Introduction
Health insurance gives you financially important protection should you experience an accident or illness. For example, health insurance may cover doctors’ services, medications, hospital care, and special equipment when someone is sick or injured in exchange for sometimes a monthly premium. This benefit may also help defray the cost of a stay at a rehabilitation hospital or even part of home health care. Health insurance can also keep a consumer’s costs down when they are healthy. For example, it can cover routine check-ups. Most health insurance also covers a lot of preventive services at no cost, such as immunizations and cancer screening and counseling.
What is a Health Insurance Plan (also called a health plan or policy)?
A health insurance plan is a package of covered health care items and services that outlines how much it will pay for those items and services. One could express this differently by saying a health plan describes the types of health care items and services it covers-that is, pays for-the amount it pays for such items and services (or groups of items and services), and for how long. Plans are often designed to last for a year at a time (known as a “plan year” or “policy year”). A health plan may be a benefit that an employer, union, or other group the sponsor gives the employees or members a facility of paying for their health care.
What are Some Types of Health Care Coverage?
Health care coverage comes in two general categories, private and public. The majority of Americans have private health coverage, either through their employer-nongovernment employer or government employer at the federal, state, or local level-or by purchasing directly from an insurance company or through a Health Insurance Marketplace. Of people have public health care coverage through government programs like Medicare, Medicaid, or the Veteran’s Health Administration.
There is also a categorization of health care coverage in terms of scope of benefits offered or the length that the coverage covers. Health insurance for example usually comes with full services ranging from emergency to nonemergency services, and psychological healthcare. Others have very minimal plans that only provide plans with cover selected conditions or diseases (for example, vision-only plans or cancer plans) as stipulated in the Affordable Care Act’s list of “excepted benefits”.
In the previous section we already discussed how most health plans cover a year. There are, however, plans that cover less than 12 months, for example gap-filling plans. These are referred to as short-term limited Plans have shorter payout periods, and they sometimes offer fewer benefits than other forms of health plans and lack some of the consumer protections available under other forms of coverage.
1. Age-Related Criteria
This is another critical factor related to health insurance. At the time of buying the medical policy, the age of family members, who would be covered has to be taken into consideration. In a family floater policy, the premium cost would be on the basis of the age of the eldest member of the family.
Of course, there will be an age limit criterion among the other things where one has to search when opting for health insurance cover. Health plans there might be, which have a minimum entry age limit of 91 days and up to the maximum entry age limit of 60 years. Then, some might have a minimum age limit of 25 years up to the maximum of 50 years. However, there are others that do not have restrictions on their age for entry. So, you can choose accordingly.
2. A Decent Balance Between High Coverage and High Premium
It can be pretty lucrative to buy health insurance with the lowest premium. But there can be two sides of it. A policy with a lesser premium can be good, if it is offering you extensive coverage at a premium that you can pay. The other aspect is lesser premium at the cost of the insurance coverage.
Hence, the best choice would be to search for reasons behind a low premium which need not necessarily come at the expense of insurance coverage. And in addition, check if there is any additional clause of co-payment, deductibles, and sub-limits, then you’d actually be paying more at the time of a claim.
You should obtain a full coverage policy that does not compromise the benefits and at a premium you can afford.
3. The Waiting Period Clause
If you know about the waiting period clause, then you would be in a better position to take a decision. The insurer is going to disallow any claim pertaining to some pre-existing illnesses or some specific illness during the waiting period. And it can range anywhere between 24 months and 48 months depending upon the insurance provider and the plan that you have chosen. Also, the benefits can be enjoyed only after this waiting time is over. This waiting time shall apply on pre-existing diseases such as thyroid, blood pressure, diabetes, etc. that one may have before buying the insurance policy. Moreover, it is applicable on specific sorts of treatments and diseases like arthritis, various veins, cataract, etc.
Thus, you can compare and choose a plan with a minimum waiting period so that you can claim the benefits in case of health emergency.
4. Cashless Hospitalization Benefits
There is cashless hospitalization, which is an available feature in most health insurance policies. Most health insurance companies have a tie-up with network hospitals, whereby the health insurance company makes an arrangement for the policyholder to receive cashless treatment during a medical emergency. Cashless hospitalizations free you from cumbersome paper work at the time of admission and claim. You don’t even need to make the payment in advance because the insurer will settle the sum insured directly with the hospital.
So, you don’t need to make arrangements for funds which then you would seek reimbursement for. You must know what all network hospitals are present in your locality, hence, check with your insurer for the list of empaneled hospitals.
5. Pre and Post Hospitalization Coverage
Most health plans cover the medical expenses incurred during the hospitalization. Buy a plan which also covers expenses incurred before and after the hospitalization as well to save expenses incurred on ambulance charges, medical tests, medicines, doctor fees, etc.
6. Maternity Expenses Coverage
Ignoring the maternity benefits in a health insurance policy is a common mistake that a lot of people make. All these, together with the increasing high cost of delivery and maternity care, make it a better deal actually to purchase a health plan that covers expenses on maternity. Normally, for this benefit, there is a waiting time of 2 to 4 years before you can claim the benefits. For example, if you are to get married or if you intend to have a family let us assume after three years then a plan which has a waiting period of 2 years will be suitable for you. Select a plan that includes the cost of hospitalization of a new-born baby apart from the delivery cost. And also, do not forget to look at the encumbrances which is levied on it.
7. Co-Payment Clause
Many people get confused with this term and tend to bypass it at the time of buying. It is actually the percentage of the amount you would have to pay at the time of claim and the remaining would be paid by the insurer. Therefore, check if any co-payment clause exists, which may come into operation at the time of your claims, before you sign your Mediclaim policy. If possible, buy a plan which does not have any sub-limits. However, if you suffer from pre-existing diseases or have crossed a certain limit of age most insurers would have a co-payment clause.
8. Claim Process
Check the wordings of the policy and familiarize yourself with health insurance claim process followed by the insurance company. A hassle-free claim procedure is a real boon at the time of settling health claims. You could do some research on the net, read customer reviews, and choose a health insurance provider known for smooth claim settlement services.