Despite being a ‘young’ nation with close to 2/3rd of its population aged less than 30 years, India faces the risk of losing its demographic advantage to the twin problems of high medical inflation and low health insurance penetration.

download (1)

The risks we face are aggravated due to the following reasons: Medical inflation stands at around 15%, which means cost of healthcare services are likely to double every six years. Modern diagnostic services and advanced treatments for critical illnesses too are likely to become costlier in the future. Rising risk of lifestyle diseases with around 130 million people falling victim to diabetes and obesity between 2010 and 2015. Just one Indian out of five has health insurance.

Mr.Rajiv Kumar, MD & CEO, Universal Sompo General Insurance- With healthcare costs – along with lifestyle diseases – rising like never before, health insurance has become a necessity for every individual today.

Question: How to choose the right Insurance cover specifically for Health matters?

Answer:  Before considering opting for a Health Insurance, it is highly recommended that the decision of buying a Health product should not be only based on the premium. In addition to the factors like price, ease of purchase and renewal, servicing etc here are a few things you should definitely look which selecting a health insurance product.

1)      Waiting Period –The insurer is not liable for any treatment which begins during the waiting period except in case of an accident. Generally, there are 30 days waiting periods for all claims except you had one year of continuous coverage. Outpatient treatment, Mother and child care benefits, listed illness and treatments, Pre-existing disease coverage all have specified waiting periods after which coverage comes into picture. You need to heed to these waiting period as in cases it may vary from insurer to insurer, product to product and Plan to plan.

2)      Cumulative Bonus benefits– Health insurance policies generally have this feature in which sum insured is increased by a specified percentage for every claim free year upto a specified maximum percentage. The same ranges from 5% to 10% per year to 100% of sum insured maximum.In case of a claim the increased sum insured (base sum insured remains unchanged) gets reduced by a specified percentage amount. You would like to see that if this feature is present in your Mediclaim policy and if it is at what terms.

3)      AYUSH Treatment– AYUSH stands for Ayurveda, Yoga, Unani, Siddha and homeopathy. Popularity of this alternative form of treatments is increasing by leaps and bounds not only in India but abroad as well. Inpatient treatment of AYUSH is covered by most health insurance policies with no sublimit. Have a look that if your health policy covers for the same and do not forget to check for the applicable sub limits if any.

4)      OPD Coverage– Some health insurance products offer Outpatient treatment which does not requires hospitalization of 24 hours with a waiting period of specified years through a network medical practitioner. Coverage is for generally consultation, diagnostic tests, dental treatment and spectacles/contact lenses/hearing aids. Terms may vary from product to product and you should have a closer look about availability and terms of OPD coverage.

5)      Sub-limit– One more area where you should have a detailed look are sub-limits, which are coverage wise limits placed by insurers on overall sum insured that will be payable if the coverage triggers. Some of common sub-limits placed are on Room rent, ambulance charges, outpatient treatment, maternity charges etc. Some insurers also provide discounts for opting sublimit options.

6)      Network Hospitals – For your convenience and better treatment you must have a look at the network hospital list of the insurer and select an insurer who has cashless tie ups with reputed hospitals in the vicinity of your place.

7)      Other important features and coverages – Other features you may look in a health insurance product is whether health checkups,  convalescence benefits, Vaccination charges for post bite treatment, daily cash for accompanying an insured child, Maternity coverage, Restore benefits, cover for people living with HIV/AIDS, Global coverage etc. In total you should after careful consideration on above factors select a product which meets your risk and budget requirements and provides comprehensive protection to you and your family.