Buying the best health insurance policy should be on your priority list. In my opinion, it may be your great investment because ultimately it is for you and your family. It May save your lot of money in case of medical emergencies.
Risk and uncertainties are everywhere and at every minute. Day by day the number of diseases/illnesses is increasing. Road accident is also very uncertain.
If you have a health insurance policy then you would be able to claim medical expenses from the insurance company.
The cost of medical expenses are very high and also increasing day by day. Everyone is not able to afford a high level of medical expenses. So, health insurance is the best option. Here are some important tips and suggestions which may be helpful to get the best health insurance policy.
Table of Contents
- 1 1- Purchase a Health Insurance Policy in Your Budget
- 2 2- Focus on Required Coverage and Avoid Unnecessary Covers: Compare Plans
- 3 3- Claim Settlement Ratio and Claim Process
- 4 4- Life Long Renewal/No Maximum Age Limit for Renewal
- 5 5- Have a Look at the Network Hospital List
- 6 6- Policy Type – Individual or Family Floater Health Insurance?
- 7 7- Check Waiting Period in Your Policy
- 8 8- Check for Discounts – Family Discount/Online Discount
- 9 9- Inclusions and Exclusions of Health Insurance
- 10 10- Selection of Right Sum Assured
- 11 11- You should Check Co-Pay/Limits and Sub-Limits
- 12 12- Pre-Policy Medical Checkup and its Cost
- 13 13- Provide Correct Information in Your Health Insurance Proposal Form
- 14 14- You Should Purchase Health Insurance Even You Have a Corporate Policy
- 15 15- Free Health Checkup
- 16 16- Buy Health Insurance at Early Stage
- 17 17- Flexibility to Add a New Member in the Midterm of Policy
- 18 18- Cumulative Bonus or No Claim Bonus
- 19 19- Pre and Post Hospitalization Expense
- 20 Conclusion
1- Purchase a Health Insurance Policy in Your Budget
Just imagine for a moment, that you purchased a health insurance policy for your family last year. You paid the premium of Rs. 1 Lac. But this year you are not able to renew it because of the budget problem. Your income is average or low and you can’t pay this too much premium this year too.
Now what? Your policy may get lapsed and insurance service will get terminated. Yes, of course, there may be a chance to reduce the sum assured or convert the plan for a lower premium. But you have to do the needful process.
You should buy the health insurance policy in your budget. It will be easy for you to afford and renew it on time. I am not saying that you compromise with the features and benefits. I am just saying that you should choose it with good features at a reasonable price.
Have a policy that you can afford and easily renew it on time. So, that you do not lose your policy renewal and policy benefits.
2- Focus on Required Coverage and Avoid Unnecessary Covers: Compare Plans
Whenever you are planning to buy a health insurance policy, just take a pen and paper and first workout it. Note down your family members details and medical history etc. Now note down your requirements – Most priority, Least priority, and no requirement.
Now you search out different plans online and offline. Compare and check which one is the best-suited plan for you. Let’s see these examples.
Example-1: You are a married person of age 45 years. You have a wife and two children. You don’t want any child further. In this scenario, the maternity features should not be on your priority list.
Example-2: Mr. X is living an average standard of life. He Does not go foreign. Even he does not have a passport also. In this scenario, an overseas medical cover may not be on his priority list. If he is getting inbuilt features of health insurance at a reasonable price then it is OK. But if it cost a heavy premium then he may avoid this.
You should maximize the features at a reasonable insurance premium but don’t compromise important features because of a premium only.
3- Claim Settlement Ratio and Claim Process
The most important factor of your health insurance policy is the claim. You should check the claim settlement ratio of the insurance company. If the claim settlement ratio is high mean company is good on paying claims to its customers.
But if the claim settlement ratio (CSR) is very low then you should have a pause here. It may be a signal for you to think again. Claim rejection chance is high if CSR is very low. You should have a look claim ratio before you purchase the policy.
It is also important that the claim process is smooth and easy. You also check that company is providing a cashless claim. Always prefer a cashless claim option.
If there is only a reimbursement option then it may not be a good option for you. In reimbursement, first, you need to pay the medical expenses and later you get the claim through the reimbursement process.
4- Life Long Renewal/No Maximum Age Limit for Renewal
Life is very uncertain. Nobody knows how many years he or she will live. Nobody knows that when she or will become ill. There is a higher chance of being sick/ill at an older age. Comparatively, there is a lesser chance of being sick/ill at a younger age.
You should go through the renewal terms of the policy. You must opt for the policy which has no age limit for renewal.
In some plans, you may see that there is a maximum age limit to renew the policy. But you should give preference for a lifelong renewal kind of health insurance policy. Because you don’t know that medical emergency will come at the age of 30 years or 70 years or at another particular age.
5- Have a Look at the Network Hospital List
Insurance company has tie-up with so many hospitals to provide cashless claim settlement to the customers. The insurer has its own network hospital list. You should have a look at the network hospital list.
In my opinion, you should prefer the insurance company which has a high number of network hospitals. But you should also check that important hospitals in your residential area/workplace are available in the list. Because you may prefer to go to your nearby hospital in case of any medical emergency.
If you will get the health insurance claim on a cashless basis then you will not have any instant financial burden due to the medical emergency.
6- Policy Type – Individual or Family Floater Health Insurance?
Suppose, I have two options 1). Sum assured of Rs. 5 Lac for each member ( four members in the family) or 2). Sum assured of Rs. 20 Lac – family floater policy ( four members in my family). Premium in both the case is almost is same.
In the above cases, I will choose the second option because here sum assured is very high. Here, if there is any medical emergency with anyone then medical expenses can be covered up to Rs. 20 lac.
However, in the first case, you can claim up to a maximum of Rs. 5 lac. An example is only for understanding purpose actual figure may be different. If you are not a single individual and have a family then you should family floater policy. However, it is totally your decision which one you choose.
7- Check Waiting Period in Your Policy
Normally, all health insurance plan in India has some waiting periods. You may have the following waiting periods in your policy:-
Initial waiting period: Accidental hospitalization is covered from day one. The initial waiting period may range from 30 days to 90 days. It is depending on the plan and the company. Generally, the minimum waiting period is 30 days.
Waiting period for specific disease: In the Specific waiting period, the insurer does not cover a set of specific disease/procedures until 24 months from the policy inception. Eg. Stone, Cataract, Glaucoma, Fibroid, etc. For details refer to your policy terms.
Waiting period for pre-existing disease: The insurance companies do not cover pre-existing diseases during this waiting period. This period normally varies according to the plan. It may be 48 months or 36 months or less than 36 months.
Maternity waiting period: There are some health insurance plans in India which are covering maternity expenses also. But in some cases, you have to serve a specific waiting period. Most of the plan has a maternity waiting period.
In my view, you should check all the waiting period and its terms before you do final purchase. You will not be disappointed later if you are aware about it.
8- Check for Discounts – Family Discount/Online Discount
Discounts may directly impact your insurance premium. You must work out how much discount the company is offering and which one you can avail of. There may be these discount options on premium.
Family Discount: You may have the option to get a family discount if you cover more than two members in one health insurance policy.
Long-term Discount: Normally, companies provide a long term policy discounts also. In this case, if you purchase policy for 2 years or 3 years then you get some extra discount respectively.
Online Discount: Some companies may offer you an online discount also. You should check all the options for the discounts. You can minimize your health insurance policy premium by availing suitable discounts.
9- Inclusions and Exclusions of Health Insurance
If you think that you may get a claim for every medical expense in health insurance then it is not practical. Every plan has some permanent exclusions list. The insurer does not pay the claim for any permanent exclusions listed in your policy.
You must check this list. So, that you may be aware that what is not covered in your policy permanently.
Normally insurance companies does not cover treatment of ageing, puberty, intentional self injury, alcohol abuse, congenital condition, cosmetic surgery (apart from medically required). These are few reference only. For details list, you have to go through your health insurance policy terms and conditions.
10- Selection of Right Sum Assured
The selection of the right sum assured is a very crucial factor while purchasing a health insurance policy. Sum assured of 1 lac, 2 lac, 5 lac, 10 lac, or 1 crore? Which one is best? The ideal answer is higher sum assured is best. But it doesn’t mean that you have to buy only a sum assured of 1 crore only.
It depends on many factor to decide best sum assured for you or your family. It should consider following points before you final it:
- In which city you are living?
- What is your standard of living?
- Most important, What is your income and budget?
- In which hospital you prefer your treatment?
- What is the average medical cost for major disease treatment and or operations?
- How many members are there in your family?
Ideally, sum assured of Rs. 10 Lac to Rs. 20 lac is OK for treatment in India. However, it also depends on the above factors.
There is no perfect sum assured because the level of medical emergency and treatment cost may go at any level. However, you should always prefer a high sum assured which you can afford.
11- You should Check Co-Pay/Limits and Sub-Limits
When we buy a health insurance policy, the first thing that comes in mind that the insurance company will bear all future medical expenses up to sum assured. But this may not be the real picture. You must go through the details of limits and sub-limits and or co-pay.
Your plan may have some capping on room rent expenses, emergency ambulance charges, and some other expenses. Generally, in the lower sum assured plan there may be the limit on room rent expenses like 1 % of Sum assured, etc
There may be co-pay condition in your policy after particular age. You must know all the limit, sub-limits/co-pay so that you be prepared for the terms.
12- Pre-Policy Medical Checkup and its Cost
Insurance companies do underwriting and analyze the risk available in particular cases and issue the policy. In some cases insurer issue policy after a pre-policy medical test of the insured.
Pre-policy medical normally depends on the age of the insured, existing symptoms, pre-existing disease, height, and weight of the insured.
Question is who will bear the cost of this pre-policy medical test? It may vary from company to company and plan to plan. Some insurance companies bear the full cost of pre-policy medical tests.
But in some insurance companies and or plans policyholders bear 50% of the cost. There may be a different scenario also.
You should be clear about that who will bear the pre-policy medical tests’ cost and how much? So, that you may not face any challenge.
13- Provide Correct Information in Your Health Insurance Proposal Form
What if the insurance company rejects your claim at the time of need? There will be a big disappointment and sudden financial burden for you. You can go to ombudsmen and court. But what if there was a mistake from your side?
For example, you provided a wrong medical history at the time of filling the proposal form. In this case, the decision may not be in your favor.
You must provide correct and complete information in the proposal form. Name, date of birth/age, medical history, about symptoms if any, habits, profession, and other required details should be proper and accurate.
14- You Should Purchase Health Insurance Even You Have a Corporate Policy
Maybe, you are a salaried person and you have a corporate health insurance plan. But does is sufficient for your family? Generally, the corporate insurance plan has the sum assured between 1 to 5 lac. If you have a high sum assured corporate plan then it may be a better one.
But what if your sum assured fall between 1 to 5 lac. It may not be sufficient. In some cases, the cost of medical treatment of a major operation is so high in some hospitals. It will be a better choice if you take another health insurance policy parallel to your corporate plan.
It will save your saving in case of any medical emergency where the treatment cost cross your corporate policy’s sum assured.
15- Free Health Checkup
Most of the insurance companies provide free health check-ups in a health insurance policy. Some insurance companies like Religare, Maxbupa, etc are providing free health checkups on every claim-free year. However, it may also depend on the plan which you choose.
Some companies and plans are providing once on 2 or 3 claim-free years. You should check out before buying the policy. The number and list of tests may also vary according to companies and plans.
16- Buy Health Insurance at Early Stage
Most people and experts will suggest you take health insurance policy at an early age. My opinion also same. There may be the following points which you may consider:-
- First, It will cost you less premium.
- Second, You will serve the required waiting period on the early stage of your life.
- Third, there is very little chance of pre-policy medical tests.
- There is very little chance of rejection of your proposal form.
The chance of illness and disease is less at a younger age that is why the premium is also lower in comparison to a higher age.
17- Flexibility to Add a New Member in the Midterm of Policy
Do you have the flexibility to add new members to your health insurance policy at renewal and midterm?
Companies provide you this flexibility to add the new member at the time of renewal of the policy or in the midterm of the policy. It depends on your insurer and the kind of plan you have.
Ask your insurance agent about terms of adding a new member to the policy. If you expect your marriage or newborn baby after buying a policy then it is very important to know.
18- Cumulative Bonus or No Claim Bonus
Your insurance company provides you a cumulative bonus when you do not file any claim for the complete policy year. In some plans, you may get no claim bonus of 20% on every claim-free year. You can add this bonus maximum up to 100% of the basic sum assured.
Some plans may provide you the 50% bonus on the first claim-free year and again 50% on second claim free year. Total maximum up to 100% of the basic sum assured. There are more than 100 health insurance plans in the market and a bonus percentage depends on plans and company you opt-in.
Let’s see an example :-
|Basic Sum Assured||Rs. 10 Lac|
|First year no claim||Addition of 50% of basic sum assured = Rs. 5 Lac|
Now total sum assured after renewal = Rs. 10 Lac (Basic) + 5 Lac (Bonus)
|Second year no claim||Addition of 50% of basic sum assured = 5 Lac|
Now total sum assured after renewal = Rs. 10 Lac (Basic) + Rs. 10 Lac ( Total Bonus)
You must read your plan in detail so that you can understand all the conditions of cumulative bonuses and terms of utilization of bonuses.
19- Pre and Post Hospitalization Expense
You must check pre and post hospitalization expenses in your health insurance policy. This is the inclusive feature that covers medical expenses incurred before admission and after discharge from the hospital.
Pre-Hospitalization: Medical expenses incurred prior to the date of hospitalization. This may be for 30 days, 60 days or more as per the plan you choose.
Post-Hospitalization: Medical expenses incurred from the date of discharge from the hospital. It may be for 60 days, 90 days, or 180 days or else depends on the plan.
These expenses are covered in the case of inpatient hospitalization only. The expenses should be related to the disease/illness for which the insured was hospitalized. You can claim these expenses through reimbursement within a specified time.
The selection of best health insurance policy required proper attention. Whenever you plan to purchase, check all the features and benefits. Compare at least 4 to 5 companies plan. This may be a very important decision for you and your family.
So, it is very important to have the best possible health insurance policy. All the best!