Features of Medical Insurance in India that You Should Look for

Deciding on a medical insurance policy that adequately meets your needs without burning a hole in your pocket can be daunting. With countless plans and features to evaluate, purchasers often need clarification about what to look for in their health insurance. This comprehensive guide covers all the key elements of medical insurance in India that you should consider when making this crucial buying decision.

Coverage Amount

The first and foremost thing to check is the total coverage amount offered under a medical insurance plan. This refers to the maximum limit up to which the insurer will pay for medical expenses incurred during hospitalisation. While basic plans cover ₹1-5 lakh, some policies go up to ₹1-2 crore coverage. Evaluate your family's medical history and choose an adequate sum that will sufficiently cover treatment costs.

Cashless Hospital Network

Cashless hospitalisation is an invaluable feature offered by insurers. It allows the insured to get admitted and discharged from network hospitals without having to pay from their own pocket. The insurer directly settles the bill with the hospital as per policy limits and terms. Check that your insurer has a wide hospital network covering your city so you can conveniently access cashless services.

Pre and Post-Hospitalisation

A standard medical insurance policy only covers in-patient hospitalisation charges. However, good policies also include cover for expenses incurred 30-90 days before and after hospital admission. These expenses typically include diagnostic tests, doctor fees and medication. Having this buffer can protect you from high out-of-pocket expenditures over and above hospital bills.

No Claim Bonus

Insurers offer a no-claim bonus (NCB) on policies if no claim is made during the policy year. The NCB typically ranges from 10% to 50% and accrues each year if you make no claims. It also increases your overall coverage amount. When porting or renewing your policy, always check if the insurer transfers/protects your accrued NCBs.

Critical Illness Cover

Treatment for critical illnesses like cancer, strokes, paralysis, etc., requires prolonged and expensive therapy. Many policies provide additional critical illness cover to pay for such treatments over and above base policy coverage. Some insurers also offer specialised critical illness plans. Based on your medical history and risk appetite, evaluate if you need this extra financial cushion.

Maternity and Newborn Cover

Delivery, both normal and caesarean, along with pre/post-natal care, entails substantial expenditure. Many employers include maternity coverage in group insurance plans. If taking an individual/family floater policy, specifically look for ones that provide this maternity and newborn cover add-on.

Alternative Treatments

Most traditional plans only cover allopathic treatment. However, insurers now offer coverage for alternative treatments like Ayurveda, Homeopathy, Naturopathy, etc., up to certain limits. If you prefer such alternative medicine practitioners, look for health plans that specifically include them.

Out-patient Department (OPD)

An OPD cover allows the insured to claim expenses incurred for doctor consultations, medications, dental treatments, etc., without hospitalisation. Though not essential, having an OPD cover offers financial ease from small but recurring medical expenses throughout the year. Some insurers also allow the use of OPD limits to pay for non-medical expenses like paying attendants, transportation costs, etc.

Lifelong Renewability

Lifelong renewability is essential for senior citizens or those with pre-existing medical conditions. Insurers must offer lifetime renewal without capping policy cover based on age or health status. This ensures you have health protection well into your retirement years.

The Bottom Line

Hope this guide gives you clarity on the key benefits that must be evaluated while purchasing your medical insurance policy. Analyse your family's unique needs and choose a customised plan that delivers maximum value. Stay smart and stay protected!