Understanding important riders in your health insurance cover

The right choice of health insurance riders can significantly help you and your family at the time of claim.

Mumbai: Choosing the right health insurance plan is one of the most crucial decisions one needs to make in life. After all, no one wants to regret a wrong decision and especially when it concerns you and your family’s health. Thus, you must take time and explore well before buying a health insurance policy as it is very important to opt for the right coverage.

At the same time, it is equally important to know about the optional riders or add-ons that make the policy much more comprehensive. The prime purpose for choosing a rider along with your health insurance policy is to enhance the protection provided by the insurer and provide cover against a specific risk. Most of the riders are optional features of a health insurance policy, which enhance the base plan coverage at an affordable price.

Most importantly, the right choice of health insurance riders can significantly help you and your family at the time of claim.

What is a rider?

In simpler words, insurance riders are not replacements for the base plans; rather they play a great part in helping the insurer to take additional cover against specific risks at affordable prices as the maximum charges are paid over the base premium. As per the IRDAI regulations, the premium on riders is capped at 30% of the basic insurance plan.

Let’s have a look at the top health insurance riders:

Hospital cash benefit:

This is one of the most important health insurance riders that are quite popular amongst the middle class population. Under the rider, the insured receives fixed cash benefit in the event of hospitalisation.

Regardless of what may be the health care expenses borne by you, hospital cash benefit rider helps you with a daily cash benefit. For instance, you have a hospital cash benefit rider that pays you Rs. 1000/day in case of hospitalised.

Now, whether your per day hospitalisation bill amounts to Rs. 1000 or Rs. 2000, the rider will pay you for the pre-decided figure, i.e. Rs. 1000.

In order to avail the benefits of this rider, the duration of hospitalization must be more than 48 hours at least. Under some insurers, if the hospitalisation demands Intensive Care Unit (ICU) facilities, the insured is eligible for twice the daily cash benefit.

Moreover, the insured is even eligible for a lump sum benefit in case of an extended surgery for any specific medical condition. In case of multiple surgeries, the insured is only eligible for one-time benefit however the surgery that attracts the highest fixed benefit is taken into consideration.

Cancer care plan

We all must know that a health insurance policy is limited to hospitalisation expenses and an average health insurance cover of Rs 5 lakh may not always be enough. It is important to have a disease–specific rider added in your health insurance, such as a cancer care plan that provides a cover beyond in-patient hospitalisation.

The total cost of cancer treatment in India may go beyond 15 Lakh in some cases. Such plans provide immediate lump sum amount irrespective of the total expenses incurred during the actual medical treatment.

A very popular plan in the market is Aditya Birla’s Active Secure – Cancer Secure Plan. The plan provides generous lump sum payout at all stages of cancer including early, major and advanced.

As per the policy terms, 50% of the total sum insured is paid in any early stage of cancer along with an additional payout of 100% on major/advanced stage. The plan demands a very low survival period that is of just 7 days.

OPD cover

As per a recent report, out-of-pocket health care expenses account for over 62% of the total medical expenses in India. Considering the share of out-of-pocket expenses, it is very important to have an OPD cover rider in the health insurance policy.

All such plans take care of outpatient department (OPD) expenses of the insured. Some of the major expenses covered in the OPD cover include pharmacy bills, dental treatment, diagnostic tests, consultations and much more.

Currently, insurers like Apollo Munich and Max Bupa are some of the major brands that provide such plans with features like cashless OPD claim settlement, setting off OPD benefit against future premium payments and much more.

Dengue care

Considering the high rising cases of dengue across the country each year, insurers have started offering single disease-specific covers like Dengue Cover that provides adequate cover against Dengue.

These special insurance plans take care of the medical expenses along with hospitalisation if required. The average cost of hospitalisation for treatment of dengue in a metro city varies between Rs 35,000 and Rs 70,000.

The Dengue insurance covers available in the market cover both inpatient and outpatient treatment costs. The single disease-specific plan offers adequate coverage, and also acts as a rider to the basic health insurance cover.

These plans are well capable of providing independent risk cover to people to meet the expenses incurred for the treatment. The average premium of Dengue Care rider is approximately Rs 1048 for Rs 50,000 SI.

(Written by Amit Chhabra, Head- Health Insurance, Policybazaar.com)