A health insurance plan is a complex technical policy document that can be tricky to completely understand. But there are certain terms that you should be aware of and understand how they affect your policy. A ‘rider’ is basically a policy provision that adds benefits to the terms of the policy agreement. They are like pizza toppings, if you want them you pay extra to get them. You can pick and choose them as you like and IRDAI has put a cap of 30 percent on them. This means that the cost of riders cannot exceed 30 percent of the premium cost.
So, what are the most important riders you should consider before buying a policy? Let’s explore.
1. Hospital expense cash
This purchase of this rider means that the insurance company will provide a daily cash allowance for a specified number of days when you get hospitalised. The allowance may vary based on your policy and it can be used to cover for out-of-pocket expenses during hospitalisation.
2. Room rent waiver
Most health policies have a sub-limit on room rent or a predefined room category that they cover under the policy. If you want a better room or an expensive room, then the extra expense comes out of your pocket. The room rent waiver rider can be bought if you wish to have a room of your choice, with higher or no sub-limit, without spending extra yourself, in case of hospitalisation.
3. Critical illness rider
The critical illness rider provides a lump sum amount to the policyholder irrespective of the total expenditure incurred during the treatment. The rider covers critical and terminal illnesses like heart attack, tumour, cancer, organ transplant, etc. Most comprehensive plans allow critical riders that can cover up to 38 critical illnesses.
4. Personal accident cover
This rider is meant to cover the aftermath of an accident. An accident, for example, may result in death, permanent total disablement, temporary disablement, partial disablement, etc. that may have serious financial repercussions on you and your family. This rider can be added to even the basic health policies, it provides coverage for expenses and injuries suffered in an accident, and can be used for unplanned expenses. It is also known as a double indemnity rider as the policyholder’s family gets double the policy amount in case of the policyholder’s death due to an accident.
5. Maternity cover
This rider allows coverage for expenses incurred during childbirth. Depending upon the insurance plan, there could be a waiting period of 24 months or more, and the coverage will kick in only after the waiting period gets over. Certain insurers also provide coverage to the newborn child until the end of policy year if they cover the maternity expense.
These are some of the most crucial riders that you should look into before buying a plan and add them to your plan based on your own specific needs.
6. Super No Claims Bonus (Super NCB)
Most insurers provide no claims bonus to the policyholder either by increasing their sum insured (at no extra cost) or by providing discounts on the premium. Most of the policies, however, offer only a 5-10% no claim benefits for every claim-free year. With the Super NCB as an add-on, insurers like Aditya Birla and Religare, provide a yearly increment of 50% on your sum insured as NCB, upto a limit of 150%.
7. Pre-existing disease
Most insurers do not cover pre-existing illnesses before a certain waiting period (usually 2-4 years). But you can opt for disease-specific plans or pay for add-ons that would enable you to get coverage from the first day itself. Apollo Munich’s Energy Health Insurance Plan, for example, has a higher premium but covers Type 1 and Type 2 diabetes or hypertension from the first day.
8. Organ donation
There are certain insurers that provide cover for organ donation and transplant but you need to understand if the coverage is built-in the policy or comes as an add-on. Star Health Family Health Optima, HDFC Ergo Health Optima Restore, etc. provide cover but at an additional cost. The cover may include caring for you as well as the donor and hence the additional charge in the premium. Also, keep in mind the post-transplant coverage as most insurers do not cover the hospitalisation and other expenses required after the transplant.
9. Unlimited sum insured restoration
Sum insured restoration is the benefit offered by insurers wherein if your sum insured gets partly/fully exhausted due to claims, they will restore the entire amount for you to use again in the same policy year. It is an add-on and you will need to pay for the restoration benefit to be added to your policy but it is useful in difficult times. Some health plans like Star Health’s Mediclassic plan do provide for up to 200% sum restoration but you can also opt for unlimited sum insured restoration through Aditya Birla’s Active Assure by paying additional cost in premiums. This ensures that your sum will be restored as many times as needed during the policy year.
10. Voluntary co-pay
Many insurers allow you to pay a lower premium for a certain specified sum insured if you voluntarily opt for co-pay. Co-pay is essentially the percentage of sum insured that you pay out of your own pocket. For example, a 20% co-pay will mean that if the claim is of one lakh, you will have to pay 20,000 yourself and the rest will be paid by the insurer. Since you share the burden of payment, the premium charged is low. This is a benefit that you can opt for voluntarily.
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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.