Things Your Health Insurance Policy Needs To Cover

Health Insurance Policy
Health Insurance Policy

If you are looking for a new health insurance policy or not sure of the details of your current insurance plans, there are few important things that you need to know about your insurance plan. Knowing this information in advance might help you to smartly choose the best insurance plans for you and your family.
There have always been long lasting questions from the customers regarding the health insurance plan. The only benefit that most individuals are aware of is tax benefit. People still are unaware of what makes the health insurance policy a winner.
Following are few things that your health insurance policy needs to cover:
Essential Health Benefits
There are many insurance companies that offer a set of preventive services at no extra cost under your cover. This might include pre-medical test and health screening. So, one must compare various quotes available online and find the best health insurance plans that come with the essential health benefits. Below mentioned are few essential health benefits that need to be covered by your insurer:

  • Hospitalization (it includes surgery)
  • Various emergency services
  • Maternity and new born care (includes care pre-birth and post-birth)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to aid people with injury, disability, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services
  • Mental health and substance use disorder services
  • Behavioral health treatment which includes counseling and psychotherapy

Check whether your Policy Covers Preventive Services
Preventive services can help in detecting diseases or help prevent illness or other health related issues. This preventive service purely depends on the age, gender, family history or medical history. However, this coverage for preventive services varies by state, so it is recommended to review the services before choosing a plan.
Medical Necessity
There can be several cases in which the doctor might set the requirement of medical care that is not covered by your health insurance plan.
There are insurance companies that determine what tests, drugs, and services they will cover. The choices depend on the understanding of the kinds of medical care that the particular patient needs. So, it is always suggested to check for this detail before opting for the health insurance plan.
Look for the Network Hospitals
Insurers have tie-ups with some hospitals, so based on the instructions the claims are settled by these hospitals from a particular insurer. So, it is always better to check which hospitals are within the network of the insurance company that you are planning to opt for. Also, one must check for its specialty and reputation.
In addition to this, cashless hospitalization options at these network hospitals are the key features that your health insurance policy offers. It assures you and your family by getting you cashless treatment along with peace of mind.
Understand the Exclusions of your policy
One of the most important factors that need to be considered is exclusions. Ensure that you read all the policy documents well and check for all the exclusions before opting for any policy. Additionally, check for which diseases you won’t be paid for a specific time period.
Check for the Waiting Period
One must check whether the policy they are planning to take up covers pre-existing diseases or not and from when. It is worthwhile that you should disclose your pre-existing disease while buying the policy to take the advantage of this cover.
Flexibility in the policy
Requirements and choices differ from person to person depending on the age, gender and the situation, hence it is recommended to check beforehand for the flexibility in the policy. Even in a family, there can be different needs of each family member as well. While you would be requiring cover for expenses for maternity, your parents would be in a need of getting a cover for pre-existing disease as quickly as possible. With the best options available, one must be able to find out what he wants and choose his or her plan simultaneously which best suits them.
No-Claim Discount that your Policy Offers
The No-Claim bonus is a common thing in health insurance and it varies from insurer to insurer. All the insurers offer these services in one form or the other. However, there is a limit on the maximum amount that can be obtained as no claim bonus. No Claim discount encourages the non-claimant by giving a defined reduction in renewal premium. Hence, it is important to check the no claim discount before selecting the health insurance plan.
Cumulative Bonus
In simple words, cumulative bonus helps in increasing the coverage amount in a defined way. So always check for the most suitable options that suit your requirement and financial capability.
At last, make sure to read all terms and conditions carefully before finalizing a health insurance policy. If you do not do that, you might end up facing some unpleasant surprises when you seek a claim. So take some time and choose the best. Health insurance plans keep on changing, so be diligent to make sure you get the plan that makes the most sense for you and suits your budget.
About the Author
Rakesh Goyal is the Director of Probus Insurance Broking Pvt. Ltd. Mr. Goyal has extensive and diverse experience in the insurance industry spanning over 22 years. His previous work experiences include several prestigious Brands; Bausch and Lomb (India), World Index Investment, International Foreign Currency Market & Gogia Capital Ltd which has helped him in developing an utmost understanding of the market.
Source :-The 10 Most Valuable Insurance Solution Providers in 2018

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