Health insurance policies provide financial coverage against expenses arising due to medical emergencies. These help to account for hospital-related expenses, daycare procedures, room rents, doctor’s fees, nursing and boarding charges, ICU charges, etc. That said, all health insurance policies come with unique terms and conditions, and they vary among plans.
With so many different policies having unique coverage, inclusions, and exclusions, people need to read their health insurance terms and conditions carefully. This will let them avoid getting their claims rejected and let them access financial assistance during times of great need.
A medical insurance policy is like an umbrella providing financial protection during times of need. However, with so many choices of health policies available, it is important to make an informed decision before choosing a health plan.
Therefore, you should always check the health insurance terms and conditions to understand if they suit your needs. Another reason to read the policy documents is that people often forget about the specifics of clauses until they need to make claims. Knowing the terms early will avoid claims rejection in times of crisis.
The following are some important terms and conditions that you should pay special attention to:
Look for these clauses in the terms and conditions before buying a policy:
When choosing a health insurance policy, you should select one with a sum insured amount that is enough to cover potential needs. For example, if you have pre-existing conditions, it may be worth paying a higher premium for coverage of specific illnesses.
The objective of a health plan is to get paid for any legitimate claim during times of need. Therefore, you should choose an insurer that follows simple and fast claim processing and have good customer support.
They allow you to get treatment without paying any cash as they are directly associated with the insurer. The more hospitals are included in the insurer’s network, the easier it is to get the cashless facility from anywhere, especially during an emergency.
You have to wait before raising a claim under your health insurance policy. Make sure to choose the policy with the least waiting period to avoid being in a medical emergency with no health cover.
This clause in medical insurance policy refers to a certain percentage of the claim amount one has to pay out of pocket when making a claim. A higher co-payment decreases your out-of-pocket expenses but increases your financial burden during medical emergencies.
Some health insurance policies offer the option to renew it every year. Choosing a health plan with a lifelong renewal facility is beneficial as it lets you avoid higher premiums due to age.
Health insurance products come in different types for different needs. Check the policy terms to know what type of health plan you are buying.
Depending on the insurer and the specific policy terms, a health insurance plan can offer the following coverage.
It includes all medical expenses incurred after the patient gets admitted to a hospital for over 24 hours. For example, it covers room rent, medicine costs, diagnostic test charges, doctor’s fees, etc.
This includes medical charges for a specific number of days before admission and follow-up treatment costs after discharge.
Some medical treatments do not require the patient to get admitted for 24 hours. Daycare expenses include these advanced treatments.
Health insurance plans cover the consultation fees of doctors, specialists, nurses, etc.
This includes rent for regular wards or ICUs (Intensive Care Units). Some do not have a cap on room rent, allowing you to rent the best rooms.
This includes all medical expenses incurred during pregnancy and delivery along with any treatment costs for the newborn baby for up to 90 days.
Some health insurance plans cover medical treatment through the AYUSH school of medicines, including Ayurveda, Yoga, Unani, Siddha and Homeopathy.
Some policies offer free preventive health check-up facilities at regular intervals.
The actual exclusions of your policy may vary depending on the insurer and health insurance terms and conditions. Make sure to read the fine print and know all the exclusions to avoid claims rejection during times of crisis.
Choosing the right health insurance plan can be fairly difficult, but you can find the right one for you and your family with a little research. First, search and compare the health insurance terms and conditions of different plans to know which one offers the best coverage at affordable prices.
Navi offers a range of health insurance policies with coverage up to 1 Crore and premiums starting as low as Rs. 241 per month. Download the Navi App from the Play Store to get health insurance plans with comprehensive benefits.
Ans: Yes. Even if you take good care of your health, unforeseen situations like a seasonal illness, accident or underlying medical conditions can affect anyone, anytime. Hence, it is advisable to have a health insurance policy to pay for expensive hospital bills.
Ans: There are two types of claims process for health insurance policies:
a. Cashless claims: The insured person avails treatment from a network hospital, and the insurer settles all bills directly with it.
b. Reimbursement claims: The insured person gets treatment from any hospital and files a claim for reimbursement with the insurer later.
Ans: Following are some of the documents you may need to furnish to buy a health policy:
• Identity proof
• Address proof
• Age proof
• Medical reports
• Passport size photo
Ans: Yes. Most health policies cover previously declared pre-existing conditions after a waiting period of around 2-4 years, depending on the insurer. So if you have medical conditions like diabetes, high blood pressure, kidney problems, etc., you should declare them before buying an insurance policy.
Ans: Yes. IRDAI has introduced two standard health insurance products- Corona Kavach and Corona Rakshak policy to cover medical expenses for treating Covid-19.
How about an affordable health insurance policy 👨⚕️ starting at a monthly premium of just ₹235? Install the Navi app now and get your policy in under 2 minutes.
Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
|Karunya Health Scheme||Niramaya Health Insurance Scheme||Best Health Insurance Repositories|
|Pradhan Mantri Suraksha Bima Yojana||Best Personal Accident Insurance Plans||Best Insurance Policy For New Born Baby|
|Third Party Administrator (TPA)||What is Super Top Up Health Insurance Plan||Deen Dayal Swasthya Seva Yojana (DDSY)|
|Best Health Insurance Plan For Parents||Incurred Claim Ratio In Health Insurance||Chief Minister Comprehensive Health Insurance Scheme|
|Best Health Insurance Policies In India||Best Health Insurance Policies In India||Best Family Floater Health Insurance Plans in India|
|No Claim Bonus in Health Insurance||IRDAI Guidelines For Health Insurance||OPD Cover in Health Insurance|
|Maternity Health Insurance Plans||Health Insurance Plans For Senior Citizens||What is Portability Of Health Insurance|
TPA in Health Insurance – Full Form, Functions and RolesTPA (full form – Third Party Administrator) is a licensed intermediary between health insurance p... Read More »
10 Best Cashless Health Insurance Plans in 2023 – Tax Benefits and CoverageConsidering the rising medical expenses, it is important to obtain health insurance for yourself an... Read More »
Top-up Health Insurance Premium Calculator -How to Use & its BenefitsAre you looking to compare top-up health insurance policies online? A top-up health insurance premi... Read More »
What is Group Insurance Policy – Best Group Health Insurance PlansGroup medical insurance policies are specially designed to provide financial coverage to a particul... Read More »
What are Individual Health Insurance Plans – Benefits and CoverThe COVID-19 pandemic demonstrated how unprepared most people are in the face of a major health cri... Read More »
Corona Insurance Policy (2023) – Types, Cover and How To ClaimCorona Insurance policy provides coverage for all medical and hospitalisation expenses incurred due... Read More »
What is a Cardiac Health Insurance Policy – Benefits and Diseases CoveredIn cardiac health insurance policies, insured individuals get financial coverage to treat heart dis... Read More »
What is Cashless Mediclaim Policy – Working, Features & How to ClaimA cashless Mediclaim policy provides much-needed financial aid during medical emergencies. Policyho... Read More »
What is Mental Illness Cover in Health Insurance – Benefits and Why it is NecessaryEarlier, health insurance companies in India covered only physical illnesses in their health insura... Read More »
Group Personal Accident Insurance – Inclusions, Exclusions and Documents RequiredMr Sharma is an owner of a company. He’s looking to insure his employees against unexpected medic... Read More »
What is Liability Insurance and What Does It CoverInsurance has become an indispensable financial product, thanks to its benefit of offering a protec... Read More »
Best SIP Mutual Funds To Invest In India (2023) – Its Types And TaxationA Systematic Investment Plan (SIP) is a convenient way to invest a fixed sum in mutual funds. For i... Read More »
All information is subject to specific conditions | © 2023 Navi Technologies Ltd. All rights are reserved.