It’s Time to Assess Your Health Insurance Coverage – Here’s Why


In view of these times, it is better to be safe than sorry and opt for a policy that also covers home expenses.

If this persistent pandemic has taught us anything, it’s that health comes before anything else. However, health is an unpredictable entity, even in a normal world. Add to that a catastrophic pandemic and insufficient insurance coverage, and you have the recipe for potential disaster in your hands. It is no wonder that in recent times the awareness and demand for health insurance has increased dramatically. COVID-induced uncertainty along with ever-increasing medical inflation is forcing more people to rethink their priorities and opt for a plan that covers most of the blind spots.

The impact of COVID-19 may be easing for now, but that shouldn’t be a reason to let our guard down. When it comes to health insurance, the key is to think, plan and prepare in advance. Does your health insurance guarantee you the protection you need in these times or if you need to reassess?

If you are asking yourself this question, rest assured, you are not alone. Insurance is a thoughtful investment for an unpredictable future and therefore a lot goes into choosing the right policy. Here are some deciding factors that will help you assess your current one.

Insured sum sufficient to cover exorbitant bills

COVID-19 has rendered people powerless by putting their lives and livelihoods at risk. In such a scenario, an exorbitant hospital bill is the last thing one needs. Since COVID has taken its toll, it is not uncommon to encounter hospital bills as high as Rs 85 lakh to even Rs 1 crore, especially in metropolitan cities.

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To help alleviate the huge medical expenses, it is essential to choose a plan that offers an adequate sum insured. The insured capital is the maximum amount that the insurer pays to the policyholder in the event of hospitalization. To put this in perspective, a plan that offers at least coverage of Rs 10 lakh or more may be deemed adequate due to the rapid pace of rising medical costs. Having insurance won’t do you any good if the amount doesn’t cover your expenses and you end up depleting your personal savings. There are several plans from insurers like Max Bupa or Aditya Birla Capital which offer coverage of up to Rs 1 crore with a very reasonable premium that can range from Rs 800 to Rs 1000 per month.

Consider coverage of home treatment costs

Home treatment takes place when the patient requires hospitalization but is treated at home due to unavailability of the room or due to the patient’s comorbidity or critical condition. The devastating second wave of the pandemic still continues to be an unfortunate reminder of the importance of staying prepared. There was no shortage of cases – many very critical cases – who could not find a hospital bed or resources and had to be cared for at home. A disease brings about an ocean of vulnerability and uncertainty. In view of these times, it is better to be safe than sorry and opt for a policy that also covers home expenses. These expenses include the costs of the home care package, drugs, nurses and doctors’ fees, tests to measure vital signs, x-rays, CT scans, intensive home care.

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Check sub-limits and user fees

Several contracts are capped either on the insured capital or on the coverage of room rental costs during hospitalization. This basically means that there will be a limit on the amount paid by the insurance company, and a certain percentage will have to be paid by the policyholder during hospitalization. Under the cost-sharing clause, the policyholder is required to pay approximately 10-20% of the total hospital bill. For example, if the hospital bill is around Rs 10 lakh, you will have to pay between Rs 1 lakh and 2 lakh out of your pocket. Likewise, as a sub-limit, there could be a rent ceiling of 1 to 2% of the sum insured. So if you have Rs 5 lakh coverage and there is a 1% rent limit, the insurer will only pay Rs 5,000 for the room.

Policies that have a sub-limit and co-pay clause have a lower premium than those that do not. But the important thing to note here is that you shouldn’t lose more than what you earn in the long run in order to lower your premium. Sub-limits can lower your premium, but can cost you money while in hospital.

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OPD, consumables and additional costs

Hospitalization generally involves a multitude of other activities such as – medical consultations, check-ups, tests, medication and also the use of several items such as PPE kits, gloves, syringes, etc. All these consultations and check-ups which do not require the patient to spend the night in the hospital are the responsibility of the OPD or the outpatient service. On the other hand, the medical aid items used during this whole process are called consumables. Each case of hospitalization is accompanied by these additional expenses. So it’s important to make sure that you choose a plan that covers end-to-end medical costs, including overheads such as OPDs and consumables.

Health insurance is an investment in ensuring your health and well-being in the face of adversity. Reassess your current policy and make sure you make a thorough decision that covers all the bases.

(By Amit Chhabra, Medicare Manager,

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