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Health insurance: 5 key terms to check before buying a policy
Health insurance buyers should not pick a policy only on low premium or high sum insured, as policy terms can reduce claim payouts. Room rent limit, co-payment, disease sub-limits and waiting periods…
Health insurance buyers should not pick a policy only on low premium or high sum insured, as policy terms can reduce claim payouts. Room rent limit, co-payment, disease sub-limits and waiting periods are critical factors that affect the final amount a customer receives at the time of a claim, according to financial advisor Aditya Shah on the Business Today show.
Shah advised choosing a policy with unlimited room rent, as a capped limit can slash the entire hospital bill, not just room charges. He also recommended avoiding co-payment clauses, since the customer's share can become very large during expensive treatments. Medical inflation is about 14% per year, so a policy that increases cover through a no-claim or cumulative bonus is essential, he said.
Buyers must check disease-wise sub-limits: some top-up plans show a Rs 1 crore cover but cap cancer treatment at just Rs 5 lakh. Consumers should also verify consumables cover (PPE kits, syringes can be 20-40% of the bill), the waiting period for pre-existing diseases, and the cashless hospital network in their area before purchasing.
Indian Opinion Analysis
IRDAI's 2024 regulations require insurers to offer at least one standard product with no sub-limits on room rent and no co-payment, but many older and popular plans still carry these restrictions. A policyholder who picks a plan with a Rs 5,000 room rent limit in a city where a private room costs Rs 15,000 may see every other charge proportionally reduced, not just the room. The cumulative bonus, which restores the full sum insured after a claim-free year, is not offered by all policies and varies widely in how it is calculated. The Insurance Ombudsman handles disputes on claim rejections or short payments, but terms like sub-limits are contractual and not always overturned. A buyer should ask the insurer or agent to list every disease sub-limit in writing before buying.
Source: bazaar.businesstoday.in
This brief was synthesised by AI from the source linked above.
