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Health Insurance With A Government Insurer? Keep These Things In Mind!

By Ramyasri
Content Writer at Beshak
2 user ratings


Choosing between government and private options is like deciding between a cosy, traditional inn and a modern boutique hotel. The government resembles the old inn, offering reliability and a trusted track record, while private options provide the fresh, personalised experience of a boutique hotel.

Likewise, in the world of health insurance, private insurers are known for their focus on cutting-edge, efficient processes, while government-owned insurers are valued for their enduring stability and trustworthiness. Many people find peace of mind in purchasing health insurance from a government insurer due to its well-established reputation for reliability.

However, when it comes to selecting health insurance from a government insurer, there are essential aspects to consider. This article explores these crucial factors.

4 Important Factors When Buying Health Insurance From A Government Insurer

Here are some key factors to keep in mind when choosing health insurance through a government insurer:

1️⃣ Get the Highest Health Cover

The healthcare landscape in India is facing a significant challenge, with the current medical inflation rate at 5.91%. To ensure that your health coverage remains effective in the face of rising costs, you need to choose the highest sum insured that aligns with your budget. Many policies with coverage below Rs. 5 lakhs entail a room rent limit of 1% of the sum insured. This limit could quickly become insufficient in the coming years. For instance, a comfortable hospital room that costs Rs 4-5K per day today could surge to Rs 10K in the next decade. To safeguard yourself against future medical expenses, you should opt for a sum insured that can keep pace with the increasing costs of healthcare.

2️⃣ Go For The Room Rent Waiver

There's a common misconception that having health insurance means unlimited benefits without the need to worry about costs. And, some individuals might take advantage of this by seeking care in high-end hospitals. This is where the concept of room rent limit comes in. It is the limit up to which your health insurance will pay for your room during your hospital stay.

Say you choose a deluxe room when you're eligible for a general room. The insurer won't only deduct the additional room charges; they’ll also apply a proportionate deduction for all other expenses related to the room you've chosen. This can place a substantial financial strain on you, making it necessary to cover the costs from your own pocket.

To safeguard your wallet against this, consider adding the waiver of room rent limit add-on to your policy, if it's available. With this option, you can remove your room category or limit for an additional cost. Opting for this waiver can help reduce the financial burden when making a claim. 

3️⃣ Opt For Hospital Cash Add-On 

Hospital cash add-on can be your lifesaver during hospital stays. When the waiver of room rent limit isn't an option, hospital cash benefits come to the rescue.

Hospital cash benefits provide you with a daily cash allowance while you're in the hospital. For instance, in the National Mediclaim Plus Policy (Plan A), you can receive a daily hospital cash allowance of Rs 500 for a maximum of 5 days under Hospital Cash cover. This allowance is intended to help you handle various expenses that might pop up during your hospital stay, such as transportation, meals, and other out-of-pocket costs not directly connected to the medical treatment you’re undergoing.

This add-on not only provides relief from deductions but also helps mitigate the additional expenses that can build up during hospitalisation. Make sure you claim this benefit when needed; it’s a detail that's easy to overlook, but can make a significant difference.

4️⃣ Select Surgery Limit Upgrades

Certain insurance companies may impose treatment or disease-wise sub-limits. For example, specific health insurance policies might set limits on particular surgical procedures like cataract treatment or joint replacement surgery. These predefined limits may not align with the actual costs of these procedures in today's healthcare landscape.

To bridge this gap, it's wise to consider add-ons that expand these surgery limits for an additional premium. For instance, upgrading a cataract limit from Rs. 24,000 to Rs. 1 Lakh per eye per policy year can ensure that you're fully covered for the actual expenses you might incur.

Think of these add-ons as protective measures to ensure you have sufficient coverage for important medical procedures, without any limitations holding you back.

We believe it's important for you to thoroughly evaluate all the available add-ons. They are tools that can bolster your coverage and cater to particular healthcare needs. So, pay attention to the array of add-on covers accompanying your policy to make the most of the advantages they offer. You can easily find information on your government insurer's website during the renewal process or consult your trusted advisor for guidance.

Want to know more? Get in touch with our vetted financial experts for a free 1-to-1 consultation to make an informed choice.

Key takeaways
  1. When opting for health insurance from a government insurer, consider factors such as the sum insured, room rent limits, and add-on benefits for comprehensive coverage.
  2. To combat rising healthcare costs, select the highest sum insured that aligns with your budget.
  3. The waiver of room rent limit and hospital cash benefit can be useful in avoiding unexpected expenses during hospital stays.
  4. Consider add-ons to upgrade surgery limits to ensure you are adequately covered for medical procedures without limitations.
  5. Thoroughly evaluate all available add-ons to enhance your health insurance coverage and for specific healthcare needs.
How did you find this article?
Ramyasri, Content Writer at Beshak

Ramyasri leverages her technical background and writing prowess to demystify complex concepts and craft insightful content. She aims to make insurance more approachable and understandable for anyone looking to make sound financial decisions for their future.

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