Health insurance is crucial to ensure your finances remain safe despite any medical emergency that can occur unexpectedly. Before you opt for health coverage, getting adequate details about the available health policies and thoroughly reviewing your needs helps you make the right decision. Understanding health insurance deductibles and types of deductibles is crucial to ensure how much claim amount you will receive when you file for it. Deductible in insurance could either be beneficial or disadvantageous depending upon the scenarios.
What Does Deductible in Health Insurance Mean?
Health Insurance deductible definition could get confusing if not explained nicely. One should know that a health insurance deductible is a pre-defined amount you must pay from your pocket for your medical expenses before getting the claim under medical insurance from the company. It is the part of the claim you must pay yearly every time you make a claim. The health insurance company will bear the rest up to the policy limits.
Generally, the higher the premium amount, the lower the policy’s deductible. In the case of a lower monthly premium, there is a likelihood that the insured person may have to pay a higher health insurance deductible.
How Does Health Insurance Deductible Work?
Let us understand what is deductible in health insurance with an example-
>> Rahul purchased an individual health policy. He raised a claim amount of Rs 40,000. The health insurance deductible set by the company is Rs 10,000. In such a case, the company would bear Rs 40,000 – Rs 10,000 = Rs 30,000, and Rahul would pay a deductible from his pocket.
>> In another instance, he makes a claim worth Rs 10,000, and the deductible amount is Rs 15,000. Here, the insurer will not pay anything as it is liable to make payment only when the claim amount exceeds the deductible amount.
Types of Deductibles in Health Insurance
In India, health insurance deductibles are of the following types, namely:
- Compulsory deductible: These deductibles are mandatory for the insured person and pre-defined as per your chosen plan. It has a fixed amount you must pay each time you file a claim.
- Voluntary deductible: It is an optional feature given to insured persons to minimize their premium costs.
- Comprehensive Deductible: It refers to a single deductible applicable for all the covers policyholders add to the policy and will continue till one reaches the maximum limit.
- Non-Comprehensive Deductible: It applies only to some specific cover under a health insurance policy. One has to pay the deductible only before getting a claim for specific medical treatment expenses and not all expenses.
When choosing cashless medical insurance, one should assess the covers that include or do not include deductible payments and the exact amount and time intervals for making these payments.
Significance of Health Insurance Deductible
The amount of deductible the insured must pay is mentioned in the policy terms and conditions. Let's understand its significance:
- Deductibles are applied to safeguard the insurance providers' interests from policyholders who do not make genuine health insurance claims or make claims of small amounts.
- It deters policyholders from making unreasonable claims and helps them realise they need to use their policy for genuine cases.
- The chances of fraudulent claims will reduce significantly with a medical insurance deductible.
- A higher deductible can be a disadvantage; when the claim amount is lesser than the deductible amount specified, the policyholders have to bear the costs from their pocket. Hence, you should pay the utmost care and thought while buying a health plan.
What to Choose Higher or Lower Health Insurance Deductible?
The deductible is calculated after considering insurance coverage, income, the sum insured, etc. It may vary from plan to plan. Remember, the deductible is critical when deciding on a health policy. But, if the question of what to choose, a higher or lower deductible, scorch your mind, read below:
- A low deductible works best for those who need higher medical coverage, especially for chronic ailments, frequent hospitalisation, long-term treatment, or therapies.
- However, those having individual health coverage with no dependants can opt for high-deductible at a lower premium.
- Health plans usually have preventive health check-up features on a cashless basis. Hence, there is no need to worry about medical insurance deductible payments for blood pressure or cholesterol checks.
Factors impacting the calculation of Medical Insurance Deductible
While understanding the concept of health insurance deductible is vital, the factors affecting its calculation are equally essential. Below are some common points to consider while deciding the deductible amount:
- Pre-existing diseases
- Present health conditions
- Past medical history
- Lifestyle-smoking/Tobacco
If you still need to opt for health insurance or your renewal is due, consider how a deductible can benefit you. Get the best health policy from Care Health Insurance at an affordable premium and deductibles to minimise the burden of high treatment costs.
FAQs
Q. What is DED in insurance?
If you ever come across the abbreviation DED while buying insurance, it simply means deductible.
Q. What is deductible in medical billing?
The deductible is the sum of money you consent to fork over throughout the claims procedure (per the terms and conditions). For instance, regardless of whether the claim is for Rs 10,000 or Rs 1 lakh, you must pay this sum if your insurance policy has a Rs 5,000 deductible provision.
Q. What is a good deductible for health insurance?
Ideally, a 10% deductible in health insurance is recommended. For example, Your surgery costs 1Lakh, and you have to pay 10% out of your pocket as a deductible, and your insurance provider will pay the rest of the cost, i.e. 90 Thousand.
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