Key Things To Know About Deductibles In Health Insurance Policy

Health Insurance Plans 'Too Complicated to Understand' - UConn Today

Do you have health insurance? Are you planning to buy one? If yes, then reading the fine print is very important. Knowing the details of your health insurance can help prevent any issues that otherwise could arise. There are a lot of terms in the policy that you should know. Read on to know about one such term – Deductibles.

Deductibles, co-insurance, and co-payment – If you read the fine print, you may find these terms in health insurance policies. Before selecting a plan, it is a good idea to be familiar with the definitions of these health insurance words.*

How do deductibles work?

The deductible is the sum that a policyholder should pay out of their pocket before the insurance provider begins to make payments. In other words, the insurance provider is only required to pay a claim when the amount is greater than the deductible. For example, if your policy’s deductible is Rs 30,000 and the insured person files a claim for Rs 40,000, the insurance company is only required to pay Rs 10,000. However, the insurer is not required to make any payments if the claim amount is less than the deductible. The premium for high deductible plans is more affordable than the premium for low deductible policies.*

Importance of Deductibles’ in health insurance

  • Deductibles stop people from filing frivolous claims or seeking unneeded medical attention and hospitalisation just because they have health insurance coverage.
  • Low premiums for policies with high deductibles are advantageous to you in the long run. You obtain a Cumulative Bonus if you refrain from filing needless claims for tiny sums. Over time, the cumulative bonuses contribute to an increase in coverage.

Remember that the cost of your treatment should be above the minimum deductible that has been set in order for the claim to succeed. Therefore, before choosing coverage from an insurer, comprehend the terms of health insurance.*

Health insurance co-pay clause

For a covered medical procedure, a co-pay is a certain sum that the insured should pay; the insurer may cover the balance. The type of treatment and medications can determine the co-pay amount. For example, you may be required to pay Rs 5,000 if your coverage contains a 10% co-pay provision and your claim is for Rs 50,000. The insurance company may pay the balance.*

The co-pay clause’s two main goals are:

  1. To lessen the burden on insurers and deter customers from filing frivolous or needless claims.
  2. People assume they can receive treatment at the most expensive hospitals if they have medical insurance. Co-pay serves as a dissuader.

Several factors, including one’s lifestyle, pre-existing conditions, physical health, and past and present medical conditions, determine whether one needs to choose deductible or co-pay insurance.

Opt for a health insurance premium calculator to help you decide. It takes various factors like salary, duration, sum insured expected and more to determine the premium of different health insurance plans. Comparing these plans online can help you make a well-informed decision.

Before committing to a policy out of the blue, it is recommended to review the health insurance specifics and comprehend the terms. By doing this, you can prevent unpleasant surprises when you submit a claim.

*Standard T&C apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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