How to Buy the Perfect Health Insurance Policy?

The ongoing COVID-19 crisis makes this an important time to look at health insurance. With reports of private hospitals charging lakhs  for treatment, people who do not have medical insurance are often left in the lurch. However, with many options available in the market, which plan do you choose? Here are a few pointers to help you make your decision.

1.    Right Policy Type
Health insurance plans have the following types:

•    Indemnity – where the insurer pays you (or hospital directly) the hospitalization expenses for any illness or disease (subject to conditions).
•    Critical Illness – where the insurer pays you a lump-sum amount if you are diagnosed with a critical illness.
•    Specific Disease – where the insurer pays you for hospitalization expenses related to a specific disease, such as COVID-19, diabetes, etc.

Indemnity plans are the most common and we will focus on these.

2.    Individual or Floater
Indemnity Plans can be taken either separately for each individual in the family or as a floater cover.  Floater policies are more economical, but they might not provide enough cover in COVID-like situations where more than one member gets hospitalized in the same policy year.  Furthermore, floater premiums are decided by the age of the eldest member who is covered.  Therefore, it is more economical to have a separate plan for your elderly parents, instead of including everybody in one plan.

3.    Base or Top-Up
Indemnity Plans can belong to two categories – Base and Top-Up.  Base policies provide cover without any deductible amount, i.e., insurers provide the entire amount of the claim within limits.  On the other hand, Top-Up policies  do have a minimum deductible amount.  Their advantage is that they substantially increase the sum insured without an equivalent increase in premium.  But Top-Up policies should not be purchased without a base plan, as the deductible amount would then have to be paid from your pocket.  These days a good approach is to have a cascading set – a good Base Plan with a reasonable sum insured, and a Top-Up whose deductible amount is the sum insured of the Base Plan.  Best of both worlds!

4.    Right Sum Insured
These days, you should at least have a cover of Rs 5 lakhs per person. This means, if you have a total of 4 members, it is wise to have a total cover of at least Rs. 20 lakhs as the sum insured.

5.    Right Insurer
Selecting the right insurer is linked to the best plan that you finally select.  However, while shortlisting the right insurer, you need to keep in mind the following points:

i.    Cashless Treatment: This is offered in-network hospitals designated by each insurer. In these hospitals, you do not need to pay first and later claim        reimbursement. The claims are directly settled by the insurer with the hospital. An insurer with more network hospitals in your vicinity is better.
ii.   Claims Ratio: Look for an insurer that has a high claim settlement ratio. You do not want to argue with the insurer when someone is ill.

6.    Right Coverage
Once you decide the sum insured, you need to choose a plan to address the specific needs of yourself and your loved ones. Here are some points to keep in mind while selecting a plan:

i.    Room Rent Limit: This differs across hospitals and room types. It is better to go for a policy that provides a higher room-rent limit.  Often the room rent limit is linked to the sum insured, in which case you might need to increase the sum insured
ii.   Waiting Period: Health insurance policies have different waiting periods, e.g. 1-4 years, after which they cover pre-existing diseases, maternity    expenses, and certain treatments like hernia etc. Make sure you choose a plan that comes with a minimal waiting period.
iii.   Co-Payment: It is the percentage of the claim amount that you will have to pay from your pocket. For instance, if you have a policy with a 10% Co- pay clause, for a claim of Rs. 1 lakh, you will need to pay Rs. 10,000 from your own pocket while the insurance company will pay Rs. 90,000. Decide, if you want this. It helps reduce premium but adds to claims burden.
iv.   Pre/Post Hospitalization expenses: Your doctor may recommend some tests before a surgery or a planned hospitalisation. Similarly, after discharge, you might still have to follow up with the doctor and continue with some diagnostics. Make sure your plan covers these expenses as well.
v.   Sub-limits in the plan: Sub-limit refers to limiting the claim amount paid for specific diseases, treatments, or surgeries. E.g. for a cataract, you may be allowed a maximum amount of Rs. 30,000, or for normal delivery only Rs. 40,000. You should carefully assess these and match with your needs.
vi.  Free Medical Check-Up: Many insurance policies include free periodic check-ups as part of their add-on benefits. With an increase in lifestyle diseases, a free preventive health check-up can be valuable.

7.    Right Premium
The best plan could cost you a fortune and therefore, managing your premiums is an important task. How much premium to pay is your choice, but keep in mind that you should set aside at least 1-3% of your annual income an annual premium. The older you or the other insured members are, the higher should be your premium budget.

SANA.Insure is a health portal that guides you in choosing the best policies as per your specific requirements – whether you are looking for family health insurance, individual policies, health insurance for senior citizens or critical illness insurance - after comparing various plans available in India. Our Health Insurance Experts are available on Call on our Toll-Free number 1800 202 8118 or on WhatsApp Chat (8278271818). We will help you navigate through the site or guide you with any information you require throughout your purchase journey.

Wish you a healthy and happy life!

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