Scientific breakthroughs have evolved medical care to deliver superior non-invasive treatments and innovative solutions for complex conditions. These improvements have also spiraled costs, including expenses for examinations, surgeries, and professional care.
Current individual health coverage options offer limited benefits. Most medical insurance
policies only cover 24-hour inpatient hospitalization to treat diseases, with restricted coverage for some advanced day care treatments. Comprehensive health insurance that covers OPD expenses, investigation costs, and corrective dental and optical treatments is rare.
The multiplicity of health insurance plans in the market makes choosing the right product confusing. Untrained agents, non-insurance distributors, and online comparison websites sell policies with little consumer education on exclusions and policy gaps.
People often decide the Sum Insured by gut feeling and sometimes by looking at the cost of the cover. A surgical procedure in a private ward can cost ten times that of a general ward admission. Seek proper advice to buy and use your health insurance plans effectively.
When selecting health insurance plans, consider:
● Your family's medical history
● The rising cost of healthcare (increasing at 15% annually)
● Your preferred hospitals and their typical charges
● Additional coverage needs like outpatient care
● Inflation impact on long-term healthcare costs
For a family of four living in a metro city, coverage below ₹10 lakhs may prove inadequate for serious medical conditions. Edify's experts can help you determine the ideal coverage amount based on your specific circumstances.
People often discover policy limitations when admitted. Reputed insurers may also have limited cashless coverage. Different medical insurance policies provide varying levels of no-claim bonus or cover restoration options. EDIFY professionals can help you find the best comprehensive health insurance suited to your needs.
When comparing comprehensive health insurance options, consider:
● Network hospitals in your vicinity
● Waiting periods for pre-existing conditions
● Sub-limits on room rent and specific procedures
● Coverage for daycare procedures
● Additional benefits like health checkups
● Restoration benefits and conditions
● Coverage for AYUSH treatments
Room rent sub-limits can dramatically affect your out-of-pocket expenses, as many hospitals tie all treatment costs to the room category. A policy with a room rent cap of ₹3,000 per day would leave you covering the difference if you choose a room costing ₹6,000, plus a proportionate deduction on all associated medical costs.
Health insurance plans have waiting periods before covering the cost of treatment for common ailments. Piles, tonsils, cataracts, appendix, kidney stones are all on waiting lists. Pre-existing diseases get coverage after many years. Take help to understand and get the best individual health coverage.
Standard exclusions in most individual health coverage plans include:
● Cosmetic treatments
● Fertility treatments
● Non-allopathic treatments (unless specifically covered)
● Self-inflicted injuries
● Certain congenital conditions
● Dental treatments (unless resulting from an accident)
● HIV/AIDS related treatments
● Specific psychiatric disorders
Understanding these nuances is crucial because discovering exclusions at the time of claim can leave you financially vulnerable. The fine print in policy documents contains important details about coverage limitations that agents may not proactively disclose.
Premium comparison websites sell based on price. We don't always buy the cheapest staples for home, so why should it be different for insurance? A cheap medical insurance policy may have limitations, co-payments, or sub-limited cost of treatments. One may accidentally choose a poor plan at low cost.
When evaluating health insurance plans, consider:
● Claim settlement ratio of the insurer
● Customer service reputation
● Ease of claims process
● Coverage comprehensiveness
● Long-term cost effectiveness
● Sub-limits and co-payments
● Network hospital accessibility
For example, a policy might advertise ₹5 lakh coverage but impose a 20% co-payment on all claims or cap cardiac procedure coverage at ₹1 lakh. These limitations only become apparent when you need treatment, often resulting in significant out-of-pocket expenses despite having insurance.
An online unassisted questionnaire tempts people to either hide their medical condition or not disclose them correctly. A diabetic not disclosing the condition can have their comprehensive health insurance denied when admitted for treatment if the insurer finds out. It's never wise to assume that the insurer will not know.
Key points to remember:
● Insurance contracts are based on utmost good faith
● Non-disclosure can lead to claim rejection
● Medical tests during claims can reveal undisclosed conditions
● Proper disclosure may increase premiums but ensures claim payment
● Many insurers now cover pre-existing conditions after a waiting period
● Digital medical records make it easier for insurers to verify information
Modern insurance underwriting has evolved to accommodate many pre-existing conditions after reasonable waiting periods, typically 2-4 years. While disclosure may result in slightly higher premiums or specific exclusions, these are far preferable to claim rejection.
Edify consultants are trained to effectively find the right health insurance plans for you and your family, taking care to explain all coverages and exclusions. This helps you invest in the best medical insurance policies, knowing that Edify claim assistance will ensure you get the best out of your individual health coverage.
Our services include:
● Personalized coverage recommendations
● Comparison of policies across insurers
● Clear explanation of terms and conditions
● Assistance during claims
● Regular policy reviews to ensure continued adequacy
● Support during hospitalization and discharge
● Guidance on preventive healthcare measures
During policy selection, we provide clear, jargon-free explanations of important terms and conditions, including waiting periods, sub-limits, co-payments, and exclusions. This transparency helps you make fully informed decisions rather than discovering limitations during claims.
For metro cities, at least ₹10 lakhs coverage is recommended.
Yes, but typically after a waiting period of 2-4 years.
We provide end-to-end assistance from claim filing to final settlement.
Specialized health plans with OPD coverage are available through Edify.
We partner with all major insurance companies to find the best match for your needs.
