As per the Global Burden of Disease Study 1990-2016, there are 93.2 million patients in India with asthma and chronic obstructive pulmonary disease. Increasing urbanisation, poor infrastructure and worsening pollution levels only add to the conundrum. Also, according to a World Health Organization report, in a test unit of not-so-well managed asthma patients, 42 per cent had to be given emergency treatment at least five times a year and 18 per cent had to be hospitalised twice or thrice. Asthma patients are at a high risk of developing conditions such as stroke, pneumonia and gastroesophageal reflux.
Hence, ongoing and timely management is absolutely critical and, if the condition is managed properly, the patient can live a healthy life without any barriers. It, therefore, becomes imperative for asthma and COPD patients to buy health insurance.
Below are five points patients should consider before purchasing health insurance:
Know the coverage: As an asthma patient, one would need a health cover that funds the outpatient expenditure, offer services of an experienced coach who can engage with the patient continuously to keep the condition well managed and covers hospitalisation, if needed. There are such condition-specific health insurance policies that offer comprehensive coverage. Thus, before purchasing health insurance, you need to know which type of plan best suits you and your budget.
Consider out-of-pocket costs: Health insurance does not cover certain elements of medical costs. There could be co-payments, deductibles, sub-limits and non-payable items. Co-payment is a specified percentage of admissible claim cost that the customer bears each time during a claim. Deductibles are the amount one pays for covered services in a given year before the insurer pays. Non-payable costs are those which the insurance won’t pay. Sub-limits are caps on amounts payable for specified items in the policy coverage. Therefore, it becomes vital to understand these costs before buying a health insurance policy.
Check if the drugs and doctor's outpatient consultations are covered: When choosing between options, the information provided may not be necessarily sufficient to know which one covers asthma best. After narrowing down your plan, it is recommended to call the insurance company to ensure if the doctor’s fees, medications and hospital charges are comprehensively covered. A good health insurance plan covers the expenses of the numerous tests along with doctor’s consultation fee and the cost of medication even if the patient is not hospitalised.
Hassle-free treatment and recovery: Asthma can make an individual go through the worst transitions, while the financial stress can cause depression, which usually hampers the recovery process. A good health insurance cover meets all the aforementioned asthma-related costs and aspects so that a patient can focus on her health and be rest assured that she is backed up by a financial safety net. Please check that you are comfortable with the brand of the insurance company and its past record of claims payment and turnaround times.
Check for other covers or services: There are products that offer services of a qualified health coach who guides an asthma patient to manage her condition well and ensures that she adheres to the treatment protocol. Relationship with a health coach is like that with a family doctor owing to the personalised attention.
It is important to be wise while investing in a health insurance plan. Please invest in a policy that can be a partner with you in health and illness and ensure that your health is well-managed to minimise hospitalisation. This will not only provide comprehensive financial protection, but also give peace of mind to you and your family.
Sriram is chief actuary, Aditya Birla Health Insurance Co. Ltd.