It has been observed that medical inflation generally increases by 10-15% year on year. This in itself is an indication that one should review the sum insured and the coverage of their health insurance policy every two years. It is advisable to assess your medical needs and previous claims, and to find out the prices of common treatments in hospitals. As a result, you can determine your policy’s coverage and sum insured. This will ensure that you and your family members are appropriately covered and reduce your out-of-pocket expenses in the event of a medical emergency.
A health insurance policy has several covers, but the most crucial ones that need to be included, especially considering Covid, are:
Cashless hospitalization: This allows the insured to benefit from cashless hospitalization services in hospitals that are part of the insurer’s network.
Consumables Coverage: This protects against the basic cost of items such as PPE kits, masks, gloves and, in severe cases, covers the expense of oxygen cylinders, ventilators, etc.
Ambulance coverage: With this coverage, the insured can easily benefit from the ambulance service without direct financial cost.
Home treatment: The doctor may advise some patients to stay at home and seek treatment there. In this case, expenses may be incurred against regular monitoring and cure during home isolation. This coverage ensures that there is no compromise in the quality of care received.
Sum insured: After reviewing the policy’s basic coverage, the next step is to assess whether the plan’s sum assured is adequate for end-to-end healing, that is, during and after treatment. With Covid we have seen that continuous or repeated treatment may be required, and that medications, regular doctor visits and hospitalization bills can be very high. Thus, an ideal health insurance coverage should reduce out-of-pocket costs for the insured.
What options do you have if your existing policy is inadequate?
Top-ups and riders: In case the insured amount of your basic policy is insufficient, it is always advisable to opt for a super supplementary policy. It upgrades your coverage to a nominal premium amount. This policy usually only kicks in after the amount of the claim exceeds the predetermined deductible. You can keep the deductible amount as the sum insured of your basic policy and as soon as the sum assured of the basic policy is exhausted, the super supplementary policy will take over the remaining amount.
“If you think you want to improve the coverage, you can opt for a top-up/endorsement like non-medical expenses cover, hospital cash benefit, etc., which will also help you reduce your out-of-pocket. You may also consider migrating your existing policy to another enhanced policy product, which gives you broader coverage and meets your needs,” says Gurdeep Singh Batra, Head of Retail Underwriting, Bajaj Allianz General Insurance.
Carrying: With the intervention of the insurance regulator, for the benefit of customers, the porting process has been simplified and you can easily change insurers online if you are unhappy with the current insurer and wish to upgrade to a better font.
By following a few simple steps, you can switch from one insurer to another. With the many changes to underwriting rules, customers do not need to meet a new waiting period when transferring from the insurer. All other benefits like the no-claim bonus continue to work uninterrupted.
“If your current plan has a co-pay, make sure it’s the minimum; otherwise, go for an upgrade, even if it means paying a higher premium. Likewise, if it has sub-limits, transfer the plan without any caps. Therefore, be prepared to bear the cost of any medical crisis, otherwise you will eventually exhaust your savings for the treatment. It is also crucial that the person confirms that their health insurance is comprehensive and protects them against other illnesses. The reason for this is that infections like black fungus and blood clots were also prominent during the second wave (of Covid). So a comprehensive plan will cover all kinds of illnesses and their sequelae,” says Amit Chhabra, Health Insurance Manager, Policybazaar.com.
Things to keep in mind when transferring a policy
“As per the current guidelines of Irdai (Insurance Regulatory and Development Authority of India), it is advisable to apply for the porting of your policy at least 45 days before the renewal date of your existing policy. It is also important for a person to know that underwriting standards vary from insurer to insurer and product to product. Therefore, it is important to know the waiting periods and deductibles, if any, before transferring your policy. Whenever you transfer your policy, be sure to do so for better coverage and better quality of service,” adds Batra. Full disclosure of your current medical condition at the time of transfer to the other insurer as well as any pre-existing medical conditions and details of past claims is also important. Insurance is a contract based on the principle of ‘fullest good faith’ and with this flexibility comes responsibility and in the interest of the client so that the client is not caught unawares when dealing with future claims due to non-disclosure of known facts.
“Remember to complete the portability form with existing insurance information, such as the name and age of the insurer. You must completely fill out the proposal form for the new insurer,” adds Chhabra.
With Covid, the need for adequate health insurance has been made clear. Make sure you do what is necessary so that you are not caught off guard.