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6 Reasons Health Insurance Policies Don’t Succeed

Health Insurance Policies

The purpose of a health insurance plan is to provide timely and adequate financial support during medical emergencies.

Policyholders often lament that their health insurance plans do not serve the requisite purpose despite the fat insurance premiums they pay.

This is because frequently, in times of pressing medical situations, either the health insurance plan does not offer sufficient coverage or the claim is denied altogether by the insurer.

Although insurers are sometimes to blame due to lack of transparency or loopholes that policyholders fail to observe, it is also true that at other times, the fault lies either with the policyholders or the process/circumstances under which the health insurance plan is purchased.


Here are some of the most common reasons why health insurance policies fail to succeed:
Insufficient cover, low premiums

To factor in the ever-growing medical inflation, it is crucial that more than adequate cover be taken while buying a health insurance policy. Without sufficient cover, even the best health insurance policy is only a piece of paper without any value.

For instance, a health plan with a cover for Rs. 3 lakhs creates a huge setback if a person suffers major health issues like a cardiac or brain surgery, which costs up to Rs. 6 lakhs. In these cases, despite having a health insurance plan, the inadequate medical cover leads to financial stress.

Also, people generally have an impression that a low health insurance premium translates to a good deal.
In reality, the reverse is true - lower premiums mean lower benefits. The insurance company may not provide coverage for both pre and post hospitalization expenses, put a limit on specific surgeries or hospital room expenses, or completely exclude certain diseases from the policy coverage. Such restrictions offset the benefits of a health insurance plan.

The fine print

It usually seems like a task to go through an insurance policy’s technical terms and conditions. However, to get a fair deal, it is important to read all terms and conditions in detail to know our rights and understand what exactly we are signing up for.

For instance, some policies have a waiting period clause stating that if there are any pre-existing diseases, then before filing the claim, the policyholder will have to wait a minimum of 12 months from the time of policy commencement. Also, hospital room/ICU charges are sometimes paid out as a pre-defined percentage and not at actuals. If a policyholder goes ahead and files a claim without being aware of such clauses, the claim will be rejected.

Hasty decisions

Most people are unaware of the different health insurance plans available and the offerings/options that come along as a package deal. People, therefore, tend to hastily purchase the first health insurance plan they come across without giving it a serious thought. This leads to an incorrect, unsuitable health plan purchased in haste either due to one’s own lack of awareness or possibly due to the insurance agents’ persuasion strategies.

Not making comparisons

Insurance agents mostly sell policies in line with their own priorities rather than the customer’s expectations, needs, and requirements. They usually focus on having people buy those health plans from which they can earn higher commissions. Hence, not comparing different policies and going blindly by the agent’s word may lead to disappointment in the future.

Not knowing enough

One of the biggest blunders people sometimes make is not researching enough on their own about various insurance products available in the market. It is always wise to do maximum research, draw comparisons, and find a health insurance policy that is in sync with yours and your family’s specific requirements.

The internet offers a wealth of information where you can find various policies, compare, understand, and decide – all at the click of a button. Making comparisons between different options can help in getting the best and customized health insurance plan with the best offerings/inclusions at the best prices.

More than a tax-saving instrument

Many of us believe that insurance is yet another tax-saving instrument. This leads to people only considering the premium amount without taking into account how useful the policy will actually be towards covering medical expenses in times of real need.

One may think they have bought a great policy by looking at the low premium payable, whereas the policy may not include essentialities like pre-existing disease coverage etc. This leads to bigger expenses in times of medical emergencies, despite having health insurance.

Avoiding these mistakes and exercising caution while purchasing a health insurance plan ensures that the policy helps overcome financial obstacles during a medical crisis.

767,296 Confirmed Cases in India*
12,655,555 Confirmed Cases worldwide*
545,742 Confirmed deaths worldwide*
Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
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