You are bound to come across the term health insurance rider when discussing health insurance or purchasing a policy. Health Insurance Rider, meaning any extra benefit or coverage, is something you pay for to enhance the scope of your health insurance policy. Getting a comprehensive health insurance policy with all the benefits you seek is tough. To customise your health insurance policy as per your requirements, you pay an additional premium to add to your requisite health insurance rider and amend the terms and conditions of the policy. In this blog, we will look at some of the health insurance riders you should be aware of.
Types of Health Insurance Riders Available in India
Given below are some of the different types of health insurance riders that are available in India:
1. Critical Illness Rider
Health insurance with a critical illness rider provides the policyholder with a one-time lump sum benefit on the diagnosis of certain listed critical illnesses. These 32 critical illnesses are diseases or conditions like cancer, heart attack, stroke, paralysis, brain tumour, coma, etc. The lump sum paid to the policyholder equals the sum insured in the policy. This rider usually has a waiting period of 90 days from the date of issuance of the policy and is one-time in nature. It ceases to exist once the payment is made.
2. OPD Rider
An Outpatient Department (OPD) health plan rider covers the expenses incurred for a medical procedure or examination in the Outpatient Department of any medical facility, such as doctor’s consultation fees, the price of medicines, and the cost of diagnostic tests without getting admitted or a minimum duration of treatment in daycare.
3. Maternity Rider
A maternity rider is a medical insurance rider that covers expenses related to pregnancy and childbirth. This includes expenses arising from delivery, pre- and post-natal care, and the newborn baby’s care. Depending on the health insurance company's policies, the waiting period for this rider ranges from nine months to six years.
4. Room Rent Waiver
The room rent waiver rider is a benefit that waives off the sub-limit on hospital room rent, enabling policyholders to opt for a room with a higher rent. Further, it eliminates any limit on room rent type, allowing the patient to get admitted without any extra cost.
5. Day 1 PED Coverage Rider
This health plan rider waives any waiting period for pre-existing diseases (PEDs). You must opt for this rider while purchasing your policy for the first time. This rider waives off any waiting period for PEDs like asthma, hypertension, hyperlipidemia, and diabetes.
6. Unlimited Automatic Restoration of Sum Insured
Suppose the sum insured of your base policy gets exhausted on account of raising either a single or multiple numbers of claims in a policy year. In that case, the unlimited restoration rider will restore the sum insured unlimited times. Whether the sum insured will get restored for medical treatment related to the same illness or for different illnesses depends on the terms and conditions of the specific policy. Care Supreme from Care Health Insurance provides unlimited and automatic recharge, or restoration, of the sum insured for hospitalisation for related and unrelated illnesses without the 45-day waiting period.
7. Reduction in PED Waiting Period
This healthcare rider reduces the waiting period to cover Pre Existing Diseases (PEDs) but does not waive it off. Usually, the waiting period to cover PEDs is 36 months. If you opt for this rider, the waiting period may be one year, two, or three years. Care Supreme from Care Health Insurance has a rider to modify the waiting period for Pre-Existing Diseases to one year, two years or three years, as you have read above.
8. Personal Accident Rider
The personal accident rider offers a lump sum benefit if the policyholder experiences partial or total disability or death resulting from an accident. In the event of disability, the health insurance company disburses the amount to the policyholder. In contrast, in the unfortunate event of the policyholder's death, the nominee or family member receives the benefit.
9. Hospital Cash Rider
The hospital cash rider comes with the benefit of a daily cash payment for each day of your hospitalisation. This is not a reimbursement but an allowance and may be spent by you to pay for any expenses usually not admitted in a medical insurance policy or for any other purpose you wish. No bills are, therefore, required to receive the benefit of this rider, and you have the liberty to save the entire amount if you so desire. This rider typically gets activated after the completion of 1 day of hospitalisation or as per the terms and conditions of your health insurance policy.
10. Zone Upgrade
Medical insurance premium in India is calculated based on the zone in which you reside. There is no airtight definition of zones, and every health insurance company in India can decide on state zones independently. Usually, there are three zones – Zone A for metropolitan cities and Zone B and Zone C covering Tier II and Tier III cities, respectively. The zone-based premium for health insurance policies is based on the cost of medical treatment in the respective zones. Zone A is expected to be more expensive than Zone II and Zone III as far as the cost of medical treatment is concerned. To offset the higher cost of treatment, medical insurance companies impose a co-payment clause when you seek treatment in a higher zone than the one you purchased for your medical insurance policy. The zone upgrade rider allows you to get your medical treatment done at higher zones without the co-payment being imposed upon you.
11. Global Cover Rider
The global cover rider entitles you to reimbursement for planned treatment done overseas. Medical treatment is costly abroad, and this rider serves the dual purpose of ensuring a better treatment for you and protecting you financially. However, this is only available if you are referred and recommended for treatment abroad by your physician in India.
Top 3 Reasons for Availing Health Insurance Riders
Now that you know the riders available with health insurance in India, you must understand why purchasing riders benefits you. Health Insurance riders offer you the following benefits:
- Enhanced and Customised Coverage: You may add specific benefits to your base health insurance policy, thereby customising the coverage to your desired levels. Thus, you turn a base health insurance policy into a comprehensive one customised to your requirements.
- Avoiding Purchase of Another Policy: Riders allow you the convenience of all the benefits you require and desire in one policy. You are spared the inconvenience of buying and managing multiple health insurance policies to access certain features or benefits.
- Lower Premiums: The additional premium you pay for riders is much less than that you would be paying for additional or multiple policies you may have otherwise purchased to enjoy certain features or benefits. IRDAI does not allow any insurance company to charge you more than 30 % of the base policy premium for riders. This capping is an advantage when you purchase riders. So if the premium of your base policy is Rs. 15,000, the total premium on account of riders can be at most 30 %, that is, Rs. 4,500.
Top 4 Advantages of Opting for Health Insurance Riders:
You have just read about the advantages of riders. However, it would be best if you considered the following before purchasing add-on riders with your health insurance policy:
1. Coverage
You need to understand precisely what the rider covers and the terms and conditions governing the rider. Purchase a rider only if it meets your exact requirements.
2. Premium
Calculate the exact premium you need to pay for the riders you choose. Even though a rider is cheaper than a regular policy, it still needs to be within your budget.
3. Waiting Period
Some riders come with waiting periods. Maternity benefit riders have a minimum waiting period of nine months, and critical illness riders have a waiting period of 90 days. Go through all the applicable terms and conditions thoroughly and understand the waiting periods applicable.
>> Also Read: Things You Must Know About Pre-existing Disease Waiting Period
4. Exclusions
Certain riders may have exclusions limiting the coverage provided by your health insurance company. Congenital diseases and ectopic pregnancies are often not covered by riders. You need to check all the exclusions to a rider before purchasing it.
Wrapping Up!
Health insurance riders are very useful as they allow you to increase the scope of your policy and customise it at the fractional cost of an additional policy. If you purchase your riders wisely after proper research, you will definitely benefit from them. However, the riders come with certain limitations and exclusions, too, and it is essential for you to read the fine print before purchasing them.
Disclaimers: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.
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