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Health Insurance Features that you Should Know

Rajat (26-years-old) is working in an advertising agency in Indore. Rajat didn’t purchase any health insurance policy as he thought he was young, healthy, and fit. But Rajat got infected with this lethal COVID-19 virus, and he shifted to a hospital because he developed some breathing complications. After getting discharged from the hospital on his 14th day, the hospital handed him an Rs. 2 lakh bill for his treatment. Since Rajat didn’t have any health policy, he paid the entire treatment costs from his pocket. At that moment, he realized that he should purchase a health insurance policy to protect him from various ailments and safeguard his savings. But Rajat is a novice buyer, so he doesn’t have adequate knowledge about insurance jargon and features of health insurance.

Here, we are going to mention some features of health policy that will be helpful for people like Rajat.

In this ongoing COVID-19 pandemic, health insurance policies are inevitable to deal with such a situation. Now, people are more inclined to purchase various healthcare policies to safeguard their health and finances against this deadly pandemic. Though people are aware of some common features of different health policies like Star health insurance features, Max Bupa health insurance features, and Care health insurance features, a policy buyer should be aware of some lesser-known features of health policies.

Feature of Health Insurance Policy


  • Pre-existing diseases (PED)

Pre-existing ailments are those diseases that you are suffering from before selecting a health insurance plan. Most health insurers don’t cover these PEDs from day 1 of your policy. Instead, most health insurance plans come with a waiting period (36 or 48 months), after which the insurer reimburses for the treatment costs of PEDs. But, this is only applicable if the policy buyer discloses everything at the time of purchasing. But if the customers conceal medical information and existing ailments while purchasing health policies, insurers may decline their claims. In addition, the insurer may reject your claim for misleading information.

  • Sub-limits on room rent

Many health insurance policies come with a sub-limit option. Room Rent is a pivotal expense that you need to pay from your pocket in the case of hospitalization. For example, if you purchased a health insurance policy of Rs 5 lakh (sum insured), the room rent is capped at 1% per day, which is Rs 5,000. In the case of ICU, the maximum room rent is 2% of the sum insured. If you choose a costlier room during your hospitalization, then the healthcare expenses in the bill will get reduced. Sometimes, the patient needs to pay the expenses from his/her own pocket.

  • Tax benefit

If you pay your health insurance premiums through cheque, net banking, or any other digital mode, then you can avail of the tax benefits against your paid premiums. But if you pay the premiums through cash, you won’t get any tax benefit. But if you make payments for preventive health check-ups by cash, you are eligible for up to Rs 5,000 tax benefit.

  • Co-payment

While purchasing a health insurance plan, you should be aware of the co-payment clause. This clause demands cost-sharing by the policyholder. Cost-sharing is the certain percentage of the claim amount that you might initiate for a reimbursement. Suppose you purchased a health insurance plan that comes with a 20% co-payment clause. Once you are admitted, and your claim amount is Rs 1 lakh, you need to pay Rs. 20000 (Rs 1,00,000 * 20%) from your pocket. The insurance company would settle the rest amount (Rs. 80,000). So, choose a health insurance plan that doesn’t include any co-payment clause at any stage.

  • Medical tests

Many health insurers often recommend medical tests to buyers before granting health insurance plans. But this is applicable for those who are above age 45. In addition, in some cases, the insurance company also asks for a medical examination for those who are below 45 years if they opted for 1a higher sum insured. Thus, industry experts always advise that a buyer must disclose his/her medical condition and family history before purchasing a policy.

  • Network hospitals

Network hospitals are those that are partnered with your selected insurance company. If you are admitted to these hospitals, you can enjoy a cashless facility without compromising your treatment. Because of cashless facilities, neither you need to worry about your financial condition at the time of hospitalization nor do you need to face difficulties at the time of claim settlement. Because the insurer directly settles your claim with the hospital on your behalf. Try to purchase those insurance plans that are tied up with the maximum number of network hospitals in your locality.

  • Check the exclusions

After purchasing a health insurance plan, you might be happy that now you and your family members will be covered by the policy against any possible hospitalization. If you ignore the exclusion section of your policy plan, then you might experience the pain of rejection at the time of claim. So before investing a single penny on your health insurance policy, go through its exclusion. Always opt for a policy that has the least number of exclusions.

  • Free health check-ups

Most Indian insurers instruct policyholders to go for health check-ups once every 3-4 years. But very often, policyholders don’t have an adequate idea about this. If there is no claim made on the policy, then this is only applicable. One should go for a full-body check-up and use the amount. The amount is capped at 1% of the sum insured of the insured policyholder. Under section 80D of the Income Tax Act, the insurer is eligible for up to Rs 1 lakh tax benefits. Rs. 5000 for premiums paid for preventive health check-ups.

Health insurance comes with a host of features and benefits. However, these are some of the lesser-known features of health insurance. While buying a health insurance plan it is inevitable to know about these as well.

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