financial commitments and planned savings will be in jeopardy. Often it has been found that a family has been ruined in the process of saving the life of one of its members. To avoid such incidents, one should definitely think of a medical cover. Not just for one individuals sake, but also for the family.

A health insurance policy is armour to protect your savings without sacrificing the quality medical attention against sudden medical expenses that can arise due to illnesses or injuries. Such insurance helps to get reimbursement of expenses incurred due to hospitalisation etc. up to the extent covered by the policy. To get the reimbursement by an insurer, a pre-settled premium is to be paid regularly. Age of the insured is the basic criterion for determining the premium amount. It is best if employer does your medical insurance, you can add value through another supplementary policy, for professionals, they have to subscribe to a medical insurance policy themselves.

The most two important aspects of buying a health insurance is to take a decision on the amount to insure and to be very particular about present medical status when you are filling in the form. If the health cover is taken for the family members also, a discount on premium ranging from 5-10 per cent is given depending on the number of the persons co-opted.

There is no need to sign up for a very high insurance amount when you are young. It is a good suggestion to have a reasonably low health-cover when you are in your early 30s and keep increasing to the cover after a regular period, say every two years. To maximize your medical cover, it is a good idea to take a policy for a sum insured of Rs 3.3 lakh. It can be assumed that at this age, a span of 10 no claim years is likely to occur and hence the cover will automatically be enhanced to about Rs 5 lakhbut the premium same as that of Rs 3.3 lakh sum insured. Currently, the settlement ceiling, in case of health insurance plans is Rs 5 lakh.

In health insurance, there should be logic for the insured amount; it should neither be over- or under-insurance. Agents will naturally try to push higher value policies because of their commission involved and they generally convince by pointing out that the difference in premium is very meagre. There is really a good degree of truth in it, but in early 30s, and in good medical condition a very high cover is not needed and other investment can be done with the residual amount.

Its essential to know the state of your health and your familys medical history. According to industry specialists, most claims in the 30-40-age bracket are below Rs 1 lakh. Therefore, if you are physically fit , a cover of Rs 1.5 lakh is presumed to be quite enough.

You should be honest and transparent at the time of joining the health plan because any indication or suspicion of fraud may result in your application being rejected moreover your claim being rejected at a later date. As for example, if you are continuing a drug that changes biological attributes for a time being, state it before taking the medical test because it may determine the amount of premium. Or wait for the effect of the medicines to wear off before taking the test. Or else your application will be unnecessarily rejected on these grounds.

Often, some small clauses in the form are overlooked and that lead to problems later. Each and every policy has certain degree and levels of coverage as well as exclusions. Its important to understand the policy most relevant to ones needs. The list of exclusions, or diseases and ailments not covered by the policy, is long. They are intended to ensure that you dont profit at the insurers expense. Existing ailments, regular medical expenses like pregnancy or vaccination, cosmetic treatments and ailments from discretionary behaviour like injury from adventure sports or AIDS are generally excluded in most of the policies. However in some policies, expenses at the time of pregnancy are partially covered. These exclusions should be minutely noted while buying the policy, so that a misunderstanding does not occur later.

Mediclaim is the most popular choice at the moment. There are some lesser-known and low-profile plans. Mediclaim cover can initially be purchased for a year and can be renewed in every year. The deposited premium is deducted form income for the purpose of calculating Income Tax. Hospital bills up to Rs 5 lakh can be reimbursed through the policy, if all the premiums are properly paid. It is very important to check the exclusions in the prospectus before you buy the plan.

Your insurance cover will increase by 5 per cent for every claim-free year, subject to a maximum accumulation of 10 claim-free years. In case of family insurance, you will get a family discount of 10 per cent in premium. Four GIC subsidiaries, namely New India Assurance, United India, National Insurance and Oriental Insurance are most frequently referred names while buying a health insurance.

Either you can be admitted in a pre listed hospital/nursing home which has an arrangement of cashless treatment through a Third Party Administrator or you have to make a claim to the insurance company after getting discharged form the hospital/nursing home. In the first case 48 hours notice is necessary if it is a planned admission. The insurance company will reimburse the amount, after running a fine-toothed comb over it to see that it conforms to its rulebook. For speedy reimbursement, claim should be presented as early as possible accompanying all medical details, admission advice, treatment history, hospital/nursing home bills, bills of drugs, discharge certificate etc. properly in a chronological manner and avoid mentioning, excluded items.

While taking admission in a local nursing home one has to remember that it should have at least minimum 10 in-patient beds, in those towns having a population of less than 10,00,000 and in all places 15 in-patient beds and should have a fully equipped operation theatre. Fully qualified nursing staff should handle the OT along with a qualified licensed medical practitioner and qualified medical practitioners should be available round the clock.

In rare cases, expenses incurred for treating an insured patient at home is allowed for reimbursement.

Tips to Remember

1) A health insurance cover should be taken at an early age; before falling sick

2) Evaluate some private insurance products specifically designed for older people

3) Take a TPA cover

4) Take a group or family cover

5) Ask you employer's insurance provider for individual cover

6) Diseases excluded under the policy should be kept in mind.

7) The cover can be increased with age depending upon ailment growing

8) List medical details scrupulously to avoid later disputes

9) Question the insurer and find out the reasons why you are denied cover

10) For any tangible discrepancy the matter should be discussed with agent, insurer and IRDA