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5 Most Important Things That People Overlook While Buying Health Insurance

Selecting the perfect health insurance plan is not an easy task. There are numerous insurers to choose from and a number of policies on offer. Even the most basic plan could have 40-50 technical and non-technical clauses that can be confusing for a common person. If you are buying from an insurance agent, he/she may forget to bring out certain points or you may not even know the right questions to ask. And as it often happens, you may not read the finer details of the policy before buying because you feel you have understood the plan broadly. But these mistakes can cost you dearly in the future.

So, what are the crucial aspects of a health insurance plan that people overlook, ignore, or avoid, and how can you avoid that mistake? Let’s take a look:

Getting Insufficient Coverage

Premiums play an extremely important role in deciding which policy to buy but policies with lower premiums also have lower coverage. Cutting cost may save you some money now but it may prove even more expensive later. Subjectively analyse your medical requirements based on health, history, pre-existing conditions, dependents, etc. and select a plan with sufficient coverage. 

Overlooking The Sub-Limits

Sub-limits are a percentage of the sum insured that covers ‘associated’ medical expenses. For example, there are sub-limits on room rents or bed charges. This means that in case of hospitalisation, any expense on hospital bed charges more than the sub-limit will be borne by the patient. 

Then, there are sub-limits on certain procedures like cataract removal, kidney stones, tonsils, sinus, knee ligament reconstruction, hernia, etc. This means that such procedures would only be covered up to the sub-limit and any extra expense would be borne by the patient.

Further, there can be sub-limits on ambulance charges, oxygen supply, physicians’ consultation fees, anaesthetists’ charges and diagnostic tests, as mentioned in your policy. The sub-limits are often ignored while buying the plan and this is where patients end up spending the most out of their own pockets. 

Yes, there are a few plans available that do not have any sub-limits but the premiums for such policies are larger. Make sure you read and understand each sub-limit of your policy clearly.

Ignoring The Waiting Period 

Your health insurance plan will not cover every medical expense. Then there are certain procedures or health conditions that they cover only after a waiting period. Read the policy carefully to understand what procedures are ‘not’ covered and what are the waiting periods for others. For example:

  1. Pregnancy-related conditions – Pregnancy and any treatment associated with childbirth are usually not covered under a regular health policy. Pregnancy can, however, be covered by maternal health policies (bought separately). They usually have a waiting period of 2-3 years before coverage kicks in.
  2. Pre-existing conditions – Pre-existing conditions include things like asthma, heart conditions, high blood pressure, etc. Insurers either don’t cover people with pre-existing conditions or they cover them after a waiting period of 2-4 years.The waiting period depends on the policy provider, the kind of pre-existing condition you have, and the risks associated with the condition.
  3. Dental, Hearing, And Vision – These procedures are often excluded in most plans. Some policies may cover them in case of hospitalisation and you may buy coverage for them in your health plan as an add-on. 
  4. Cosmetic surgery – Cosmetic surgery is only covered in case of medical necessity. Superficial and appearance enhancing cosmetic surgeries are not included in health plans. 

Non-disclosure Of Medical History

People often hide their medical history because they think their application will either be rejected or the premiums will become higher. But an insurance company will refuse any claim if they find out you were not honest or you purposely hid your medical history from them. They can also sue you for illegal claims in this case. Do not ever make this mistake.

Claim Settlement Process 

Go through the claim settlement process of insurers in detail and choose the one which is more convenient, quick, and has a higher rate of claim settlement. Find out about the network of hospitals covered by the plan to know which hospitals are more accessible for you. And clearly understand the pre- and post-hospitalisation benefits they offer as your illness may need out-of-hospital care as well.

Keep the above mentioned aspects in mind while buying a policy. It may take some time now but it will save you a lot of time, effort, and money later.

OneAssure is a distribution platform that helps you make right decisions on matters where health and finances converge. Visit oneassure.in to know more about your health insurance choices.


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