Factors To Consider Before Opting For A Health Insurance Plan

factors consider choosing health insurance plan healthcare policy coverage india

Being in a perfect state of health is our ultimate goal, but it has also increasingly become difficult to cope with our stressful lifestyle - the root cause for many ailments. Many families find it hard to meet their medical needs, even more since healthcare costs are going up. Thus, having a health cover is vital, but choosing one can be a daunting task, considering that the market is replete with numerous options offered by several health insurance companies in India. It is better to do your research and decide what is best for you and your family. 

In other words, you should select medical insurance with the best coverage that will protect your finances, mostly when medical emergencies occur without the slightest warning. 

Things You Must Consider Before Getting Health Insurance 

For keeping things easy, here is a list of factors you should check to make an informed decision. 

1. Type Of Health Policy 

There are various types of health insurance policies in India, such as individual health insurance, family floater, senior citizens health insurance, critical illness health insurance, etc. Assess your medical needs first that will help you decide the type of coverage you require. Nowadays, there are also maternity plans and disease-specific plans in India that health insurance companies, such as Care Health Insurance and HDFC Ergo, offer their customers. For example, Care Freedom is a customized health plan by Care Health Insurance that people having diabetes can opt. 

2. Sum Insured 

Ailments or injuries can strike anytime. Having adequate health coverage will help you remain worry-free even in times of emergency hospitalization. To select the right sum insured, estimate the medical costs you would incur in a year. Going for a higher sum insured is a wise move, considering the medical inflation due to which some medical procedures have become expensive. 

3. Health Insurance Premium 

Health insurance premium depends on various factors, such as age, the sum insured, the number of insured members, pre-existing condition, etc. Getting the best medical insurance would not be expensive only if you look closely. After a quick comparison of various premium amounts, using an online health insurance premium calculator, you will get an idea about the best health cover – that is affordable and gives maximum coverage at the same time. Look for premium discounts that are often available if you select a longer policy term. 

4. Cashless Hospitalization Facility 

Review the network hospitals of the insurer you have chosen. It will help you know if you have quick access to the cashless hospitalization facility. With this facility, a family will no longer have to go through the elaborate task of arranging money and making cash payments for medical bills. It is the insurer that will settle the expenses on behalf of the insured. The wider the hospital network is, the greater are your chances of locating a network hospital in your area – a useful tip when selecting the best medical insurance policy. 

5. Features And Benefits 

Do not settle until you have checked the benefits and various features of the health policy. A good health plan will provide you coverage for in-patient care, room rent, ICU charges, ambulance charges, pre and post hospitalization medical expenses, domiciliary care, and day care treatment cover. Additionally, look for benefits such as no claim bonus, annual health check-up, and automatic recharge of sum insured. These will provide additional financial support for the policyholders. Some plans also offer alternative treatment cover, which is particularly beneficial for senior citizens or people with chronic conditions like diabetes. 

6. Exclusions 

While you have checked the things that your policy covers, do not forget to read the exclusions to understand the various expenses that your policy will not cover. It will help you safeguard your finances and plan for out- of-pocket costs. 

7. Waiting Period 

Health insurance plans come with the waiting period clause. Usually, they are classified into: 

- Initial waiting period 
- Waiting period for specified ailments 
- Waiting period for pre-existing conditions 

A policyholder has to wait for a specified period before he or she can get a claim on the medical expenses, as defined in the policy document. Because of this fact, precisely, one should get a health cover early, more so, as the chances of having a pre-existing condition are lesser when one is young. 

8. Co-Payment 

There is a feature of co-payment in health insurance plans wherein the policyholder has to bear a certain percentage of the total claim amount. The percentage may vary depending on the insurer. Check this feature before you finalize an option. 

9. Claims Procedure 

You would want to avoid any hassle that might come in the way of making a successful claim. To ensure, you should be completely aware of the claims procedure. Usually, there are two ways you can make a claim: 

- Reimbursement Claim: You have to pay for the expenses from your pocket, and the amount will be reimbursed by the insurer after you have submitted the claim form and relevant documents. 

- Cashless Claim: In this facility, you can get admission in any network hospital using a health card and go for cashless treatment. The insurer will settle the expenses with the hospital, subject to policy terms and conditions. 

Checking the claim settlement ratio is a good way to know about the track record of health insurance companies in India. It is the number of claims an insurer settles in a year to the total claims made. The higher the ratio, the better it is. 

10. Lifelong Renewability 

Opt for a health policy that offers you the lifelong renewability option. With this option, you can continue to get coverage in the same policy through successful policy renewals and get all the benefits it has to offer. Getting a health cover becomes difficult as a person ages. So, the lifelong renewability proves to be a blessing. 

Healthcare Plan Considerations Conclusion 

Of all the things that matter to you, your family’s well-being is foremost. Your loved ones should get adequate healthcare protection, and for that, you should invest your time selecting the best health cover after considering all the points mentioned above. This way, you will keep your health insurance coverage policy savings intact and ensure a safe future.

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