What should be our first investment, its answer is there in another question that, what is the biggest asset for us? The most important asset is MYSELF, because my earning potential unlimited, and that’s why is very important to take care of ourself? There is a famous saying “If you have life, you have the world”. If we take care ourself then only we can realize our earning potential, that’s why it is very important to invest in your body and health and that’s why. The first investment we should do is to get Health insurance, but when we go to buy health insurance, may questions come to our mind, do I need health insurance according to my career stage or age? Or how much total cover should I take? Sometimes some companies provide health insurance to their employees, so they think that they’re done, but is that cover sufficient? If you buy the health insurance policy then what is included and what is excluded, on what you should focus more on? And if we’re buying any policy then should we buy the cheapest one? Sometimes, even if you buy the policy, the claim gets rejected, some pre-existing diseases are not covered in that, what are restoration benefits, top-up cover, and super top-up cover?
Firstly, we’ll see the benefits of health insurance, Secondly, we’ll see about inclusions and exclusions that means about the features, what all things are included and excluded in a standard policy and what all things to keep in mind, on third, we’ll see about how much total cover we should take, either as an individual or as a family.
The first benefit of health insurance is that your savings remain untouched at times of emergency, any medical problem occurs in your family, and as we know medical costs are very high nowadays,
Surgery or treatment cost of any critical illness is very high like 5-15 lakh, so in this case, your savings will not be affected much, and you’ll get total cover from health insurance, 2nd huge benefit is cashless treatment and we don’t have to pay anything from your pocket, Most of the standard policies have a network of hospitals where you can get cashless treatment, 3rd benefit is, there are Corporate plans Top-up, Many companies provide 2-3 lakhs insurance cover, But it’s not sufficient in most cases so you can Top-up that also, 4th benefit is, if you buy insurance at a young age, the your premium is less and most of your diseases are covered, Because there are fewer chances of diseases at young age, but over a period of time, the chances of diseases or any illness increases, Most of the policies have a wating period for pre-existing diseases of around 3-4 years, If that will be covered than any other diseases will be covered in future, 5th Benefit is, you get cover for all the lifestyle diseases, Nowadays most of the job are desktop jobs, COVID time, most of the people are working from home, so it becomes more important in that times, And 6th benefit is, you get many other benefits other than hospitalization like, Maternity benefit or daycare facilities, Many surgeries or treatments do not require hospitalization, that is also covered in many policies, Many viral diseases are covered and there are special policies for COVID that days, 7th benefit is, Tax benefits, Under Section 80D, you get a tax deduction of Rs.25,000 if you choose the old slab. However, it’s not a big thing but it may be a big advantage for some people.
About inclusions and exclusion, the first future you have to check in any policy is, In your nearby hospitals, check which policy is providing cashless treatment, Secondly, check that whether pre and post hospitalization charges are covered or not, Pre and post hospitalization charges are the charges which include during treatment charges, And along with that, 30-60 days of Pre-hospitalization period, which includes consultation of a doctor, diagnostic test, any physiotherapy, etc., And post-hospitalization may also include physiotherapy, diagnostic consultation. So many policies cover 30-60 days of pre-hospitalization expenses, And cover 60-180 days post-hospitalization expenses, so keep this in mind as well, you should also care Day care Facilities because nowadays, may surgeries last just for 1 day, That means you don’t need night admission in hospitals, Many policies do not cover Day care facilities, so keep this in mind as well, Along with this, many policies cover Ambulance charges as well, You have to check the coverage and there should not be any cap on different diseases or treatments, Besides this, some policies also contain a Co-pay option, That means you also have to give some money, so if treatment costs Rs.1 lakh and 10 % is Co-pay clause, Then you have to pat Rs. 10,000 so it’s better not to have a Co-pay options. One more thing to keep in mind is how much Room rent is available, all these charges are linked to your room rent and let’s say room rent is high under the policy, So you have to Co-pay accordingly, That’s why it’s important to see the room you would prefer accordingly to your lifestyle. One more benefit which is available in some policies is the Restoration benefit, if all your cover is exhausted in one year, i.e., Rs. 3,00,000 covers exhausted for a family member, so that cover will be restored for another member. Hence, restoration benefits are also there. And in some policies these restoration benefits are available during hospitalization.
Similarly, there’s one more benefit which is the Top-up benefit, If there is a company insurance going on, and if someone wants to take Top-up insurance then that is a very good option, if you have a cover of Rs.3 lakhs and you want it to be Rs.6 lakhs, Then you can buy an additional cover of Rs. 3 lakhs which is called Top-up cover. Top-up cover means if your Rs.3 lakh cover is exhausted, then additional Rs.3 lakhs cover will be available, And there is one more beneficial plan which is Super Top-up cover, In which your multiple claims are also covered, and multiple claims means if a family member fallen sick and it cost Rs. 1 Lakh for the treatment, Then the remaining Rs. 2 lakhs got spent on another family member and the total cover exhausted. Now you will get a Top-up of Rs.3 lakhs again which is called super Top-up. And if you buy Top-up or Super Top-up cover then your existing conditions are continued as it is, That means the waiting period is continued as it is. This is the benefits of Top-up or Super Top-up.
Understand what Pre-Existing Disease and Waiting Period is, because most of the claims used to get rejected because of this earlier and today as well, so to tackle this, IRDA defined the Pre-existing diseases properly, so the diseases diagnosed 48 months prior to the date of policy buying is called Pre-existing disease. And this is considered basically for your claims. Example, if someone is suffering from diabetes, and he took the policy in Nov 2023 and he was already suffering from diabetes, Hence, it is a Pre-existing disease. So he can claim the cost of its treatment from the 5th year onwards which means from Nov 2027. But definitely, if you have any existing conditions of illnesses, then your premium increases, and this waiting period can be different for different diseases, it is generally 2-4 years of duration, Along with this, remember that you don’t have to hide you existing condition, if you smoke, you’re diabetic, or have nay type of hearts condition then clearly mention it, Because if you will not tell and later on it got detected, then your policy may get terminated.
Besides this, you can check the No Claims Bonus in your policy, Because of that, conditions of decrease in premium maybe there or you get extra cover, if you took policy for the current year without doing any claim and you were paying the premium regularly, and you continued that policy, then you may get 10% extra cover or a rebate of 10%. So No claim bonus may go up to 50-100%, so check how much No claim Bonus is available.
Along with it, if you have No Claim for nay year, then you get Preventive Health check-up in many policies, In which you can do your health check-up in a hospital and you get its refund, you didn’t claimed for 2 years then you may get Rs. 2500 to Rs. 5000. It depends on how much is your total cover.
How much Health Insurance Cover should you take? It depends on many factors like your age, medical history of the family, existing conditions, nature of your job, Is there any danger involved in that, income level, lifestyle, etc.? If you’re buying a policy as an individual.
Then you should take a minimum cover of Rs.3 lakhs, because there are fewer chances of existing diseases at young are, And as your age increases, you can increase your cover with that, about the family cover, a standard family with 2 adults and 2 kids then you should take Rs. 5-10 lakhs standard cover. And these are some thumb rules, You can choose one among the 2 thumb rules, Like 50% of annual salary or you can choose what’s the cost of heart surgery in you city, if the cost of heart surgery in your city is 4 lakhs then you can choose the cover of Rs. 4 lakhs, but if you are a Tier 1 city, it may go around Rs. 7-8 lakhs so you can take cover according to that. But it is also depends on your income and lifestyle, so a minimum cover for a family should be Rs.5-10 lakhs, besides this, if your parents are above the age of 50-60 years, you can keep them in a separate policy, otherwise, your premium will be very much high, because the premium is decided according to the highest age.
How should we buy health insurance?
So firstly, understand that the cheapest is not the best. That the brand value of a company is also very important when we buy insurance, so it becomes important that whether that company will pass our claim or not. So for this, we can check Incurred Claim Ratio and Claim Settlement Ratio.
