3 Things to Know Before You Pick Medical Insurance

3 Things to Know Before You Pick Medical Insurance

You may feel healthy and fit, but that should not stop you from investing in robust health insurance. With increasing instances of lifestyle disorders, it has become vital to be watchful of your health at all times. It includes periodical health check-ups and ensuring an active lifestyle. Top it all with health insurance.

We are fortunate that technology is improving at an impressive pace and more and more healthcare facilities are introducing cutting-edge diagnostic technology and treatment modalities. The unfortunate aspect is the rising healthcare costs. Today, hospitalization for even minor illnesses can drain a significant part of your savings. Even worse is, not being able to access top-notch facilities due to insufficient funds. This is where medical insurance helps you.

Benefits of Health Insurance

Health insurance promises financial protection against medical expenses in the face of a contingency including a sudden illness and accident-related health conditions. It covers the cost of hospitalization, treatment, medicine, and more.

Medical insurance offers a cashless facility to policyholders. It allows you to seek treatment in a network hospital without paying anything out of your pocket. The medical bills are directly settled with the hospital by the insurer. In case you prefer treatment at a hospital that is not listed as a network hospital, you just need to pay the bills upfront and then raise a claim with the insurer for reimbursement. 

These days, people are more inclined towards cashless coverage as it allows bypassing the bill payment before claiming through policy. However, reimbursement has been made faster with the use of online transactions.

Three Things to Consider When Buying Medical Insurance

You may opt for an individual plan or family health insurance, but remember to consider a few important factors before making the payment. These factors will determine if your medical insurance is truly worth it or not.

1.Sum insured

When settling a claim request, the sum insured is the maximum amount promised by the insurer. Any amount over and above the sum insured will have to be borne by you. The most common range of coverage value offered by insurance companies in India is from Rs 3 lakh to Rs 2 crore.

While insuring your family, a policy with a high insured amount is better than one with lower coverage. Family health insurance covers all the members of the family. Therefore, having a lower sum insured can prove inadequate if multiple family members need medical attention at the same time.

For individual medical insurance, the deciding factor is the health and fitness status of the person. But when you need to secure the whole family, you should consider the health status of all the family members, particularly elderly members who need frequent medical attention and hospitalization.

2 . Coverage

Coverage is critical in determining how useful medical insurance will be. Inclusions of the policy are when you can raise a claim and for what. Here are some common inclusions of medical insurance:

  • Pre and post-hospitalisation expenses

Hospitalization is the point of initiation for making a claim through health insurance. Some policies cover medical expenses before and after hospitalization. The coverage includes the costs of diagnoses, consultations, physiotherapy etc. However, every policy comes with a set time frame. The policy pays for expenses incurred during that time frame. Broader the period, the better the policy is.

Coverage up to 60 days of admission and 180 days post-discharge is among the best available in the Indian insurance market. A broader period benefits those with chronic conditions and who need frequent hospitalization.

  • Daycare treatments

If you have a family member suffering from a long-term condition such as renal failure, you must look for policies covering daycare charges. It covers procedures and treatments such as dialysis and chemotherapy that do not require 24-hour hospitalization.

  • Home healthcare

Some diseases, geriatric conditions, and accidents may render the patient bedridden, making home healthcare necessary. Another reason for home care is the non-availability of hospital beds in epidemic circumstances. In such cases, some policies cover medical expenses such as home consultation, physiotherapy, minor procedures etc. It excludes nonmedical costs such as those of sanitary and daycare products.

  • Organ donor’s expense

There may be instances wherein a donor is available, but the recipient cannot afford the expenses of organ harvesting from a donor and their hospitalization. Some medical insurance covers donors’ hospitalization costs and treatment expenses.

  • Mental healthcare expenses

Medical insurance covers hospitalization expenses incurred for treating psychological disorders.

  • Ambulance cost

The policy covers the ambulance cost incurred to shift the patient to a hospital for treatment.

  1. Policy features

When buying medical insurance, look out for some important policy features to ensure adequate support in time of your need. These features are:

  • Sum insured rebound

It is the restoration of the insured amount after the exhaustion of the base sum insured. This is based on certain terms and conditions.

  • Free pre-renewal health checkup

Every policy requires periodic renewal. Many insurers allow free health checkups between the expiry and renewal of an existing policy.

  • Lifelong renewability

Some policies require the policyholder to buy a new policy after a certain age rather than renewing their existing policy. Lifelong renewability allows you to renew the same plan till you die.

  • Top-up options

Top-up allows you to expand the coverage beyond the basic sum insured. A top-up policy increases the sum insured at a much lower price than the cost of buying a separate policy for the same sum insured.

  • Exclusions

Every plan excludes a set of ailments or conditions from coverage. The most common exclusions include:

  • Adventure sport injuries
  • Self-inflicted injuries
  • Hospitalization due to war, riots
  • Accidental injuries occurred during defense operations
  • Sexually transmitted diseases such as HIV-AIDS
  • Cosmetic surgeries to enhance beauty and treat obesity


Unquestionably, medical insurance is an essential cushion for the financial aspects of medical expenses and it is crucial to analyze your requirements before buying a policy. When several policy providers are available, it is better to compare the features of different plans and pick the one that fits your circumstances the most.

 Disclaimer – The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.


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