The awareness of having a suitable health insurance policy is slowly rising among individuals as medical expenses are increasing and diseases are too. Even as new and modern treatments are being invented to tackle illnesses, their costs blow a hole in your pockets if you don’t have a health insurance plan. Earlier, the need for health insurance was not felt by all. According to a National Sample Survey, conducted between July 2017 and June 2018, 86% of the rural population and 81% of the urban population were without health coverage. Have a look –
However, the importance of a health insurance policy is slowly being felt and the pandemic has made individuals realize why a health plan is important. As per the latest survey conducted by Max Bupa, the importance of a health insurance plan has increased manifold post the pandemic. Even millennials have realised the importance of having adequate health insurance coverage with a significant rise of 23% from pre-Covid days.
So, if you are also looking to buy a comprehensive health insurance plan, you should buy a plan after careful research. There are different aspects of the policy which you should consider when buying health insurance. Let’s unravel what these aspects are –
- The type of policy needed
The first thing which you should understand is the type of health insurance policy that you need. Some tips for the type of plan you can consider:
- Usually, a comprehensive family floater plan is sufficient for covering yourself, your spouse and dependent children.
- However, if you have dependent parents, opt for a separate senior citizen policy for them so that they can be adequately covered and their claim experience does not hamper your coverage.
- If you already have an existing health plan and you want to enhance your coverage, you can opt for top-up or super top-up health plans that help in increasing coverage at affordable premiums.
- Moreover, a critical illness policy can also be supplemental coverage for covering dreaded illnesses like cancer, stroke, dialysis, etc.
- The coverage benefits:
The next thing that you need to check is the coverage benefits that the plan offers. The basic coverage benefits under almost all health insurance plans include – - Sub-Limits of inpatient hospitalisation:
This is one of the most crucial benefits which needs to be checked at the time of opting for a health insurance plan. Some plans have an upper limit on the total amount that can be sanctioned as room rent and ICU charges, doctor’s fees, etc. If the room rent charges are higher than the specified limit, then the entire claim would not be accepted, but a proportionate claim would be paid.
For example:
Usually, if you choose health plans up to a sum insured of Rs.5 lakhs, there might be a sub-limit on the room rent. This limits the scope of coverage and if the actual room rent is higher than the allowed limit, your claim amount is reduced. Other limits can be found under coverage for AYUSH treatments, OPD expenses, maternity coverage, daycare treatments, etc.
Pro Tip: The new-age health insurance plans do not have a sub-limit cap, which is definitely better even if it costs a little high. So, try and avoid plans which have these sub-limits and if the limits are inevitable choose plans that allow liberal limits for maximum coverage.
- Pre and post-hospitalisation:
Most health insurance plans provide coverage for pre-hospitalisation for at least 30 days and post-hospitalisation expenses for at least 60 days. This covers costs like diagnostic tests, medicines, doctor visits, etc.Pro Tip: Some health insurance plans provide coverage for as long as 90 and 180 days or pre and post-hospitalisation expenses also. This helps in covering the additional costs, especially if the same entails a lengthy and expensive diagnosis procedure.
- Daycare treatments:
Most health insurance plans provide a generic list of accepted daycare treatments for which 24-hour hospitalisation is not needed for the treatment like cataract operation, angioplasty, etc.
Pro Tip: Check the list of daycare treatments covered by the plan. Some health plans also mention “all” daycare treatment coverage, as well.
- Other associated expenses coverage:
Like ambulance costs, AYUSH Treatment coverage for non-allopathic treatment, organ donor expenses, etc.
- No Claim Benefits:
Health plans offer increased coverage, wellness benefits, etc. as no claim bonus for every claim-free year. Some plans club free health check-ups along with NCB while other plans offer it once after a specified number of years.Pro Tip: Check the NCB and Annual Health Check-Up Benefits as that can help you extend your coverage and make the most of the available benefits.
- Lifelong renewability:
Almost all individual indemnity health insurance plans offer lifelong renewability provided the policy does not lapse.
Besides these basic coverage benefits, you should look for other benefits which enhance the coverage offered.
Additional Benefits:
Some of the common benefits which you should choose include –
- Sum insured restoration or refill, when the initial coverage is extended, an additional amount of coverage is provided for an unrelated ailment or a different family member under a floater plan.
- Maternity and new-born child expenses if you are planning to start a family
- OPD (Outpatient department) expenses if you incur considerable OPD charges in a year for a doctor consultation, especially for older parents or chronic ailments.
- Additional riders or add-on benefits like critical or terminal illness coverage, hospital cash, etc. are available at a nominal additional cost which can enhance your policy coverage!
Tip: Customize according to your needs!
Then, you should customize your coverage depending on your coverage requirements. For example, maternity coverage is a must if you are planning to have a child soon. Similarly, adding a critical illness rider would help you extend the coverage in case of a dreaded illness. Likewise, if you prefer international treatments, many health plans allow coverage for the same. You should, therefore, look at such plans where international treatments would be covered.
- The sum insured
The sum insured by your health insurance policy should be adequate enough to cover the medical expenses incurred in an emergency. Factor in the rising medical inflation, the average hospitalisation expenses and the number of members covered for selecting an adequate sum insured.
Pro Tip: A sum insured of Rs.5 lakhs and above is a must for a small family. You can also increase your coverage at a later point in time. However, if affordability is an issue, you can increase your existing health insurance coverage with a top-up or super top-up plan at a nominal amount as well!
- Cost Benefit
After factoring in the coverage benefits and the sum insured, check the premium rate charged by the insurance company. Compare the premiums across similar plans to pick the best deal. However, when comparing, always compare the premiums vis-à-vis the coverage offered. You might find a big difference in the premiums of the two plans but their scope of coverage would also differ.
Pro Tip: So, compare the premiums vis-à-vis the coverage and then pick the plan which offers the best coverage at the lowest premiums.
- Policy exclusions
Every health insurance plan has a list of exclusions which specify the medical costs and illnesses for which the policy would not pay a claim. You should go through these exclusions to understand the scope of coverage offered.
Some of the most common exclusions include the following –
- Pre-existing illnesses during their waiting period
- Cosmetic surgeries
- Dental treatments
- Illnesses or costs incurred due to war, nuclear contamination and related perils
- HIV/AIDS or other sexually transmitted illnesses
- Congenital defects
- Self-inflicted injuries or injuries suffered under the influence of intoxicating substances
- The waiting periods applicable
If you already suffer from an illness when buying a policy, such an illness would be considered to be a pre-existing illness. Coverage for such an illness would be offered after the waiting period for the same is over. Under health plans, the pre-existing waiting period ranges from 12 months to 48 months. So, if you or any covered family member suffers from any pre-existing illness, opt for plans which have a low waiting period.
Besides pre-existing illnesses, waiting periods are also applicable for specific illnesses like hernia, tonsillectomy, piles, fibroids, etc. Even maternity coverage comes with a waiting period.
Pro Tip: So, check these waiting periods and opt for a plan wherein you can get coverage at the earliest.
- Discounts
Health insurance plans allow different types of premium discounts to reduce your premium outgo. Hunt for the maximum discounts to get the best deal on the policy.
Discounts are usually offered for the following –
- Buying a multi-year policy like 2 or 3 years
- Buying online
- Paying the premium in one lump sum and not in instalments, i.e. annual plans are usually cheaper than monthly ones
- Covering two or more family members under the plan under a family floater option is cheaper than opting for separate health plans for everyone individually
- Practicing a healthy lifestyle and opting for wellness benefits
Pro Tip: Try to avail as many discounts as possible to get the maximum benefit!
- The claim procedure
Understanding the claim procedure of the insurance company is important before you buy the company’s health plan. The simpler the claim process, the easier it would be for you to get your claim settled without hassles. Nowadays, companies have launched their own mobile applications which have simplified the claim process greatly.
Pro Tip: So, opt for plans which have a simplistic approach to claim settlements for an effortless claim process. The claim is the most important reason for opting for a health insurance plan. Hence, that process should be seamless. Also, remember to educate your family members about the same, so that they can process it on their own as well!
- Network of cashless hospitals
The last thing that you should check when buying a health insurance policy is the network of hospitals in which you can avail of cashless treatments. Health insurance companies are tied-up with multiple hospitals pan India and the larger the hospital network that the company has the easier it would be for you to locate a preferred hospital and get cashless claim settlements.
Conclusion:
So, don’t buy health insurance plans in haste. Consider the above-mentioned factors and then compare handpicked plans. Ensure the coverage is comprehensive and the premium is affordable so that your health insurance policy helps you when you need it the most. A well-researched plan would be your best bet in case of emergencies and so, a little effort on your part would go a long way.
