11 tips to choose the best health insurance plan

Mr X, one of your society members, bought health cover plans last month. Last week, he was admitted to the hospital. He believed the insurer would pay his bills or settle his claim. But it was all in vain. He didn’t get any money from his insurance company.

What might be the reason?

No, the insurance company was not at fault.
Not even Mr X was liable.

It was his lack of insurance knowledge that put him in trouble.
He was making a claim for a pre-existing disease just after 3 weeks of buying a policy. Companies usually have a specific waiting period before settling a claim. So, the proper knowledge will provide you with financial protection at the time of requirement.

Indian stand-alone health insurance companies sold around 13.8 million health cover plans
last year. Though thousands of people might have bought the same policy from the same insurance company on the same day, everybody’s claim settlement procedure will differ. This is because everyone has a different health history, age, and medical conditions.

This blog will discuss essential terms and concepts followed in health insurance (and you must be acquainted with them).

Tips to consider before buying health insurance
Here are 11 pointers that impact your policy purchase and claim settlement:

1. Pick the correct type of health insurance plan: Determine whether you want individual medical insuranceor a family floater plan. The features and coverage might vary in both. Individual health insurance will cost you less than a family plan. In a family plan, the SI amount can be utilised by any member, while in an individual plan, you can solely avail yourself of the benefit. You can also go for a critical illness insurance policy if you have any critical illness.

2. Choose the right SI amount: The higher the Sum Insured (SI), the more the premium. Sum Insured is the amount that an insurance company pays an insured in case of a mishap after considering certain factors. You can decide the SI amount by considering the following factors-
a. Analyse your regular annual medical expenses.
b. Check your current age because, with time, the chances of developing a health condition increase.
c. Consider your health history. A higher SI amount might be needed if you have any pre-existing disease.
d. If you already have health insurance coverage, a lower SI amount might work.

3. Check for cashless facility: Claims are settled in two ways- reimbursement and cashless. Primarily, companies provide cashless treatment when you get admitted to their network hospitals. So, before choosing your insurer, check whether the topmost hospitals in your city are among its tied-up hospital list. Otherwise, you have to clear the bills from your end and then file a reimbursement, which might be time-consuming.

4. Comprehensive coverage: If you do not take allopathic treatment, you can also buy a health insurance policy. Many companies also cover AYUSH (Ayurvedic, Yoga, Unani, Siddha, Homeopathy) treatment, domiciliary care, etc. Ask your insurer about these treatments to make an informed decision.

5. Rewards: Many insurance providers offer bonuses, renewal discounts, and benefits over a claim-free policy year- these are additional perks that are called health insurance riders. Check for all these too and get higher coverage.

6. Capping and co-payment: It is the fixed percentage of the medical expenses that the insured pays. For example, if a company has a 15% capping on arthritis, then the insured has to pay that percentage of the expense and the insurance company will pay the rest of the claimed amount taking into account the terms and conditions. So, it is quintessential to make yourself aware of these.

7. Ask for renewal procedure: You have to renew your health insurance after its tenure is over. In case of multi-year policy, the same has to be renewed before the tenure expires. Moreover, raising and settling a claim should be accessible. Ask for the ease of the renewal process before your pick your insurer.

8. Understand exclusions: If you are drink and drive some night and you hit somebody on the road. The accident injured both of you. Will your insurer pay the claim?
No.
No health insurance company covers permanent exclusions because there was no uncertainity in such cases. A person invited troubles and created risks for himself, so, no coverage is available.
Exclusions are restrictions on certain treatments, self-inflicted injury, procedures and services. Some other examples are- suicide attempt, cosmetic surgeries, pregnancy and child birth, miscarriage, etc. Make sure you read them well before signing on the dotted line.

9. Knowledge of PED Waiting Period:
The diseases that you have been suffering from or have already recovered or which have signs or symptoms received within 48 months before issuing the first policy are called PEDs (Pre-Existing Diseases). According to the regulatory body IRDAI, PEDs are subject to underwriting policy and product design and are covered only after serving a certain waiting period.
So, you must inform your insurance company about any existing illness or any treatment you have gone through. It will ease your health insurance buying and claim settlement journey.

10. Know the claim settlement ratio: On choosing a health insurance company, claim settlement ratio makes a big difference. This ratio is the percentage of the claims settled by an insurance company out of total claims received. Raising and settling a claim should be accessible. Ask for the ease of the renewal process before you pick your insurer.

11. Slow growing ailments: Cataract, tumour, stone, cyst, hernia, are some of the named ailments that all the health insurance companies cover after a defined waiting period. Also, companies have respective clauses for the same, as they are covered after a certain period of buying the policy. You can’t raise a claim for a named ailment or a slow growing disease instantly after buying a policy. So, having the right knowledge of coverage of slow growing diseases will smoothen your process.

Winding-up
Congratulations on taking the first step towards educating yourself regarding health insurance policies. We have covered the best tips that you must keep in mind before buying one. Now, by the end of the blog, you are proficient with the most important terms like pre-existing diseases, named ailments, SI and more. It’s important to be well-versed with them because a little knowledge is a dangerous thing and may have harmful consequences.

FAQs
Q1. What is maximum age to buy a health insurance policy?

Ans. According to the provisions of Regulation 12(i) of IRDAI Regulations 2016 (HIR 2016), health insurance policies should provide an entry age of up to 65 years. There are several insurance policies that offer coverage beyond this age too. Also, if a senior citizen has been renewing his/her policy without any break, then renewal should not be denied. So, health insurance is a lifelong policy.

Q2. What will affect my premium amount?

Inflation rate affects the amount of premium. Also, if you buy any add-ons then the premium will increase. Moreover, age, PED, residential area etc. affect your premium of health insurance coverage.

Q3. What are the topmost standalone health insurance companies?

Care Health Insurance, Niva Bupa, Aditya Birla are the largest standalone health insurance companies.