Health insurance help: What you must consider before buying health insurance

Health care is one of our basic needs. Each one of us is susceptible to health contingencies anytime, anywhere. Your past health record is really not the best indicator of what is to follow and you probably also have dependents to care for. With medical costs rising exponentially, health insurance benefits are plenty.

Demystifying health insurance plans can be a daunting task- given the complex terminology and fine print. However, it is worth understanding what you must really consider before getting a policy, so that when a health emergency does arise, you’re covered by the best. Take a look.

Decide whether you want a group/family insurance or individual insurance

If you want to insure your family, you could either go for individual sum insured or floater sum insured. The latter is more cost-effective, but may not provide enough health insurance coverage if the total sum insured is low. Also, since premiums for the elderly are higher, you might want to consider separate plans for them. A word on employer provided insurance plan. While it may come to you at a reduced cost, it may not actually be the best plan for you. You may get an option of purchasing into a group plan, but if your health is above average; you could actually be better off with an individual plan- since a group plan has its premiums based on the average health of the group.

Know your plan type

Understand health insurance basics- there are four plan types to choose from: platinum, gold, silver and bronze with different coverage options. For instance, while a platinum plan will pay 90 percent of the medical costs covered by the plan, a bronze plan will pay only 60 percent, while you pay the rest in deductibles, copays and co-insurance.

Compare between plans

Choosing a plan based only on the premium isn’t prudent. The lowest priced plan may not cover you enough to be useful, in the event of an actual contingency. So compare plans from different health insurance companies not only along the price vertical but also with respect to the type of expenses, diseases and treatments that are covered.

Don’t just look at the price of the plan

Always look for a comprehensive plan at a reasonable cost. But don’t overlook your health insurance deductibles, copay’s and co-insurance. Certain plans with lesser health insurance premium may actually result in higher out-of-pocket expenses for you, when you take into account your copay’s and deductibles etc. Be clear on how the claims process works, how your healthcare providers get paid and what fraction of the expenses you need to bear. Also, request to know your cashless options.

Check whether your doctor/hospital is covered

If you’re looking for specific doctors, do make sure they’re a part of the network. Also different plan types (HMO, PPO etc.) have different rules and guidelines on which doctors you use and how much the plan covers. HMOs are the most restrictive, limiting you to doctors in the network. PPOs let you go outside the network for a higher fee and POS plans allow you to go outside the network by paying an extra fee, only on a referral from a network doctor.

Check the list of drugs covered

Also check the list of drugs to make sure your medication is covered.

Check what ailments are covered

The future is unpredictable and you’d want your policy to cover you against critical illnesses or accidents that may arise in future. Do consider coverage for such unexpected health scenarios. Carefully examine what ailments your policy covers. If you want to reduce the premium, strike out treatments like cosmetic surgery etc., that’s probably be only a rare chance.

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