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You should consider saving premium over opting for this "good to have "
cover.
The same premium can be used to buy a super top-up policy, you will have much better coverage for "must-have
benefits".
Physician consultations, Health Check-ups, pharmacy and laboratory fees, which are not linked to hospitalisation, are covered under the outpatient benefit.
They are normally excluded from health insurance unless they fall under Pre and Post Hospitalization.
There are some companies that provide outpatient benefits with a cap. Some companies offer an option to add an additional benefit based on the sum insured and an additional premium.
Do not confuse the Outpatient benefit with the pre post hospitalization benefit, even though both are setting the outpatient bills. The pre & post hospitalization bills relate to the inpatient hospitalization or day care procedure.
Outpatient benefit does not bring much value but it could help to some extent but buying this benefit with additional premium is up to one’s family health conditions and usage per year.
Opt for Out patient benefit only if you want to take full advantage of section 80D benefits under income tax.
We are allowed to claim deduction of Rs.25K from our taxable salary for Mediclaim Insurance premium.
But so many of you will be covering yourself (including spouse and kids) within Rs.10K to 15K only.
You can utilise the balance benefit by purchasing Outpatient Benefit Insurance add on cover.
For example, let’s say your Mediclaim premium is Rs.9000. (This is the normal premium you pay for 5 lacs cover for self+spouse+2 kids.
You can now buy an additional Outpatient expenses insurance policy for Rs.16K. This gives you additional two benefits
Hence the total benefit of paying Rs. Additional 16K premium is Rs.30500
As the name says, the No Claim bonus is the benefit which an insured received upon making no claims in the previous policy year. Now the question is how this benefit is provided to the insured in health insurance.
Until certain limits are reached, the total Sum Insured will increase every Claim-free year without any additional premium.
It helps us to tackle medical inflation.
Most insurers offer this benefit, but the rate at which it is increased varies from policy to policy.
Some insurers provide 10% and some provide 20% for every claim-free year.
When a claim is made, some insurers decrease the Sum Insured by a similar percentage (or all at once) to the earned cumulative Sum Insured till date.
Nowadays some insurers are providing optional cover for No Claim Bonus.
It has been named differently by different insurers like Super NCB, Multiplier benefit etc.
If you have planned for a Super Top Up policy as well, then you need not bother about what percentage of Sum Insured is being offered as NCB.
However, 10% of NCB is for sure provided for every claim free year. And interestingly NCB is also a part of some Super top up policy plans.
Hence instead of paying for an optional cumulative bonus rider it’s advisable to take a super top policy rather than trying to enhance this tentative coverage which would vanish upon a single claim.
In case of emergency hospitalization, the ambulance charges are covered up to a certain limit in every health insurance plan.
Some policies even cover the air ambulance.
This is not a parameter on which you decide the health insurance plan as it has least impact on any claim.
Some policies offer a complimentary health check up every year or in the span of 1,2 or 3 claim free years. The cost of a health check up is usually linked to the Sum Insured.
If the sum insured is exhausted during a claim, then the sum insured is restored to full amount which can be used for future claims within the same policy year.
Some Insurers define that the future claims within the policy year should not be related to the same ailment for which the first claim was made.
There are 2 drawbacks to this feature.
Hence it is good to go for a top up (Super Top up) policy instead of having such an option as a rider (optional benefit upon payment of premium) to avoid such limitations.
This benefit under the policy covers the medical expenses of the insured person incurred outside India.
It is important to understand that global coverage guidelines vary from company to company such as
Global coverage limit will be restricted to sum insured including the cumulative bonus. It will not be extended to recharge or restore benefits.
Worldwide coverage will be available on a reimbursement basis. Few companies also provide coverage on a cashless basis.
The insured also needs to check whether the coverage includes or excludes the United States and Canada.
Copayment is also applicable sometimes varies from 10 to 20%.
The waiting periods for pre existing disease, 2 years waiting period will be applicable as usual as per the policy terms.
A health policy with worldwide coverage or a travel policy which one is better?
Travel policy comes with additional benefits like emergency hospitalization, public liability, loss of baggage, passport etc. But pre-existing diseases will have a waiting period.
Whereas the worldwide coverage in Health policy, you can get the benefit of coverage of preexisting diseases or 2 years excluded conditions after completion of the waiting periods. You can also afford to travel to the best countries where advanced treatments are available in case of uncertain conditions. Insurance gives you the privilege of better treatment at a very nominal price.
We can suggest some health insurance products inbuilt with travel insurance coverage which will be helpful to frequent travelers. It will help the insured to get the benefit of completion of waiting periods.
In simple terms, if your policy has a co-payment of 20%, then 20% of the admissible claim is supposed to be paid by you and the rest 80% is paid by the insurance company.
Deductible acts in a little different way. It says the amount to which the insured is supposed to pay the claim from pocket. Only the amount above the deductible, the Insurer will pay.
For example,
The option of co-pay is useful if you are already covered by some other insurance like insurance provided by your company.
In case of any claim, the copayment or deductible amount can be claimed under your group policy and the rest of the amount can be claimed under your individual policy. In the new policy, you can choose the appropriate copayment or deductible to bring down the premium amount.