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Why Do I Need A Health Insurance Policy and What it should cover?

Why Do I Need A Health Insurance Policy and What it should cover?

I am not going to tell you which is the best health insurance policy available in the market or which one you should take. For that, you are smart enough to do your own detail research on various insurance websites or can take professional help. I am going to tell you why you need it and what essential things your health insurance policy should cover.

Disclaimer – I am not affiliated with any health insurance company or agents. My answer will be solely based on my personal experience with my own patients and real incidents which I have witnessed in my career in healthcare. So let’s discuss it.

Why do you need a Health Insurance Policy?

You don’t want to get hurt or get sick ever, Right? But is it entirely under our own control? A big No. You can’t tell bacteria or viruses to not come near you. You can’t put No Entry sign for parasites. Neither it is possible to predict the future. No matter how religiously you follow those traffic rules, there will always be someone who is drunk and driving. Even if everyone becomes law-abiding citizens, you can’t control your own reflexes. Even though you are trying to eat healthily and doing physical activities daily, there are some genetic conditions which make you inherently prone to some diseases.

So in short, since we can’t predict the future and possible outcomes but we can prepare ourselves for many possible outcomes. For that having a health policy is one of the essential criteria. Health insurance usually covers essential health benefits which include covering the cost for treatment of various medical conditions or accidental damage to your body. These treatments are usually expensive so your health policy reduces your burden of medical expenses. You can save money for your other plans like vacations, family planning or retirement planning. Health Insurance policies also cover preventive expenses like vaccination and regular screenings and check-ups. It’s always good to catch diseases at an early stage.

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What should my health insurance policy cover?

Glad you asked. Many times people buy health insurance policy just for the sake of it. May be to reduce some tax burden. Agents will sell you those policies on which they are getting a maximum commission. And when the time comes for reimbursement, your health insurance policy company denies the claim. They will show you terms and conditions, which you never read, and deny your medical claim. So before buying any health insurance policy, always look whether your health insurance policy covers the following 10 criteria or not:

1. OPD services.

Not only hospital admission but your health insurance policy should always cover your outpatient (OPD) services. You maY need to visit your doctor for regular checkups without getting admitted. So make sure you choose those policies which cover your OPD expenses also.

2. Emergency services.

According to me, this is the most important aspect of choosing the right health care insurance policy. Since you can’t predict which health issue you can get or when and where you can get in trouble, it is always wise to choose that health insurance plan which has a wide coverage of network (more hospitals under it). A good health insurance policy should not only cover the hospitals near you but also hospitals from other locations (which you visit frequently). If it has wide coverage all over the country then you should prefer it over others.

3. No Extra Charge for out of network hospitals.

If a health insurance policy doesn’t charge you any extra money for coverage if you take emergency medical help from out of network hospitals then prefer it over others. Make sure you don’t have to call you insurance provider every time you need emergency medical care.

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4. Coverage of Surgery cost and hospitalization stay.

Choose that health insurance policy which covers more surgeries than other providers. Not only it should cover your surgery cost but also hospitalization stay after the surgery. You don’t want the burden of extra medical expenses especially for post-surgical care and hospital stay.

5. Coverage of Pregnancy and new born baby.

Always make sure that your health insurance policy covers all expenses related to your pregnancy and delivery. Not only that but your health policy must cover all expenses related to your baby. It should cover healthcare services both before and after your baby is born.

6. Rehabilitation Services.

Your health insurance policy should have health benefits for rehabilitation too. Rehabilitation is the time period when you are recovering from your illness and your health policy should cover expenses related to that too. Rehabilitation services may include devices and services to help people with injuries, disabilities, or chronic conditions.

7. Mental Health and Substance Use Disorders.

Many health insurance policies don’t cover mental health issues and substance use disorders (addictions). Always prefer those health insurance policies that do cover them especially when you know that you may need insurance for these issues too.

8. Screening and Prevention Services.

Yes, you need coverage of your treatment costs. But also make sure your health insurance policy covers screening and prevention costs like yours or your kid’s vaccination needs and regular screening tests for everyone who is covered under the policy. By the way, Covid-19 vaccination will be provided free of cost all over India.

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9. Coverage for pre-existing conditions.

Many of the health insurance companies will deny you the coverage if you are already suffering from some health issues. So always make sure you get that health policy which not only covers health issues which you can get in future but also the pre-existing ones.

10. Non-essential coverages.

Many insurance plans don’t cover non-essential services like dental coverage or birth control methods like Intrauterine devices, birth control implants or permanent sterilization surgeries. They may be included separately with additional costs. So if you are not much bothered about these coverages then you can look for other essential criteria which I have mentioned above. Otherwise, choose health policy which covers these non-essential services also.

So these were the 10 essential advice which you should take and always keep in mind while buying your health insurance policy.

Stay Safe, Stay Healthy !!

For National Health Insurance Schemes by Indian Government Read on official website.

If you have any question, you can ask here on our page Free Online Health Consultation.