God forbid, one day you start having excruciating pain in your left hand, you feel pressure in your chest and suddenly you cannot handle the pain. Your family members call the doctor and he advises you to get hospitalized immediately for an emergency heart bypass surgery.

Everything happened so quick that you were not even in the condition to look at the expenses.

In recovery, on the hospital bed you are now thinking about the dent this surgery will have in your savings which you had kept aside for your 17-year-old daughter’s education.

What could’ve been done differently?

A health insurance could’ve protected you in such a situation. It secures you and your family against the heavy cost of unforeseen events like hospitalization on account of accident, critical disease or illness.

In the times of Covid-19, it is essential that you buy a Covid-19 Specific Cover for you and your family.

We at Policy Square, are driven to provide you the right sum insured according to:

• Your Family History
• Your risk of illness
• Cost of treatment

1. No Room Rent Capping

Room rent capping is the maximum limit of hospital room rent that an insurance company will cover per day.

Imagine falling sick and you can’t even choose a comfortable room in the hospital because your insurance policy has a clause of room rent capping.

Your insurance includes 1% room rent capping (if sum insured is ? 5 lacs, then the maximum room rent the insurer will cover is 5000 per day)

You take room that charges ? 8000 per day because you want your treatment to be done comfortably and you are willing to pay the balance amount.

When you are discharged, you come to know that the insurer will pay only ? 5000 of and only 62.5% of the services rendered in the room (like surgeon fees, consultant fees, diagnostic fees) because you had chosen a costlier room.

Your fees come to ?50,000. So, in turn, you pay ? 6000(2 days of the room) and 18750 which comes to a total of ? 24750 from your own pocket.

Hence, it is always better to avoid any room rent caps in your policy.

2. No Sub limits on diseases

When your policy has disease wise sub-limits, it means that your insurer will only cover a specific amount during a claim. This means that the insurer has put cap on the coverage amount for diseases like knee replacements, cardiovascular diseases, etc.

Suppose, you suffer from a pulmonary embolism and there is a need for emergency operation. Your surgery is successful and you are relieved because you have a health cover of ? 10 lacs to support the cost of treatment which sums up to 8lacs.

You are flabbergasted when you come to know that your insurance has a disease wise sub-limit on cardiovascular disease and the capping ? 3 lacs. This means that the insurer will only cover ? 2 lacs and the additional 6 lacs will be given from your pockets.

Hence, one needs to be absolutely sure that there are no sub limits on diseases in your health insurance policy.

3. No Co-payment Clause

Co-payment is a percentage that is paid by the policyholder out of his pocket in a health insurance policy. It can cut down your premium but the question arises, is it even worth it?

Imagine a scenario, you took a health insurance policy worth ? 10 lacs with the 20% co-payment clause of which decreased your premium.

But what happens at the time of claim?

You bill is amounted to ? 5 lacs and you are relieved you have a sufficient health insurance policy. Your insurer only pays ? 4 lacs and they ask you to pay ? 1 lac from your own pocket. Hence, it is always advisable to buy a health insurance policy with a no co-payment clause unless it is absolutely compulsory.

4. Low Waiting periods

Every insurer will make sure you answer questions like:

• Do you have diabetes?
• Do you have any cardiovascular diseases?
• Do you have any other pre-existing diseases? And so, on

Your medical tests might also be done to know your entire medical history. According to your medical history, your waiting period for a claim will be decided (ranging from 2 to 4 years).

You cannot make a claim before the entire waiting period is completed. Waiting periods are very common and no one can be excused from it. What one can do is pick a policy with the least amount of waiting period.

5. Day care Treatment

Day care treatment is a term used for hospitalization for less than 24 hours.

Imagine, on a Sunday, you are relaxing with your family and suddenly you feel uneasy and a pain starts shooting in your back and it is unbearable now. You stand up to get some water and you just black out, next time you open your eyes, you find yourself in a hospital bed. Luckily, it wasn’t anything major but a small procedure had to be performed. When you see the bill, you are flabbergasted as it adds up to Rs 45,000.

You remember that you have a health insurance cover of ? 5 lacs and you feel relieved. You inform the insurance company and you are taken aback when they say that they will not cover the procedure.

You go through the policy document and see that the insurer would not cover day care treatments. So, the ? 45,000 is going from your pocket.

Hence, always pick the policies with day care treatments included.

6. Cashless Claims

You suffer from a heart attack and you get hospitalized for a bypass surgery. You do not have to worry about the expenses because you have a health insurance of ? 10 lacs and the total cost of treatment is ? 6 lacs.

Your surgery is successful and you are on the path of recovery. Everything is looking good but you miss out on one detail. On discharge, you’re informed by your insurance company that right now you have to pay the entire amount and you will be reimbursed later.

And then you realize that your health insurance policy does not include cashless claims facility. Arranging that kind of money is a dent in your savings for some time.

Hence, our advice is to always opt for cashless claims feature in your health insurance policy so that you do not have to pay anything from your pockets even for a short amount of time.

7. Pre and Post Hospitalization

For instance, you have suffered from a heart attack and you’ve just had a surgery. You have a long road to recovery even after discharge which includes medical tests, MRIs, CT scans, etc.

After a few months, the costs of tests and treatments after hospitalization went up to ?50,000 and then you realize that your insurer will not pay for post hospitalization and you have to pay ?50,000 from your pockets!!

It is always better to pick a policy that covers pre and post hospitalization. Usually, the period is from 30 to 60 days.

8. Auto Restoration

After getting discharged from the hospital and using up the entire sum insured of Rs 5 lacs, you have a sudden fear of what will happen if you or your wife needs a hospitalization as you both have a joint policy?

If she is hospitalized anytime soon, insurance will not cover the expenses and bearing the costs of medical treatments from your own pockets in this day and age seems like impossible.

But Auto restoration benefit can come to your rescue. With this benefit in your policy, the entire amount of the original sum insured is restored by the insurance company.

While many insurers offer unlimited restoration for all illnesses, few might have some restrictions. It is always advisable to check all the particulars on how the sum insured is restored.

9. Domiciliary Treatment

The Covid-19 pandemic has hit the world and the situation has worsened over the past 1.5 years. One day, you also start having a runny nose and dry mouth with temperature of over 100°.Unfortunately, you also test positive for this deadly virus. You’ve been advised by the doctor to get a treatment from home because there are no beds available in the hospital.

You know that domiciliary treatment costs are huge. At that point, your insurer comes to your rescue and informs that the treatment costs will be covered as the reason for the domiciliary treatment is unavailability of beds.

Domiciliary treatment is a must have feature because the situation today demands it to be.

10. No Claim Bonus

You have made a religious practice of staying fit and healthy because you do not want to land up in the hospital. Now what if your insurer incentivizes this practice of yours?

What if your insurer ups your sum insured by 50% every year you don’t make a claim?

You could start with a cover of Rs 10 lacs, next year you could end up with Rs 15 lacs which is a pretty good deal.

No claim bonus is must have feature if the percentage of bonus is considerable and companies can offer up to 50% NCB.

1. Free Health Check ups

You have always been conscious about your health and hence you have a customary ritual of doing your body check up (blood tests for cholesterol and diabetes, weight check, height check) once a year. It is advisable by the doctor and you are more than willing to do it is a precautionary measure.

Well, your insurer also thinks the same because you receive a message about a free health check up for you and your family in the designated hospital.

These checkups do not cost more than Rs 1000 per person but it does not hurt it for free in a reputed hospital.

2. AYUSH Treatments

AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) Treatments are treatments for alternative medicines.

You have cold and cough for months now. You have tried allopathy, even changed doctors but nothing has worked. One of your friend suggested an Ayurvedic treatment in the nearby government certified facility (AYUSH Centre). You go and have a check up where the doctor suggests treatment that costs Rs 25,000 which is quite expensive.

That’s where your health insurance policy comes to your rescue and now you can go through the procedure without any worries.

As per the guidelines set by IRDAI, insurance companies are liable to cover the expenses of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) that are taken by the insured but it is necessary that the treatment happens at a government-authorized hospital.

3. Ambulance Cover

Air and road ambulance covers and usually included in the health insurance plan and if it is not, then taking a rider for ambulance cover is important.

Suppose there is an emergency and you have to be air transported at a specific hospital your doctor has specifically advised. What will you do? You cannot go against your doctor because he is talking about your health. You have read your health insurance policy wordings and it does not cover ambulance expenses.

Air ambulance expenses can be substantial and bearing it’s cost can be strenuous.

Would you save Rs 50,000 or a few thousands?

4. Donor Expenses

6 months back, you had a kidney failure where both your kidneys started shutting down and since then you have been looking for a donor. You go to your hospital for your regular dialysis and that’s when you hear the good news that the hospital has found the donor.

You have a huge relief! Your weekly dialysis days are gone now.

But what about the hospital expenses of the donor? Your weekly dialysis has already used up a major part of your savings.

You talk to your insurer and that’s when you hear the golden words, “We will cover it."

You thank your younger self for opting for this add-on while buying your health insurance policy.

1. Outpatient department (OPD)

You visit your doctor at least once in two months which in total sums to 6 visits every year. Your doctor is excellent but his consultation fees are sky-rocketing.

Therefore, you opt for an out-patient department (OPD) add-on so that you get reimbursed every time you visit your doctor.

Nothing comes for free and it might be possible that you end up paying premiums that are higher than the reimbursements you receive. Hence, opt for an OPD cover if you genuinely need it.

2. Maternity Cover

Thinking of parenthood? It is wise to take a maternity add-on right now because usually a maternity cover has a waiting period of 2-4 years.

A maternity cover can take care of all the hospitalization expenses during the pregnancy and also post-natal.