Life is full of uncertainties and medical emergencies are one of them. With the increasing cost of healthcare in India, buying a health insurance policy is almost inevitable.
But with so many options available, it can get confusing to find an insurance policy that would work just right for you. Do not worry, we have simplified this for you. Here is a quick rundown of the 10 things that you can consider to buy the best health insurance plan for yourself and your family:
1. The Age Criteria
Age is one of the crucial deciding factors when it comes to health insurance. While purchasing a medical policy do keep in mind the age of the family members who need to be insured. Like in a family floater policy, the cost of premium would depend on the age of the eldest family member.
Also, you would need to check out the age limit criterion when buying a health insurance cover. For instance, there are health plans that have the minimum entry age limit of 91 days and the maximum entry age limit of up to 60 years. And there are plans that have a minimum age limit of 25 years up to a maximum of 50 years. However, there are plans that do not have any restrictions on the entry age. So, you have the option to choose accordingly.
2. The Right Combination of Premium and Coverage
It can be lucrative to buy health insurance with the lowest premium. But there can be two sides to it. A policy with a lesser premium can be good if it is offering you extensive coverage at a premium that you can pay. The other aspect is lesser premium at the cost of the insurance coverage.
So, the best approach is to look for the reasons behind a reduced premium, as it should not be at the cost of the insurance coverage. Check if there is any additional clause of co-payment, deductibles, and sub-limits, and if it is then you would actually end up paying more at the time of claim.
You should buy a policy that offers adequate coverage, without compromising on the benefits and at a premium that you can afford.
3. The Waiting Period Clause
If you are aware of the waiting period clause then you would be in a better position to make a decision. The insurer will not accept any claim arising out of pre-existing illnesses or specific illnesses during this period. And it can range anywhere between 24 months and 48 months depending on the insurer and the plan that you have chosen. Moreover, you will be able to claim the benefits only when this period is over.
This waiting period shall apply to pre-existing illnesses like thyroid, blood pressure, diabetes, etc. that one may have before buying the policy. Additionally, it is applicable to certain specific treatments and illnesses like arthritis, varicose veins, cataract, etc.
So, you can compare and choose a plan that comes with a minimum waiting period to be able to claim the benefits in case of a health emergency.
4. Cashless Hospitalization Benefits
Health Insurance companies usually have a tie-up with network hospitals where the insured members can avail cashless treatment in case of a medical emergency. It saves you from the tedious paperwork that is required at the time of admission and claim. Moreover, the insurer pays the sum insured directly to the hospital.
So you don’t need to arrange for funds and then file for its reimbursement. It will be helpful if you check with your insurer for the list of empanelled hospitals and know what all network hospitals are there in your vicinity.
5. Pre and Post Hospitalization Coverage
Most health plans cover the medical expenses that are incurred during the hospitalization. Buy a plan that covers expenses incurred before and after the hospitalization as well to save expenses incurred on ambulance charges, medical tests, medicines, doctor fees, etc.
6. Coverage of Maternity Expenses
Ignoring the maternity benefits in a health insurance policy is a common mistake that a lot of people make. With the cost of delivery and maternity care already hitting the roof, it is better to buy a health plan that covers maternity expenses as well. Usually, there is a waiting period of 2 to 4 years before you can claim the benefits. For instance, if you are planning to get married or are planning a family let’s say after three years then a plan with a waiting period of 2-years will work for you.
Choose a plan that also covers newborn baby medical expenses apart from the delivery cost. Also, do not forget to check the limitations that are attached to it.
NCB refers to the discount offered by the insurance company for all the years that you have not filed a claim. Basically your coverage amount is increased at the time of subsequent policy renewals for all claim-free years.
However, most health insurance provides specify the NCB limit. And the increase in the sum insured would depend on the limit that is specified by the insurer.
For example, if you buy a health insurance plan of Rs. 5 lakh and the insurer offers 10% NCB for every claim-free year up to a maximum of 50%. The table below illustrates how NCB will affect your sum insured amount:
|Claim Free Year||Sum Insured|
|1st claim-free year||₹ 5,50,000|
|2nd claim-free year||₹ 6,00,000|
|3rd claim-free year||₹ 6,50,000|
|4th claim-free year||₹ 7,00,000|
|5th claim-free year||₹ 7,50,000|
Disclaimer: The above calculation is for illustration purposes only.
The maximum sum insured capping here is Rs. 7.5 lakh ( 50% of Rs. 5 lakh). So, before making the purchase make sure that you check the policy wordings for the NCB clause.
8. Preventive Health Check-up Facility
Even the cost of preventive health check-ups for cardiovascular diseases, cancer screenings, MRIs, etc. have gone up. When you can have it covered in your health insurance policy and have your insurer pay for the same, then why not do that? You can definitely save some money there. While deciding upon a medical insurance policy make sure that you check the coverage limit of preventive health check-ups as well.
9. Co-Payment Clause
A lot of people find this term confusing and tend to ignore it at the time of purchase. It is basically the percentage of the amount that you would need to pay at the time of claim and the rest will be paid by the insurer. So, before you sign your mediclaim policy check if there is any co-payment clause applicable that might impact your claim amount. If possible buy a plan that does not have sub-limits. However, if you have any pre-existing medical issues or have crossed a certain age limit most insurers would have a co-payment clause.
10. Claim Process
Check the policy wordings and go through the health insurance claim process that is followed by the insurance company. A smooth claim procedure is a boon at the time of settling health claims. You can do some research, read customer reviews online and select a health insurance provider that is known for its seamless claim settlement services.