Health Insurance Checklist
Make sure your health plan includes essential coverage, fits your budget, and aligns with your needs. Use this checklist to compare policies and choose the right one with confidence.
Must-Have Features
1. Avoid Co-Payment Clauses
Some insurers may encourage you to opt for a co-payment clause, requiring you to bear a percentage of every claim (10%, 20%, or more). Unless necessary, it's best to avoid co-payments to ensure full coverage.
2. Room Rent & Restrictions
Certain policies impose a cap on room rent, and exceeding this limit means additional charges for every service used—not just the room itself. Choose a policy with minimal restrictions on room selection.
3. Watch for Disease-Specific Sub-Limits
A high coverage amount (e.g., ₹10 lakhs) may seem attractive, but some insurers impose disease-specific limits, reducing the actual claimable amount for specific illnesses. Always check for these limitations.
4. Pre & Post-Hospitalization Coverage
Medical expenses don’t start or end at hospitalization. Diagnostic tests before admission and follow-up treatments post-discharge can be costly. Ensure your policy covers both pre and post-hospitalization expenses.
5. Choose a Low Waiting Period
If you have pre-existing conditions (diabetes, hypertension, thyroid disorders, etc.), insurers often impose a waiting period before covering related claims. Look for policies with waiting periods of three years or less.
6. Coverage for Daycare Procedures
Certain treatments like chemotherapy, dialysis, and minor surgeries don’t require a 24-hour hospital stay. Some insurers may exclude these, so opt for a policy that explicitly covers daycare treatments.
7. Restoration Benefit for Coverage Refill
If you exhaust your sum insured after making a claim, a restoration benefit can automatically reinstate your coverage for future claims within the policy year. Look for policies that offer at least one restoration per year.
Good-to-Have Features
1. No-Claim Bonus (NCB) for Staying Healthy
Many insurers reward policyholders with additional coverage for every claim-free year. Check if your policy offers a No-Claim Bonus to maximize long-term benefits.
2. Annual Free Health Check-Ups
Some plans include free yearly health check-ups, ensuring you stay on top of your health without additional costs. Consider this feature for preventive care.
3. Consumables Coverage (Gloves, Syringes, PPE, etc.)
Hospital bills include costs for consumables like gloves, masks, syringes, and PPE kits, which many insurers exclude. Opt for a policy that includes consumable coverage as a standard feature or add-on.
4. Domiciliary Treatment Coverage
In cases where hospital beds aren’t available or a patient requires home treatment due to mobility issues, domiciliary coverage ensures medical expenses, equipment rental, and practitioner fees are covered.
5. Alternative Medicine Coverage
If you prefer alternative treatments like Ayurveda, Unani, Siddha, or Homeopathy, check if your policy includes coverage for these under AYUSH benefits.
Frequently Asked Questions
A robust restoration benefit is essential to ensure coverage isn’t exhausted when multiple family members require treatment. A no-claim bonus of at least 50% helps increase coverage over time. Additionally, free annual health checkups can be particularly beneficial, especially for households with young children.
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