Covid-19: Why and which health insurance policy to go for?

Reports suggest covid hospitalisation is costing around Rs. 5 lac on an average in a private hospital. This means not just that we must take utmost precautions but should also keep at least Rs. 20 lac handy to cover the risk if we are a family of four and we are not very confident about the government covid care centres. It’s a big amount, isn’t?

Go for Health Insurance

The amount is exorbitant. Indian Health Bureau suggests the following:

Get your existing policy topped up to at least Rs. 5 lac per family member
Buy a policy if you don’t have one. It can not be as important as now. Cases are increasing and it is very unlikely that we and our family members can remain immune to it for long.

It will be wise to go with a policy that has no sub-limit (capping) for room rent i.e. the policy should cover every room category. The premium may be high but it may help save you a good sum of money eventually. Below is how.

Suppose you go with a policy that covers room rent up to Rs. 4,000/ day. Now, say room with that rent is occupied or not available in the hospital at the time of hospitalisation (it happens many a times), what will you do? You will go with any room that is available, especially if it is emergency, right? Now what if the room costs Rs 10,000 per day and your total hospital bill adds to Rs. 5 lac for a total stay of 10 days? How much do you think you will have to pay from your pocket? Not just Rs. 60,000 (difference of Rs. 6,000/ days X 10 days) but nearly Rs. 3.0 lac and this even if the sum insured is Rs. 5 lac and you haven’t claimed even a single rupee before.

The insurer will not just pay 60% less on Rs. 1 lac room (Rs. 10,000 per day X 10 days) rent to reach the figure of Rs. 40,000 @ Rs. 4,000 per day but will also apply proportionate (60%) deduction condition on all the associated medical expenses, which put together forms the major part of the hospital bill. Roughly put, it’s 60% deduction on the entire bill (Rs. 3 lac). The difference (deduction), you pay from your pocket.

Isn’t it better then to go for a policy that has no sub-limit (capping) on room rent?

There are a few more things to look at while topping up and / or buying a policy. Below are some of them.

1. Plan– Go for a family floater plan for a more number of people can be covered in a lesser premium as compared to individual policy for everyone.

2. Coverage amount – The more, the better. In this Covid era, policy should be of at least Rs. 5 lac per person if you are leaving in a metro city and at least Rs. 3 lac per person if you are leaving in a non-metro city. For people at high risk, the sum insured should be even more.

3. Sub-limit– The higher, the better. Prefer a policy with no sub-limit or fewer sub-limits.

4. Co-payment – The lesser, the better. Preferably go with a policy with no co-payment clause. Co-payment is the pre-defined percentage of the hospital bill you pay from your side every time you avail the hospital and insurance services.

5. Deductible – The lesser, the better. Preferably go with a policy with no deductible clause. Deductible is the base amount after which you policy activates. The base amount is payable from your side to the hospital.

6. Waiting period– The lesser, the better. Many policies do not cover some pre-existing diseases and some specific procedures right from the beginning of the policy. Check the list and pick a policy that has a fewer numbers and lesser waiting period.

7. Pre-hospital and post-hospitalisation benefits– The more, the better. See if at least thirty days pre-hospitalisation and sixty days post-hospitalisation expenses are covered.

8. Exclusions– The lesser, the better. Study it well and see how relevant or irrelevant it is for you.

9. Insurer claim settlement ratio– The higher, the better. Check on the IRDA site and see if the insurance company you are buying the policy from has a better or at least at par claim settlement ratio with others offering the similar product.

10. Age-renewal – Need of policy increases with the age. See if you can renew the policy even when you go old and old.

11. Cost (premium) comparison– See if other companies are offering similar product at a better price.

12. Reviews – Good to go online and find people’s experiences with the company and the product.

Disclaimer: Medivisor Health does not claim any responsibility for the information contained in this article. The information may not hold good for everyone. The post is for general awareness only and should not be construed as a substitute for qualified medical opinion. Please consult your own doctor to know what is good for you.