aspect of maternity benefits is a key consideration among those planning to raise a family. Check for policies that pay maternity expenses, from delivery charges to newborn care.

Key Aspects to Examine:

• Maternity Cover: It includes the hospitalization expenses for delivery, whether it is normal or cesarean.

• New Born Cover: Extends the coverage to the newborn baby right from its birth up to the policy renew

• Waiting Period: Usually between 9 months to 4 years depending upon the insurer.

7. Critical Illness Cover

Critical illness insurance is a rider coverage, wherein a one-time lump sum is paid to the policyholder in case of a critical illness diagnosis. So it is one of the most essential factors for actual protection against those exceptionally costly treatments and life-threatening ailments.

Some very common critical illnesses that are usually covered under typical critical illness insurance are:

• Cancer
• Heart attack
• Stroke
• Failure of the kidney
• Major organ transplant

8. Claim Settlement Ratio

That is, the policy claim settlement ratio means the number of claims settled by the insurance company among the total received claims. A higher ratio implies the reliability and efficiency of an insurer in claims processing.

Why it’s important:

Reliability: Now you don’t have to worry about your claims being settled quickly and effectively.

Transparency: It brings out the commitment towards customer satisfaction by your insurer.

9. Policy Renewal Terms

It’s an investment for the long term, and hence the ability to renew this policy with no conditions is very important. Look for policies that have lifetime renewability so that you have continuous coverage with no maximum entry age or health checkups.

Things to consider:

• Renewability Age: Go for those policies that give you lifetime renewability.

• Grace Period: Time permitted for renewal of policy without losing its benefits.

10. Additional Benefits and Riders

Many health policies come with extra benefits and riders to add cover. These can be personalized based on needs and offer additional protection.

Common riders and add-ons include:

• Accidental Death Benefit: This policy provides an additional death cover due to an accident. His nominee receives the total assured under both policies.

• Hospital Daily Cash: Payment of fixed benefit daily for lodging expenses for hospitalization-related care for ailments or injuries.

• Personal Accident Cover: Accidental Injuries, leading to disablement or death, are covered.

• Room Rent Waiver: Based on the category chosen, the sub-limits over the room rent charges would be removed.

Also Read – Comprehensive Guide to LIC Plans for 5 Years

Role of Aapkapolicywala in Choosing the Right Health Insurance Policy

Aapkapolicywala plays a very crucial role in guiding a person and his family members through the complexities associated with choosing the right health insurance policy. As an independent online insurance portal, it provides a lot of helpful resources and tools for a careful analysis of the various offerings.

1. Comprehensive comparison tools

Aapkapolicywala provides comprehensive comparing facilities for users to compare various health insurance policies side by side. This functionality is helpful in intuitively understanding the differences in terms of coverage, benefits, premiums, and other important aspects of various policies.

Benefits of comparing tools:

• Helps make Informed Decisions: Users can compare policies in detail for evaluation purposes.

• Saves Time: This feature reduces the research time needed to be undertaken by users when planning to take up a number of policies.

2. Expert Guidance and Support

It provides expert guidance and support through knowledgeable insurance advisers. Such advisers help in deciphering the meaning and terms of the policies, their benefits, exclusions, and other details so that the user can choose an appropriate policy for himself.

Some of the key services offered are:

• Customized Advice: Based on individual needs and preferences, appropriate suggestions are given.

• Claim Support: The process of filing claims to its settlement is assisted by these experts to make it smooth and hassle-free.

3. Easy-to-Use Interface:

Aapkapolicywala is rich in user-friendly navigation that eases the way of browsing, preferring, and obtaining health insurance policies. The website has been designed to be human-friendly since the company keeps aiming for smart maneuvers of its customers so that they can find the information they require very easily.

• Navigation: Well set, neat, and good layout.

• Details: Policy details explaining coverage, exclusions, and premiums.

4. Wide coverage of policies

The diversified nature of the policies available by the platform provides a one-stop shopping site for health insurance policies from most of the big insurance providers; hence, this ensures enough diversity that will enable the user to have at its disposal enough options that can address different needs and budgets.

Advantages of Diverse Options

• Customization is the possibility of choosing policies that fit particular needs.

• Competitive Pricing – There are policies available with low, medium, and high costs to come with a structure of benefits.

A wide range of educational resources including articles, guides, and FAQs contribute to enhancing the user’s understanding of health insurance. Resources available on this website include a range of aspects from choosing the right policy to discovering the benefits and procedures of making a claim.

Why Do Educational Resources Matter?

• Empowerment with Knowledge: It arms users with knowledge to make the right choice.

• Continuous Learning: Keeps updating the user with every latest trend and change taking place in health insurance.

6. Customer Reviews and Ratings

The platform also contains reviews and ratings given to the different health insurance policies by the customers. Such reviews will help the user understand the experience of other policyholders and hence judge the reliability and performance of the different policies.

Customer Reviews and How They Help:

• Real World Insight: Offers practical insights based on real user experiences.

• Trust Building: Helps in building trust and confidence in the chosen policy.

Make the most out of your Health Insurance policy

• Fully understand the method of deriving the maximum possible benefit from whichever health insurance policy is selected alongside Aapkapolicywala. The below-mentioned points may be followed.

• Understanding Policy Documents: Read and familiarize yourself with terms and conditions, details of coverage in policy documents, as well as exclusions, and the procedure to file a claim. This will prevent a great deal of last-minute unpleasant surprises if you have to attend to a medical emergency.

Key Focus Areas

• Coverage Details: Learn what is covered and what is excluded.

• Policy Limits: Be aware if the policy has any limits with regard to room rent, specific treatments, or surgeries.

• Claim Processing: Understand the procedures for making a claim and the documents needed for the claim.

Remember your Renewal Date

Remember to renew the health insurance policy – on time. Renewal of any Health Policy is as good as purchasing a new one. Remember the dates of policy renewal. Failure to renew the policy means losing accumulated benefits, namely the cumulative bonus, and continuity for pre-existing diseases.

How to Remember Your Renewal Date:

• Digital Calendars: Keep calendars in soft copies. Feed in details regarding policy renewal dates.

• Grace Period: Be aware of the grace period granted by the insurer and make sure the policy is renewed within the given grace period.

Avail Preventive Health Check-ups

Most health insurance schemes cover preventive health check-ups. Health check-ups can help you discover diseases early so that you can take proper care of your health.

Benefits Of Preventive Check-Ups:

• Early Diagnosis: Can diagnose health problems at an early stage.

• Better Health Management: Helps a great deal in timely medical intervention and treatment of the disease.

Live Healthily

Remaining healthy is not only advantageous for you or the quality of life you are living, but it also earns policyholders favors from insurance companies.

Things are done to keep healthy: 

• Exercising: Physical exercises that help you stay fit.

• Diet: Maintaining good eating habits.

• No Smoking: Abstain from the use of tobacco and cutting down on smoking.

• Avoid harmful habits: No alcohol beyond the limit.

Preparing required Documents

In the event of a medical emergency, it is convenient to have all the documents available to claim right at the time of the accident. Keep a folder with all relevant documents needed for your health insurance policy.

Save Documents:

•  Policy Document: Original policy document and renewal receipts.

• Medical Records: Previous medical records, prescriptions, diagnostic reports.

• Identity Proof: Valid proof of identity.

Avail At Your Network Hospitals

Always know the network hospitals available to you; it will save you time and lots of stress during emergencies. Choose only good hospitals near your residence.

Why it matters:

• Cashless Treatment: Entitles the customer to cashless treatment.

• Quality Care: Good hospitals with quality care

Educate Your Family

Make sure the family is aware of the policy details, what is covered, and how the claims can be made. This becomes necessary since at times when you suffer a critical illness, you may not be in a position to follow up.

Ways of educating the family:

• On the Policy: Brief them regarding the key features and benefits of the policy.

• Process to Claim: Lead them on how to claim.

• Emergency Contacts: Provide them with contact numbers of the insurance company and network hospitals.

Also read – High-Risk Jobs Insurance: Things to Know

Conclusion

There are many features and benefits associated with a properly selected health insurance policy. Simply concentrating on coverage, sum insured, network hospitals, waiting periods, copayment, maternity benefits, critical illness cover, claim settlement, renewal, and bonus and additional riders can let one attain extensive cover for him and one’s family.

Aapkapolicywala is there with its in-depth comparison tools, expert advice, user-friendly interface, a plethora of policies, educational resources, and customer reviews. Now you will not shy away from confidently opting for a health insurance policy that is capable enough of taking good care of all your needs during a sudden medical emergency with the support of Aapkapolicywala.