Things to Consider When Deciding Health Insurance Plans

Health insurance - Insurers and the type of plans

This is one of the most important decisions when taking health insurance plans. Various companies provide insurance services in India. Again, all the companies have their own plans with different features and coverage. Therefore, you have to analyse your own needs, pre-existing health conditions, budget, number of members, etc., before selecting the company and the plan. If you want coverage for your entire family, then a family floater health insurance plan may be more helpful than individual health insurance. The family floater covers all the members under a single policy.

Age criteria

Age becomes the primary factor when calculating premiums for health insurance plans. Lower the age, lower the premium. This is because the chances of you developing life-threatening or chronic diseases are less at a younger age. This reduces the risk for insurance companies. Also, different companies have different protocols to charge premiums. Some charge premiums considering the age of each member in the policy individually, while others charge premiums considering the age of the eldest member in the family.

Premiums and top-ups

Premiums vary among different policies and insurance companies. This is because the coverage provided under different policies is different. Therefore, find a suitable policy with a premium that fits your budget. However, it is of utmost importance not to compromise with the risk coverage in lieu of lower premiums. Ultimately, the goal is protection against uncertainty. The policies also provide an option for riders and top-ups, where you can cover some additional diseases or increase the sum assured by paying an extra premium. If you feel that your base sum assured does not cover your all health risks adequately, then you can opt for a top-up health insurance policy as per your needs.

Network hospitals

Usually, insurance companies settle claims in two modes, i.e., for the reimbursement and cashless modes. Under reimbursement, you will have to pay medical bills from your pocket initially. Later, after lodging the claim, the insurer will reimburse you according to the terms and conditions of the policy. The other method is cashless. Here you pay directly to the hospital, and you don’t need to shell out money from your pocket. However, a cashless facility is available only in those hospitals with which the insurer has tie-ups. Therefore, it is necessary to see the network hospitals of an insurer before buying any policies.

Waiting period

The waiting period is the period during which no claim can be lodged for hospitalizations for pre-existing health conditions. This ranges from a year to three years for different companies. Go for a policy with as low a waiting period as possible. If any hospitalization occurs during the waiting period due to an already existing health condition, the whole medical expense will fall on your shoulders.

Pre & post-hospitalization coverage

Normally, insurance companies cover the expenses for a certain duration before hospitalization and after patient discharge. This is known as pre- and post-hospitalization coverage. While buying health insurance plans, ensure that the number of days covered under the pre- and post-hospitalization clause is more.

Portability

As a normal practice, if you switch your insurance company, there is a waiting period for existing health conditions to be considered. However, some companies provide a portability option where you can change your insurer without complying with new waiting period requirements and other limitations, thereby keeping the continuity benefits intact. Portability is easily available at a younger age, whereas, for senior citizens, many insurance companies may refrain from providing this feature as the risk is high.

No claim bonus

Each year, where no claim is made to the insurance company, it provides a no claim bonus. Usually, it is an increase in the sum assured for the same premium amount. The percentage of increase may differ among various policies, but this is usually a standard practice followed by all companies. Therefore, select a company with the highest percentage of increase.

Claims and co-pay clause

Look into the process of lodging a claim, reimbursement period, etc., before buying health insurance plans. For senior citizens aged 60 years and above, some companies incorporate a co-pay clause in the policy. The co-pay clause signifies that a portion of every claim shall be borne by you. The company will settle the rest. Usually, the co-pay ratio is around 10%, where you will bear 10%, and the company will settle the rest 90% of the claim. The lower the ratio, the better it is.

Maternity leaves, emergency hospitalizations, surgery, and operations coverage for new policies

These are exceptional cases, and you should be clear whether your policy covers these cases or not. New policies may not cover surgery and operations for initial one or two years. Many policies also do not cover maternity cases. Besides the above, ambulance charges, ICU charges, and transplants, are a few clauses that you should be aware of. These cases usually involve a high amount of expenses when the insured event is triggered.

Conclusion

The above points are a guide for the selection of the best policy. Always read the policy document or brochure containing all the terms and conditions and coverage of the policy before selecting one. You don’t want any shocks at the time of claim settlement because you overlooked certain conditions while purchasing your policy.