Health insurance is insurance that helps us pay for hospital expenses if we have an illness or accident.
When I ask for health insurance, no one usually agrees. People often ask me why I have health insurance when I am in good health. Or I have health insurance from work, so why should I get it from outside?
What is Health Insurance?
The first thing to understand is that health insurance is not a way to make money. Health insurance is a precaution to prevent the savings we have made from being destroyed. Take a look, do you know of a family that used to live well but is now struggling financially? In such stories, four out of five families are in financial crisis after a hospital stay. There are few people in our lives who have not had to stay in the hospital for three or four weeks at least once. If it is a minor illness, it will not be a big problem, but if it is necessary to stay in the ICU or have an expensive surgery, it will cost a lot of money. No ordinary family can afford the long hospital stay of a member without insurance.
It may seem like the health insurance you have while you are at work is not enough. Economists say it is not enough. Imagine that when you change jobs, you will need to pay for a hospital stay, and then you will have to pay for it yourself. You will not be able to join a new job. Otherwise, you need to be sure that your job will never change and that the company will not let you go. Don’t the old saying go together when times get tough? In my experience, that is more or less true. Health insurance is said to be necessary so that everything we have worked and earned throughout our lives is not destroyed by a month or two of hospital stay.
But then there are those who ask if it is not enough to take it only when you get sick and are bedridden. Insurance companies are not stupid. Health insurance policies cover pre-existing illnesses only after a certain period of time (usually one or two years) after taking out the policy. Therefore, it is better to take it out now without thinking about the need. Similarly, if you take it out before major illnesses occur, the policy premium will be lower.
When taking out the policy, you should ask about how you will claim money if you have to go to the hospital. If you do not obtain the necessary documents to claim insurance, such as a discharge summary, upon discharge from the hospital, it will be difficult in the future.
Similarly, you should also ask and understand which illnesses are covered and which are not.
Another thing to consider is the credibility of the insurance company. If someone you know has a history of claiming hospital expenses after taking out insurance, it would be better to take out insurance from that company.
How to buy health insurance?
The first thing to consider when buying health insurance is the credibility of the company. If the company does not pay us when we get sick after we buy insurance, then buying health insurance will be in vain. Opinions and complaints about health insurance companies are available on the internet. You should research these and buy insurance only from the company with the least complaints.
Health insurance is sold in two types, individual policy and family floater policy. An individual policy is a policy that provides separate coverage for each person. A family floater policy provides coverage for all members of the family. For example, if a family of a father, mother, and two children wants to buy a health insurance policy worth Rs 5 lakh, if they buy an individual policy, they will have to buy four policies with a coverage of Rs 5 lakh each. If they buy a family floater, they only need to buy one policy and the policy will cover up to Rs 5 lakh if anyone in the family gets sick. An individual policy is better if all four people get sick together, but since the chances of that happening are low, a family floater policy is sufficient. If you take a family floater plan of Rs 5 lakh, the insurance company will help up to Rs 5 lakh no matter who gets sick in the family.
But nowadays, if we say a big hospital expense, it is 20, 30 lakhs. A family floater health insurance policy of 20 lakhs cannot be afforded by an average family. This is where the top-up plans available in the market come into play. Top-up plans are plans that provide insurance if the amount spent exceeds a certain limit. For example, imagine that you have taken a top plan that provides coverage from 5 lakhs to 30 lakhs. If you have a hospital expense, you have to pay the first 5 lakhs yourself somehow. After that, top-up plans will pay for the amount up to 30 lakhs. Since top-up insurance provides insurance only after the upper limit is reached, the monthly premiums for these plans are very low.
So, to ensure high security for our family, it is better to take a family floater plan of Rs 3 lakh or Rs 5 lakh and then buy top-up plans of up to Rs 30 lakh or Rs 50 lakh above that limit. By doing this, we can reduce our insurance premium.
Similarly, there is a policy called critical illness coverage in the market. These policies provide us with additional security in case of certain fatal illnesses. These can generally be purchased without much cost along with family floater plans. Some policies will pay a large lump sum or a fixed amount as a monthly income if the illnesses mentioned in them occur. When buying such policies, you should pay close attention to which illnesses it covers and whether it includes any hereditary diseases in your family.
So, when buying a health insurance policy, make sure to buy a family floater plan, a top-up plan on top of that, and if you can, a critical illness coverage. Remember, a health insurance policy will take care of your hospital expenses without affecting you. But don’t forget to create an emergency fund to meet your family expenses during the time you are unable to go to work.
It is intentional not to give an example or an estimate of the premium of a health insurance policy. This is because the health insurance policy will vary depending on the health condition of each individual and family situation. When buying a policy, you should compare the policies of two or three of the best companies and buy it.
Things to consider before buying health insurance
Below are some things to consider when buying health insurance.
Illnesses before purchasing the policy
All health insurance policies have a waiting period before they cover pre-existing conditions. If you have an illness when you take out the policy, you will only start receiving treatment for that illness after the waiting period has passed. Be sure to check the waiting period when you buy the policy.
Cashless Facility
Cashless facility means a method where you do not have to pay money. There will be several hospitals in the network of the insurance policy. If you go to these hospitals, you do not have to pay money from your pocket, and if you provide the policy details, the hospital will collect the money directly from the insurance company. You should check whether the hospital you regularly go to and the specialty hospitals near your home are in this network. After buying coverage for a high amount, if you have to go to North India to get good treatment with cashless facilities, then buying insurance will not be in vain.
Hospital room rental
Most policies have a limit on the amount of room rent you can pay per day. For example, some policies only cover a maximum of Rs. 1,000 per day. Others cover up to Rs. 5,000. You should buy the highest coverage that fits your budget.
Medical examination for insurance
Sometimes companies will ask you to undergo a medical examination before starting the insurance. This will be at the expense of the insurance company. This is so that the company can know if you currently have any terminal illnesses. If you have terminal illnesses, the company may not be willing to cover you. There is no point in trying to cheat the company here. They are experts in detecting such scams. Therefore, it is better to start taking a health insurance policy at a young age. Otherwise, sometimes when the time comes to take out a policy, we may not be able to buy health insurance.
Exclusions or expenses not covered
All policies have exclusions. This means that the policy will not cover certain types of hospital expenses. For example, cosmetic surgeries. Similarly, some specific illnesses may not be covered by the policy. You should read and understand what these are before taking out a policy. It is always better to buy a policy without many conditions.
Annual Bonus
Some companies will give you a bonus on your insurance coverage for years when you don’t make any claims. All other things being equal, get an insurance policy with a bonus offer.
How to claim money after a hospital stay
If you have a hospital stay, you should ask and understand what paperwork is required to get your money back before taking out the policy. When I tried, getting money from the insurance company was as difficult as pulling teeth. I got the money after walking behind for ten months. When someone is in the hospital, there is no point in thinking about what paperwork is required to get money from the insurance company. You should know that in advance. When you are in the hospital, no one is in the mental state to call the insurance company’s call center and ask for things.
Reliability of the company from which the policy is purchased
This is a very important matter. I have heard that some private companies offer a lot of benefits when it comes to paying money. You should only buy health insurance from reputable companies. Before buying health insurance from a company, you should check the complaints against them on the internet. Similarly, it is better to buy policies from companies that have been operating for a long time. It is difficult to know how they are going to work if you buy from new companies.
