Day by day, the number of diseases and new diseases are growing in a fancy fashion. Proportionately, the medical expenditure is doubling. In the midst of COVID-19 times, neither can one predict the future nor the present. In this blog, I walk you all through the importance of having a separate medical insurance and also lay out the main factors one need to consider before purchasing a medical insurance. This article might sound a bit inclined towards India, I have tried to keep it as neutral as possible.
Co-Pay Percentage
As the terminology says, Co-Pay means both the stakeholders (insurer and insured) will pay the medical bill. Each health insurance policy has it’s own percentage for Co-Pay. The trend seen in the recent times is also that major insurance providers are making Co-Pay a mandatory. The lower the Co-Pay percentage, the better it is for insured.
Multiple Claims
This is by default a possibility in 90% of the insurance types in these days. That is, if one is hospitalized for XYZ reason in a year and they are hospitalized again for another/same reason they will still be able to make the claim again if there is amount left from the sum insured. But, it is important to double check this.
Cashless Facility
Not all insurance provider has cashless facility. Cashless facility is a system wherein, from the time of hospitalization till discharge one need not pay any amount. The opposite of this is reimbursement, wherein the insured pays cash and claims the amount. Since this process is a bit tedious. Going cashless is the best way.
TPA review
Third-Party Administrators(TPAs) are middle men who handle operations of medical claims. Starting from use case of a patient to approvals. It is most important to check the service provided by TPA, their response time and availability matters the most.
Diseases not covered
Each insurance offering firm has their own list of diseases for which they do not offer medical claim benefits. Do go through them.
Network Hospitals
Not all hospitals will be under the coverage of an insurance provider. Each insurance provider hosts a list of covering hospitals on their website. Also, some insurance providers do approve claims if the hospital in not in their covered network but meets minimum criteria like posses 50 beds..etc.
Restoration benefit OR Refill benefit
Probably the most important parameter among all. Imagine in a year Person X gets hospitalized twice and empties his sum insured. Then for the rest of the covered period, although he has a medical insurance on paper, his claim amount is nil. But, many insurance providers today offer a refill policy. Do check out details regarding the same before buying the policy.
Conclusion
Only goes by the famous quote that — “A decade ago, we had Steve jobs, Bob Hope, and Johnny cash. Now, we have no jobs, no cash, and no hope”. I do not mean to resonate the same but in world of intertwining possibilities no-body knows when can one lose hope, cash or job for that matter. Yes, both private and public jobs cover employee and their first circle relatives medical bills. But this comes with lot of limitations and also one cannot be sure on when/how the policies by the employer will change. Thus, one of the most important thing a citizen needs to be informed about is on their health prospects. I also feel like Aadhar, PAN and VoterID. India should plan for One Nation One Insurance and provide a unique identity for each insured individual. Go buy your medical insurance now.
To ease the process, the Insurance Regulatory and Development Authority recently announced a new policy. Arogya Sanjeevani. Go Check out the here.