How to determine the right health insurance policy for you?

What to consider when buying health insurance?

Assess your needs and priorities

Before diving into the ocean of health insurance policies, take a step back and analyze your healthcare needs and priorities. Begin by considering your current health status, any pre-existing conditions, and your family’s medical history. Do you want coverage for routine checkups and preventive care, or are you more concerned about potential emergencies and hospitalizations? An assessment of your needs will lay the foundation for the type of policy you should focus on.

Understanding Policy Types

There are different types of health insurance policies, each catering to specific needs and preferences. It is very important to choose the right health insurance policy for both you and your family. The sum assured should adequately meet your needs as and when the situation demands.

Coverage and Benefits

Carefully examine the coverage offered by each policy. This involves looking at some key components such as:

Inpatient Hospitalization Coverage: Hospitalization refers to a patient’s stay in a hospital for more than 24 hours for treatment or medical care. All insurance companies provide adequate coverage, often up to 100 percent, for inpatient hospitalization. Look for a plan that offers optimum coverage for inpatient hospitalization.

Coverage for Day-Care Treatment: Some medical procedures can be completed in a single day at the hospital, such as cataract removal, tonsillectomy, chemotherapy, and more. Therefore, look for a plan that covers a large number of daycare treatments.

Room Rent Allowance: It refers to the provision of hospital room cost as mentioned in the selected plan. While some plans have no prescribed limit on room rent, others allow a certain percentage of the sum assured towards room expenses. For example, with a coverage of Rs 3 lakh and a cap of 1 per cent room rent, the maximum room entitlement would be Rs 3,000. However, this may prove to be insufficient. It is beneficial to be aware of the maximum room allowance in order to effectively strategize your insurance needs.

Coverage of pre and post hospitalization expenses: This includes reimbursement of pre-hospitalization expenses incurred and direct post-discharge costs from illness or injury caused by the policyholder’s admission. Generally, the eligibility period for pre and post hospitalization is 30 and 60 days respectively. Nevertheless, some plans impose limits on the coverage amount. Look for a plan that offers comprehensive coverage for pre and post hospitalization expenses.

Read the fine print to understand coverage limits, exclusions, or waiting periods. Some policies may have limits on certain treatments, services or drugs. Being aware of these restrictions ensures that you are not caught off guard when you need coverage most.

Sub-limits for specific expenses / treatments

The sub-limit is the maximum limit of the amount that the policyholder can claim for a particular expense or medical procedure. For example, as seen in the case of room rent, some plans impose sub-limits on specific treatments. For example, cataract surgery may have a specified sub-range per eye. Similarly, maternity services often have sub-limits, including a limit on normal delivery and a separate limit for cesarean delivery.

network of providers

Cashless service involves availing medical treatment without paying the bills in person. The insurance company takes the responsibility of settling the medical expenses of the hospital directly. However, while all insurers offer this cashless service, it is important to note that not all hospitals across India are affiliated with the cashless network of insurers. In fact, out of 50,000 private hospitals in India, insurers expand the cashless network to 4,000 to 8,000 hospitals. The extent of this cashless network varies between different insurers. Therefore, it is advised to thoroughly review the list of hospitals covered by the cashless service of the insurer to determine whether major hospitals in your city are covered or not. It is important to focus on the quality of hospitals in your city rather than the total number, as about 90 percent of hospitalizations are planned. This ensures that you choose a hospital that provides top-notch healthcare services.

cost considerations

While health is priceless, budget constraints are real. It is essential to understand the costs associated with a policy. Pay attention to the following:

premium

This is the amount you pay periodically (monthly or annually) to maintain the coverage. Consider your financial ability to pay these premiums continuously.

deductions

The deductible is the amount you pay out of pocket before insurance coverage begins. Policies with lower premiums often have higher deductibles.

co-pay and co-insurance

Co-pay is the fixed amount you pay for specific services, while co-insurance is a percentage of the cost you share with the insurance company. Balance these against the premium to assess the overall cost burden.

out of pocket max/limit

This is the maximum amount that you will have to pay in a policy year. Once this limit is reached, the insurance company covers the remaining cost.

consider future changes

Anticipate any changes in your life that may affect your insurance needs. If you plan to start a family or change jobs, make sure your policy is flexible enough to accommodate these changes without disrupting your coverage.

comparison shopping

Now is the time to embark on the journey of comparison shopping, armed with a clear understanding of your needs and various policy components. Use online tools, insurance comparison websites and consult insurance agents to gather quotes and detailed information about different policies.

Read reviews and find recommendations

Don’t underestimate the power of reviews and recommendations from friends, family and online communities. Learning from the experiences of others can provide valuable insight into the claims process, the quality of customer service and the overall satisfaction level of policyholders.

Review the reputation of the provider

Research the reputation of the insurance company in terms of customer service, claim settlement efficiency and financial stability. You want an insurer that is there for you when you need it most.

Review and adjust annually

Your health insurance needs may change over time. As your circumstances evolve, it is important to review your policy annually to make sure it still fits your needs. You may find that a policy that was once suitable no longer meets your needs, prompting you to look for alternatives.

Disclaimer: None of the Business Standard journalists were involved in the making of this content