8 things to contemplate while buying medical health insurance, after the pandemic

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After the pandemic, an upward trend has been seen within the sale of comprehensive medical health insurance plans assisted by insurer’s nudge to draw increasingly customers via value-added offerings. Policyholders are increasingly health insurers for wellness advantages and wider coverage beyond in-patient hospitalization.



In-order to cater to the growing needs of consumers. Insurers are increasingly offering extra advantages either built-in or as optional riders and add-ons.

Let’s have a look at eight critical aspects that each individual must include while buying a health cover:

Pre and Post Hospitalization:

Pre-hospitalization expenses are medical costs incurred by the insured before getting admitted in a hospital. Post-hospitalization expenses are medical costs incurred after discharge from the hospital. Insurance policies offer extensive periods of coverage under this profit starting from 30/60 days to 60/180 days of pre and post hospitalization coverage respectively. Higher the variety of days covered will enable the insured to cover a bigger period of medical expenses.

Co-Payment Clauses

Co-payment clause means the insured is sure to pay a pre-defined percentage amount of the hospital bill. Although these policies would cost less, it might entail unnecessary burden on the insured to foot a portion of the expenses. It will all the time be advisable to have 0% co-pay, in order that there isn’t any additional outlay on the time of hospitalization. But when budget is a constraint, even a ten% co-pay may end up in significant decrease in premiums.

Waiting Period


There is usually a waiting period attached to pre-existing conditions similar to diabetes, hypertension, thyroid etc. There are also waiting periods attached to specific diseases like cataract, arthritis, hernia etc. This era ranges from 12-48 months and the insured members should wait for this era before they’ll file a hospitalization claim from these conditions. Depending on the insured requirements, it’s critical to decide on the proper policy as per the waiting period.

OPD Treatments

Although OPD treatments are covered as a part of pre and post hospitalization, customers are increasingly standalone OPD advantages in insurance. At present, nearly all of the OPD expenses in India are incurred out of pocket and never covered through insurance. Inclusion of OPD cover within the policy is an additional benefit that a person can get in select plans.

Room Rent Waiver

Treatment cost at hospitals varies directly with the alternative of room type opted. Because of this, the claim settlement affects the general bill when a patient covered by medical health insurance opts for a room that exceeds his policy limit.

On the time of emergency, such critical decisions could also be ignored leading to a poor claim settlement experience. In an effort to have a peaceful and hassle-free experience, there was increasing preference towards choosing medical health insurance policies with none adversarial room rent capping.

Need to incorporate mental wellness cover

Insurance regulator IRDAI, vide its circular dated August 16, 2018, stated that insurance is liable to be provided for mental illnesses upon the enactment of the Mental Healthcare Act 2017. Nevertheless, the duvet continues to be subjected to sub-limits and doesn’t cover treatment on OPD basis which forms many of the healthcare expenditure towards mental illness.

Home Care Treatment


While domiciliary treatment is roofed by nearly all of retail medical health insurance plans, it comes with its set of conditions with respect to unavailability of hospital room or inability of patient to be taken to a hospital. Certain illnesses similar to dengue, pancreatitis, COPD management and plenty of more will be treated from the comfort of home. There are specific policies which are now offering home care treatments as well.

Latest trends in medical health insurance policy:

Tele-consultation

Because of the reasonably priced web and advent of Covid, there was an increased adoption of doctor tele-consultations. Insurers have began addressing the needs of consumers by rolling out in-built and optional tele-consultation coverages. Most insurers as of today have a built-in second medical opinion for major critical illness cover built-in for the insured. In a rustic with a poor doctor to patient ratio, it becomes a win-win proposition for all stakeholders i.e. insurers, medical staff and patients.

Critical Illnesses

Hospitalization costs for certain major chronic illnesses similar to cancer, organ transplant, renal failure are major outliers in comparison with average hospitalization costs for other surgeries. At such instances, the medical health insurance coverage opted by customers falls short of necessities. Customers are increasingly lump sum or indemnity-based critical illness or cancer covers along with their medical health insurance.

There remain loads of areas where there’s scope so as to add value. Dental coverage, high-end diagnostic tests, allowing portability for combining two policies into one, end-to-end digital claim filing etc. are some features that insurers should evaluate and add to service their customers higher.

India continues to be at an inflection point where growing demand for good quality healthcare must be complemented by comprehensive and reasonably priced medical insurance.

The creator Anuj Parekh is the
co-founder and CEO of Healthysure.in.

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