Does Your Health Plan Cover Every Eventuality? Let's Find Out

Every responsible individual today understands the necessity of buying health insurance for themselves and their loved ones. At a time of global pandemics, it does not do to be casual about having health coverage – not only is it imperative to buy a good policy, but it must also be one that suits you and your family members down to the T.

How can you be certain that your health plan covers all bases? Start by asking the following questions:

• Does the plan delink healthcare from your income?

The point of taking health insurance is to have a safety net in place for future health concerns, so that they do not burden your income. The health policy must provide adequate coverage for three main heads under health emergencies: Hospitalisation, Surgery and Treatment/Medicine costs for serious or critical illnesses.

Do ensure that the health insurance plan mandatorily covers hospitalisation under different categories, i.e. required for illness, treating a chronic disease, and injury due to accidents.

• Does it offer vital features like personal accident and critical illness insurance?

Taking a health plan is moot if it does not offer personal accident insurance and critical illness insurance. Treatment and hospitalisation costs for both heads are astronomically high, and the costs increase every few years with inflation. If your current plan does not include these, please include when you renew your plan at the end of the year, or port to another comprehensive insurance policy.

Critical illness coverage is vital – treating a critical illness is a long drawn and expensive affair. Ensure that the plan offers a 100% pay-out upon diagnosis of the illness (most of the best policies do) and includes a long list of major health conditions, from cancer to paralysis.

• Does it offer flexibility to customise the plan as per your needs?

A ‘one size fits all’ approach can hardly work for health and life insurance. Your own health needs and those of your family members, are different from any others’. What works for another family may not work for yours, so the health insurance policy that you buy must necessarily be fitted to your unique requirements. Study the policy you are about to buy. Does it offer adequate coverage? Are its features and riders sufficient or necessary for you? Does the premium, sub-limits and other terms suit you? You should research comparable health plans to find the one that fits your requirements the best. If there is a risk of genetically occurring critical illnesses in the family, then the coverage must be the highest possible.

• Is there a need to take a top up or super top coverage?

When you buy a health plan with a certain sum assured, the coverage amount seems adequate at the time of purchase. But as the years pass and rising inflation makes its presence felt, the coverage amount of yesterday seems inadequate today. For example, the Rs 5 lakh family floater plan you purchased five years ago may not suffice today. Additionally, if there is a chance that one family member will require repeated hospitalisation in a year, then the entire coverage will be exhausted on that individual’s treatment while the other family members will be without coverage. If this is likely to happen, you can either buy an individual plan for that family member, or purchase a top up or super top up plan to supplement the coverage on your primary health plan.

• How are hospitalisation and surgery costs calculated?

Hospitalisation for minor ailments or to keep a patient under observation for 24 hours is not too expensive. However, when combined with treatments for critical illnesses and major surgery, it can become prohibitively expensive. When buying health insurance, ensure that hospitalisation or bed costs cover at least 2% of the sum assured in the plan for every day of hospitalisation. Meanwhile, check the coverage offered for different types of surgeries, and how many surgical procedures are included in the plan. The higher the number of included surgeries, the better for you. The policy will pay 100% costs for major procedures like transplants, valve repairs and bypass. The percentage might be lower for other surgeries.

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