Checklist for a Good Health Insurance Policy or How to Choose the Best Health Insurance Plan for you

While Health Insurance is an important decision, there are several terms that you may need to know. There is also a wide range of insurers with a variety of plans to choose from. Don't let all this confuse you.

So, what do you check? Allow us to simplify this decision. Look for these essential aspects while selecting a health insurance plan.

1. Your plan should satisfy your primary requirement

Are you buying this plan while you are single? Or are you planning to start a family? Are you a diabetic or suffering from any other ailment? Identify what is your trigger and need to purchase health insurance and understand if the plan that you are considering will satisfy that need. Do not just think of the existing situation. Think ahead and plan to keep in mind your growing needs before you select the plan for you and your loved ones. A family floater can be a better option for you, wherein all the members of the family are covered under an umbrella plan.

2. Will the cover be sufficient

As a general rule, your health insurance cover should be approximately six times your monthly salary. Say if your monthly salary is Rs. 70000, then your cover should be anywhere between Rs. 4.5 lacs to Rs. 6 lacs.

3. Easy Claim Settlement Process

In case of a claim, you require a trusted brand that will make the settlement fast and hassle-free. It would be best if you select a brand that you can easily reach out to in that hour of emergency.

4. High Claim Settlement Ratio

It is the number of claims settled by the insurer divided by the total number of claims it receives. Higher this ratio, more is the chance that your claim will be settled.

5. Does your insurer have a cashless tie-up with the best hospitals in your city?

Are the hospitals in your proximity, having a tie-up with your insurer for a cashless facility? If this is the case, the insurer directly settles the hospital bill. If there is no such tie-up, you need to settle the bill first and later claim the bill from the insurer. More the hospitals in the insurer’s network, better is the plan.

6. Low Waiting Period

If you have a pre-existing disease or illness, then your insurer will have a waiting period up to 4 years for it. Only once the waiting period is over, you can make any claims for that disease. Lower the waiting period, better the plan is for you.

7. Minimum Restrictions and Limits

Most plans have restrictions and limits for:

• In-patient hospitalisation
• Day care treatment - Treatments that require less than 24 hours
• Room Rent - Generally, this has a cap of 1-2% of sum insured. (For example, if your cover is Rs. 500000, then the maximum room rent you can claim per day is Rs 5000. If you are admitted to a hospital with room rent of Rs 12000 per day, then you will have to pay the balance Rs 7000 from your pocket.
• Pre and post hospitalisation eligibility
• Sub-limits on Claim and Procedures - There is a limit on how much you can claim - especially when it comes to maternity.
• Lower the restrictions, in a plan, the better it is.

8. Lesser Co-payment

This means a clause that requires you to share the medical expense along with the insurer. For example, if the co-payment fixed percentage is 10%, then for a medical cost of Rs 1,00,000, you will be required to pay Rs 10,000, and the insurer will bear the rest. We suggest you go through the plans that have a lower co-payment ratio for you.

9. Exclusions

Make sure the list of diseases that are covered are as exhaustive as possible. If you have a family history of a particular illness or a pre-existing disease, then make sure the policy covers that disease. Also, look out for any other exclusions so that there are no surprises in store for you while making a claim.

10. Benefits specific to Coverage

There are particular benefits such as a No Claim Bonus and Restoration benefits that could be important for you to consider. A no claim bonus increases the sum insured if there is no claim made in the term of the health insurance policy. Restoration, on the other hand restores the sum insured in case it gets completely exhausted.

11. Other Expenses

Check if the plan covers OPD expenses, wellness services, provides a World-wide Cover, Health Check-ups and Riders.

At all times, make sure you have understood the policy wordings thoroughly. Choose a plan that meets most (say 7 or 8 out of your 10) requirements – if not all.

If you need help to know anymore, we can solve your queries. Call us now.