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Good to have benefits under a health insurance policy


You should consider saving premium over opting for this "good to have " cover.
The same premium can be used to buy a super top-up policy, you will have much better coverage for "must-have benefits".

Physician consultations, Health Check-ups, pharmacy and laboratory fees, which are not linked to hospitalisation, are covered under the outpatient benefit.

They are normally excluded from health insurance unless they fall under Pre and Post Hospitalization.

There are some companies that provide outpatient benefits with a cap. Some companies offer an option to add an additional benefit based on the sum insured and an additional premium.

Do not confuse the Outpatient benefit with the pre post hospitalization benefit, even though both are setting the outpatient bills. The pre & post hospitalization bills relate to the inpatient hospitalization or day care procedure.

Outpatient benefit does not bring much value but it could help to some extent but buying this benefit with additional premium is up to one’s family health conditions and usage per year.

Opt for Out patient benefit only if you want to take full advantage of section 80D benefits under income tax.

We are allowed to claim deduction of Rs.25K from our taxable salary for Mediclaim Insurance premium.

But so many of you will be covering yourself (including spouse and kids) within Rs.10K to 15K only.

You can utilise the balance benefit by purchasing Outpatient Benefit Insurance add on cover.

For example, let’s say your Mediclaim premium is Rs.9000. (This is the normal premium you pay for 5 lacs cover for self+spouse+2 kids.

You can now buy an additional Outpatient expenses insurance policy for Rs.16K. This gives you additional two benefits

  • Outpatient expenses benefit of Rs.25K.
  • 30% tax saving on Rs.16K additional premium. (assuming you fall into the 30% tax bracket)

Hence the total benefit of paying Rs. Additional 16K premium is Rs.30500

As the name says, the No Claim bonus is the benefit which an insured received upon making no claims in the previous policy year. Now the question is how this benefit is provided to the insured in health insurance.

Until certain limits are reached, the total Sum Insured will increase every Claim-free year without any additional premium.

It helps us to tackle medical inflation.

Most insurers offer this benefit, but the rate at which it is increased varies from policy to policy.

Some insurers provide 10% and some provide 20% for every claim-free year.

When a claim is made, some insurers decrease the Sum Insured by a similar percentage (or all at once) to the earned cumulative Sum Insured till date.

Nowadays some insurers are providing optional cover for No Claim Bonus.

It has been named differently by different insurers like Super NCB, Multiplier benefit etc.

If you have planned for a Super Top Up policy as well, then you need not bother about what percentage of Sum Insured is being offered as NCB.

However, 10% of NCB is for sure provided for every claim free year. And interestingly NCB is also a part of some Super top up policy plans.

Hence instead of paying for an optional cumulative bonus rider it’s advisable to take a super top policy rather than trying to enhance this tentative coverage which would vanish upon a single claim.