How to Choose the Right Health Insurance Plan?

13 Tips to Choose the Right Health Insurance Plan

Here are a few smart tips to select the right health insurance plan for you and your family:

1. Pick a Plan As Per Your Health Needs

   If you want to buy medical coverage for yourself, you must opt for an individual health insurance policy. But if you want to cover your entire family, go for a plan instead of buying individual policies for each family member. Family floater plans are more affordable than individual plans as they cover all family members on a floater sum insured basis. Similarly, elderly people aged 60+ years must buy a senior citizen health insurance policy.

2. Choose an Adequate Sum Insured Amount

   When purchasing a mediclaim policy, make sure to choose a sum insured that you actually need. While a higher sum insured will increase your premium, a lower sum insured will be insufficient to cover all your medical expenses, leading to increased out-of-pocket expenses. Moreover, you must consider the age and medical history of all family members, your city of residence and future medical inflation while choosing the right coverage amount.

3. Opt for a Plan with the Right Coverage

   While buying medical insurance, analyze the health needs of your family and choose a plan that offers the right coverage. Ideally, you must go for a comprehensive health insurance policy that covers beyond hospitalization expenses, including OPD treatments, home care treatments, teleconsultations, non-medical expenses, ambulance charges, modern treatments, etc. Moreover, you can consider customized plans for specific coverage, like maternity insurance for newly married couples.

4. Pick an Affordable Plan

   Make sure to choose a health insurance policy that fits your budget. Ideally, you should choose a plan that provides the right coverage for an affordable premium. Buying a comprehensive but costly policy may make it difficult for you to afford premiums in future. On the contrary, if you go for a plan with the lowest premium, you may lose out on a lot of coverage benefits.

5. Prefer Plans with No Sub-limits/ Co-payments

   At the time of choosing your ideal mediclaim policy, look for plans without any sub-limits or co-payment clauses. While sub-limits restrict the maximum amount you can claim for a treatment/procedure, co-payment is the share of the claim amount you agree to pay during claim settlement. Since sub-limits and co-payments increase your out-of-pocket expenses, avoid buying plans with these clauses and prevent any financial burden during claim settlement.

6. Choose Plans with a Lower PED Waiting Period

   While choosing medical insurance, especially for parents or senior citizens, prefer plans with a lower pre-existing disease (PED) waiting period. The PED waiting period is the time period during which you cannot raise any claims for pre-existing diseases. Although most plans cover PED after 1 to 3 years, some plans offer PED coverage from day 1 for diseases like hypertension, diabetes, etc. Since elderly people have age-related issues, a lower PED waiting period can help them file claims sooner.

7. Go for Plans with Restoration Benefit and Annual Health Check-ups

   To choose the right health insurance policy, make sure to consider plans with restoration benefits and annual health check-up facilities. The restoration benefit recharges your sum insured before renewal if the original coverage amount is partially/completely exhausted. On the other hand, the annual health check-up benefit pays for your preventive medical tests every year. These benefits are useful to enhance your coverage quality and, thus, should be preferred.

8. Pick Plans with a Longer Coverage for Pre & Post-Hospitalization Expenses

   A good medical insurance policy covers pre & post-hospitalization expenses for a longer duration. While pre-hospitalization expenses cover medical expenditures incurred before hospital admission, post-hospitalization expenses cover those incurred after hospital discharge. Thus, make sure to go for plans that offer coverage for at least 60/90 days of pre-hospitalization expenses and 120/180 days of post-hospitalization costs.

9. Check the Policy Exclusions

   Every health plan comes with some standard and some specific exclusions. It is essential to check exclusions in a health insurance plan to know what the insurer will not pay for. For instance, health insurers do not pay for cosmetic surgery, intentional self-injury, etc. So, if you seek coverage for a specific treatment/disease, make sure to pick a mediclaim policy that has not been included on their list of exclusions.

10. Opt for Plans with Preferred Riders and Add-ons

    Riders or add-on covers can enhance the coverage of a standard health insurance plan on payment of an additional premium. You can consider add-on covers, such as critical illness cover, inflation shield, personal accident cover, etc., and riders like hospital cash rider and global cover rider to extend your policy coverage. For instance, senior citizens can opt for a PED waiting period reduction rider to claim their PED expenses early. Therefore, prefer plans that offer your preferred add-ons or riders.

11. Go for an Insurer with a High Claim Settlement Ratio

    While buying a mediclaim policy, go for an insurance company that enjoys a high Claim Settlement Ratio or CSR of 95% or above. The CSR is the ratio of the total claims settled against the total claims received in a year. A higher CSR indicates that the insurer settles most claims it receives. Thus, if you opt for an insurer with a high CSR, you have a higher chance of getting your claim settled.

12. Check the Reputation of the Insurance Company

    Before you purchase a health plan, make sure to check the reputation of various health insurance companies in India. You can check customer reviews online and prefer insurers that offer good after-sales customer services, an easy claim process and speedy claim settlement. Prefer an insurer with a large network of empanelled hospitals, preferably 7000+. Moreover, check the insurer's track record and prefer those with an extensive record of 5+ years.

13. Compare Health Insurance Plans Online

    One of the best ways to pick the right health insurance plan is to compare various mediclaim polcies online on the basis of their coverage, benefits, and premiums. Comparison helps you to find the plan that offers the best coverage within your budget. You can easily compare health insurance online on websites like Policybazaar.com to get the best deal.

How to Choose the Right Health Insurance Plan If You are Planning for Kids?

If you are a newly married couple planning for kids, you should prefer a health insurance policy with maternity cover. Maternity insurance covers the medical expenses incurred during pregnancy and childbirth, including delivery expenses and pre-natal and post-natal expenses. Besides, they also pay for newborn baby treatments and vaccination expenses.

Here are a few things to consider while choosing the right maternity insurance plan if you are planning for kids:

• Expensive Maternity Procedures – Maternity procedures and scans are quite expensive in India. For example, normal delivery charges in Delhi range from ₹25,000 to ₹90,000, while C-section delivery charges range from ₹35,000 to ₹1,20,000. Make sure to opt for a policy that comes with a sub-limit sufficient to cover delivery expenses in your preferred hospital.
• Spouse Clause – Several pregnancy plans come with a spouse clause where both you and your spouse should be covered in the policy to activate the maternity cover. Make sure to read the policy terms and conditions carefully to know if there is a spouse clause in the policy.
• Maternity Waiting Period – All maternity insurance plans come with a waiting period ranging from 3 months to 6 years. You cannot file a maternity claim unless you serve your maternity waiting period. So, if you are planning for kids in a year or two, opt for a policy with a shorter maternity waiting period of up to 1 year. On the contrary, if you are planning to have kids after a few years, you can opt for a longer waiting period of over 2 years.
• Costly Maternity Premiums – Most health insurance plans do not have in-built maternity cover. You need to opt for maternity cover separately on the payment of an additional premium. Hence, make sure to choose a maternity policy with a premium who can afford to pay.

How to Choose the Right Health Insurance Plan If You are a Salaried Individual?

If you are a salaried individual, you must opt for a personal health insurance policy even though your insurer may offer a corporate health policy. This is because corporate policies usually have a small sum insured of up to ₹5 lakh and are active as long as you work in the company. Besides, corporate policies may have limited coverage and restrictions like room rent limits.

Having a separate medical insurance policy can come to your rescue in case your corporate policy falls short of paying your medical bills or if you switch your job.