Comprehensive Check-list For Getting Health Insurance

The Right Policy

Since health insurance plans come in different variants, the first step is picking a befitting plan. For those who do not formerly have health insurance coverage, buying a family floater health insurance plan is advisable. For customers with health plans offering low cover, opting for a super top-up is a good choice as it helps enhance coverage at affordable premiums. Also, critical illness health insurance plans pay a lump sum benefit in critical illness. Such a plan could be added to the portfolio for additional protection.

Optimal Sum Insured

Once the type of policy is selected, the next step is to choose an optimal sum insured. It is crucial as health plans only cover the policyholder up to the chosen sum insured. Based on the growing medical expenses, a high sum insured is imperative. A high sum insured may be availed by opting for super top-up plans to supplement the coverage. The idea is to ensure that there is sufficient coverage to meet the expensive medical treatments. An individual metro-dweller must have a minimum sum insured of at least ₹10 lacs, while for a non-metro family it is ₹6 lacs to ₹10 lacs.

Family Inclusive Cover

Ensuring that all family members are covered under the policy is the next step here. Ideally, try to include all members of the family during this part. It is advisable to opt for a separate senior citizen policy for the elderly and to not include them in the family floater policy. This drives up the premium and dissolves the no claim bonus. Additionally, a separate plan would also provide extra tax benefits.

Cover Benefits

Say, for instance, if the policyholder is planning to have a child soon, ensuring that the plan allows maternity coverage is a requisite. Furthermore, in cases involving frequent consultations and outpatient treatments, it’s wise to check for OPD coverage. Health plans also allow optional coverage benefits called riders or add-ons. Adding suitable riders for enhanced coverage is strongly advised. For instance, if you want coverage against critical illnesses and the plan offers a critical illness rider, choose the rider and get covered against critical illnesses.

Coverage Sub-limits

Often health plans have a sub-limit or restriction on their coverage benefits. Such sub-limits restrict the extent of coverage and harbour out-of-pocket expenses. Hence, do not forget to check the sub-limits applicable under the plan while picking out your policy. Try and avoid plans with sub-limits, especially in the case of room rent. Room rent capping is the limit of hospital room cost that is borne by our insurance provider. This capping can either be a whole figure that states how much room rent expenses are paid by the insurer or as a specific percentage of the sum assured. The lower the limit, the wider would be the scope of coverage.

No Claim Bonus & Health Check-up Benefit

Health plans allow no claim bonus if no claims are made during a policy year. This bonus can either be a top-up to the sum insured or a reduction in the renewal premium. Fee health check-ups are also allowed either annually or after 2-4 continuous years. Note the limits of these check-ups and their recurrence.

List of Hospitals

One of the prime advantages of getting treatment from a network hospital is its immediate relief. In times of medical emergencies, customers get cashless claims at network hospitals. It takes away the additional financial pressure in unfortunate events and helps customers attend the medical emergency at hand more proactively. So be sure to choose a plan that has more network hospitals while purchasing health insurance. By doing so you get wider coverage in the events of a medical emergency. Also check that the hospitals in your city and locality are featured on the list to avail of easy, cashless settlements.

Check the Exclusions

Knowing what is covered under the plan won’t suffice. That’s why you also need to know what is not covered in your health insurance policy. Check the exclusion list of the policy to find out what the policy won’t cover so that you have a more firm control on any unfortunate situation.

Check Waiting Period

Check the waiting period if you or any family member suffers from a pre-existing condition. Waiting period of 4 years for pre-existing diseases is a standard clause in almost all health policies. This is helpful to the policy holder because an insurance company cannot deny a claim after 4 years, i.e., once the waiting period is over.

Claim Settlement Ratio

It is calculated as the total number of claims received against the total number of claims settled. Simply put, claim settlement ratio is the total settled claims divided by the total claims filed. Let us say, a Health Insurance Company received 100 claims and among those, it settled 98, then the claim settlement ratio is said to be 98%.

Once you tick off all the above points before getting a health insurance policy, you are sure to bag the most relevant policy for yourself and your family. Remember, the purpose of this insurance is for you to get complete financial security.