How to Maximize Your Personal Health Insurance Benefits?


How to Maximize Your Personal Health Insurance Benefits?

A personal health insurance policy is typically used to pay for the costs of medical treatment for the insured if they are hospitalized due to illnesses or accidents. But other benefits can be derived from personal health insurance plans that are unknown to many users. Health insurance plans come with many benefits, some of which would be useful during hospitalization. In contrast, others can be utilized even when there is no hospitalization.

Let us look at some benefits you could avail yourself of, even when you haven’t been hospitalized.

Avail Annual checkups:

Most health insurance plans in the market offer annual health checkups to all eligible policy members for every claim-free year. The health checkups can be availed at any of the impaneled diagnostic centers of the health insurance company with prior intimation to the insurance company. These health checkups are termed preventive health checkups. These can help both the insured as well as the insurer. The insured is encouraged to practice certain preventive measures to overcome the health effects reflected in the health checkup reports.

The annual checkups can cover different tests based on the health insurance plan opted by the insured. These preventive health checkups range from basic to advanced and could cover certain diagnostic tests such as urine, blood and other tests as specified in the policy. The same diagnostic tests, if taken outside, would easily cost substantial money. The process of availing of annual health checkups is quite easy. Insured can dial the insurance company’s customer care and request annual health checkups. Then the insurance company would check up on the impaneled diagnostic centers within the insured’s location and book an appointment with the insured.

Second Opinion:

The other benefit that can be availed from a personal health insurance plan is the second opinion in case of certain diseases or illnesses. Patients usually seek a second opinion if they are not satisfied with the treatment of the current doctor or if they feel that they are not recovering enough from the current treating doctor. Patients usually seek a second opinion when they are not sure of the treatment prescribed by the current treating doctor and would like to know the alternatives. For example, if a person is undergoing treatment for cancer and the current treating doctor says there is no treatment at this stage that can save the person’s life. The person would like a second opinion with another doctor who could suggest any viable survival way. The insurance company usually offers a second opinion from among the list of impaneled doctors. However, most insurers would provide the option of a second opinion only in case of critical illnesses.

Reduce Waiting Periods:

Waiting periods are standard in every health insurance plan. The motto of the waiting periods is to prevent the insured from taking undue advantage of the health insurance plans. Health insurance is intended to provide financial support by paying hospital bills in case of unforeseen health issues. A customer often comes to know of a health condition, anticipates treatment in a couple of years, and then buys a health policy.

Waiting periods are in place to prevent any person from solely benefitting by taking undue advantage of health insurance. There are waiting periods such as pre-existing diseases, specific disease waiting periods, initial waiting periods, and maternity waiting periods as prescribed by the IRDA. The major advantage offered by certain health insurance plans is to reduce the waiting period by paying extra premiums. This health insurance benefit is provided only by a few insurance companies to give a head start to customers who want medical benefits for certain diseases early. If you anticipate some health risks soon, consider buying this waiver by paying an additional premium. Such additional premiums can help pay for a medical emergency, which might have otherwise been excluded.

Go for Super Top-Up:

Various health insurance policies in the market can act as an extra cushion to your existing health care plans. Super top-up health insurance policies are indemnity-based ones that can enhance your existing health coverage. Your existing health coverage could be personal or employer-sponsored. Super top-up plans trigger after the sum insured in your base policy is exhausted. The top-up plans have a deductible applicable for every claim made during the policy period. While there are two variants of top-up policies, i.e., a Top-up policy and a Super Top up policy, the Super Top up policy is a better product. Let’s understand with an example.

For example, if a person takes a top-up plan for Rs.6 Lakhs with a deductible of Rs.2 Lakhs, then in case of a claim with Rs.4 Lakh, the insurer would be liable for up to Rs. 2 Lakh only, i.e. (Rs. 4 Lakh, the claim amount – Rs.2 Lakh, the deductible). This would be repeated for each and every claim made during the policy period, so every time a claim is made, Rs.2 Lakhs would be deducted from the final claim bill towards the deductible amount under the plan.

In the case of super top-up health insurance plans, the deductible would be made on an aggregate basis, i.e., the deductible would be made in the first few claims. For example, if a person takes a super top-up plan for Rs.6 Lakhs with a deductible option of Rs.2 Lakhs and has made a claim for Rs.4 Lakhs, the insurance company would pay Rs.2 Lakhs after deducting the Rs.2 Lakhs. If the customer makes a second claim in the same policy year for Rs.4 Lakhs, then the super top-up health insurance plan would pay the entire amount without any deductible as the whole deductible amount has been applied in the first claim itself.

Tele Consultation:

Tele consultations are offline interactions between the doctor and patient, i.e., on the phone or via a video call. As can be gauged, such calls are advisory. But one of the major advantages of teleconsultation is that patients can avail of such services from their homes. Tele consultations gained popularity during the covid period when people were confined to their homes and consultations were done electronically to reduce the spread of disease. All the medical reports can be uploaded to the website, and teleconsultation services can be availed. Most insurance companies provide unlimited teleconsultation facilities to their customers.

However, it is important to note that teleconsultation should be practiced only with a registered medical practitioner. And such consultations should not be used for serious medical conditions. Tele consultation comes under the OPD coverage offered by the insurance company. IRDA has also asked the insurance companies to permit claim settlement for telemedicine consultation cases that allow normal consultation.

Tele consultation offers customers a wide range of benefits, such as reducing the cost and time associated with visiting a doctor, increasing convenience, etc. If the telemedicine consultations are a part of the pre and post-hospitalization expenses, then the customers can recover the costs associated with it under their health insurance plans. One can maximize the benefits of personal health insurance plans by utilizing the teleconsultation facilities in times of need, thereby saving considerable travel and other costs.

Wellness Benefits:

Insurance companies are now providing an array of health benefits for their customers. Such benefits are aimed at preventive care as opposed to reactive care. Wellness benefits include rewarding the insured with reward points that can be redeemed instead of the health insurance renewal premium. Insurance companies offer certain points for every physical activity carried out, which would add up to the discount on renewal premiums. Wellness programs aim to incentivize customers to maintain good health and sound mind to reduce the chance of falling sick and subsequent hospitalization. This would benefit both the customers and the insurance company as the customers would get health in addition to the reduced premium. In contrast, the insurance company could reduce its loss ratio if fewer people were hospitalized.

To summarize, you can maximize the gains from your health insurance plan by availing of these hidden benefits, which would contribute to a considerable return on your premium paid. Personal health insurance doesn’t mean only hospitalization expenses can be claimed. Other benefits are to be explored. For more information on the hidden benefits of your personal health insurance plan, please visit Ethika Insurance and book a call with our health insurance experts.

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Susheel Agarwal

Namaste. I'm Abhinay Nedunuru, a Fellow of the Insurance Institute of India with a passion to make insurance simple and crisp. I write on insurance and investment. I have a passion for teaching and training in particular to insurance. I'm currently doing my PhD from IIM in Management.