8 things to consider while buying health insurance, after the pandemic

After the pandemic, an upward trend has been seen in the sale of comprehensive health insurance plans assisted by insurer’s nudge to attract more and more customers via value-added offerings. Policyholders are increasingly looking at health insurers for wellness benefits and wider coverage beyond in-patient hospitalization.

In-order to cater to the growing needs of customers. Insurers are increasingly offering extra benefits either built-in or as optional riders and add-ons.

Let’s look at eight critical factors that every individual must include while buying a health cover:

Pre and Post Hospitalization:

Pre-hospitalization expenses are medical costs incurred by the insured before getting admitted in a hospital. Post-hospitalization expenses are medical costs incurred after discharge from the hospital. Insurance policies offer extensive periods of coverage under this benefit ranging from 30/60 days to 60/180 days of pre and post hospitalization coverage respectively. Higher the number of days covered will enable the insured to cover a larger period of medical expenses.

Co-Payment Clauses

Co-payment clause means the insured is bound to pay a pre-defined percentage amount of the hospital bill. Even though these policies would cost less, it would entail unnecessary burden on the insured to foot a portion of the expenses. It would always be advisable to have 0% co-pay, so that there is no additional outlay at the time of hospitalization. But if budget is a constraint, even a 10% co-pay can result in significant decrease in premiums.

Waiting Period

There is generally a waiting period attached to pre-existing conditions such as diabetes, hypertension, thyroid etc. There are also waiting periods attached to specific diseases like cataract, arthritis, hernia etc. This period ranges from 12-48 months and the insured members have to wait for this period before they can file a hospitalization claim from these conditions. Depending on the insured requirements, it is critical to choose the right policy as per the waiting period.

OPD Treatments

Although OPD treatments are covered as part of pre and post hospitalization, customers are increasingly looking at standalone OPD benefits in insurance. At present, the majority of the OPD expenses in India are incurred out of pocket and not covered through insurance. Inclusion of OPD cover in the policy is an added benefit that an individual can get in select plans.

Room Rent Waiver

Treatment cost at hospitals varies directly with the choice of room type opted. As a result, the claim settlement affects the overall bill when a patient covered by health insurance opts for a room that exceeds his policy limit.

At the time of emergency, such critical decisions may be overlooked resulting in a poor claim settlement experience. In order to have a peaceful and hassle-free experience, there has been increasing preference towards opting for health insurance policies without any adverse room rent capping.

Need to include mental wellness cover

Insurance regulator IRDAI, vide its circular dated August 16, 2018, stated that insurance is liable to be provided for mental illnesses upon the enactment of the Mental Healthcare Act 2017. However, the cover is still subjected to sub-limits and doesn’t cover treatment on OPD basis which forms most of the healthcare expenditure towards mental illness.

Home Care Treatment

While domiciliary treatment is covered by the majority of retail health insurance plans, it comes with its set of conditions with respect to unavailability of hospital room or inability of patient to be taken to a hospital. Certain illnesses such as dengue, pancreatitis, COPD management and many more can be treated from the comfort of home. There are certain policies that are now offering home care treatments as well.

New trends in health insurance policy:

Tele-consultation

Thanks to the affordable internet and advent of Covid, there has been an increased adoption of doctor tele-consultations. Insurers have started addressing the needs of customers by rolling out in-built and optional tele-consultation coverages. Most insurers as of today have a built-in second medical opinion for major critical illness cover built-in for the insured. In a country with a poor doctor to patient ratio, it becomes a win-win proposition for all stakeholders i.e. insurers, medical staff and patients.

Critical Illnesses

Hospitalization costs for certain major chronic illnesses such as cancer, organ transplant, renal failure are major outliers compared to average hospitalization costs for other surgeries. At such instances, the health insurance coverage opted by customers falls short of requirements. Customers are increasingly looking at lump sum or indemnity-based critical illness or cancer covers in conjunction with their health insurance.

There remain plenty of areas where there is scope to add value. Dental coverage, high-end diagnostic tests, allowing portability for combining two policies into one, end-to-end digital claim filing etc. are some features that insurers should evaluate and add to service their customers better.

India continues to be at an inflection point where growing demand for good quality healthcare needs to be complemented by comprehensive and affordable medical insurance.

The author Anuj Parekh is the co-founder and CEO of Healthysure.in.