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Tips To Get Maximum Coverage In Your Health Insurance Plan

When it comes to seeking health care, you would want the best possible service for your loved ones and you. Here are some tips to get maximum coverage in your health insurance plan -

Choose the right plan

Try to estimate the potential medical expenses your family and you may have to incur depending on health and age. Choose a plan that covers the treatments you can reasonably predict.

As far as possible Use the health Insurance Network of Hospitals:

Insurance companies specify a network of hospitals that they have affiliated with – and where you might avail cashless treatment or the expenses incurred are reimbursable. It is advisable to get admitted in a network hospital.

If one gets admitted in a non-network hospital, irrespective of whether one has cashless mediclaim, one needs to bear the entire expenditure out of pocket. Post this, when the claim is filed, the insurer will scrutinize all the costs and only approve an amount which is deemed to be justifiable and reasonable enough to be approved under terms of the policy. It is highly likely that the entire amount may not be approved.       

So when you choose your Insurance plan– keep in mind the network of hospitals they adhere – and ensure it is acceptable to you, thereafter try and stay within that network.



If you have reached the limit of your deductible expense (self-paid as per insurance contract)

An insurance policy with a deductible is when the insured has themselves agrees to pay a specified sum in exchange for a lower premium amount.

 In case you have subscribed for such a health insurance policy and your expenses have already reached the deductible amounts – it is a good idea to get the remaining tests and treatments that you may need at that time itself and not put it off for a later date. This is because once you reach the deductible amount – there would be very little out of pocket expenses for you and the insurance would take care of the remaining expenses within that treatment.

Avail of Insurance Top-up and Super-top up policy:

If you have incurred an expense that is higher than your insurance limit and you feel the need for higher levels of insured amounts in the future – then a top-up plan is cheaper than getting a new basic insurance policy.  In a Top-Up Plan, you can increase your insurance coverage amount – for a certain premium increase. It gets activated if the basic amount is insufficient to meet the medical expenses. Top up plans are generally for each treatment. If you have insurance of 5 lakhs and have incurred an expense of 4 lakhs, where 3 lakhs is your deductible then the insurance company will pay the amount of 1 lakh. In case you are hospitalised again – you will once again have to bear the expenses to your deductible amount and thereafter the top u[p plan will kick in.

In the case of Super Top Up Plan – the limits are per insurance policy period wise. If you had insurance of 5 lakhs and took a super top-up of Rs 2 lakhs. In such a case even if you had recurring treatments of say 4 lakhs and thereafter 2 lakhs in the same insurance period – you would have to pay the deductible amount of 3 lakhs only and the balance (4+2-3) 3 lakhs would be borne by the insurance company.