How to Get the Best Health Insurance Plan

Tips How to Get the Best Health Insurance Plan in India

The web has brought to focus all that can be sold and bought. These include health insurance policies too. Also understood as medical coverage plans, these can be bought online either from your choice of the insurance company or from the sites of online insurance aggregator portals that list details of some major health insurance companies along with details of the health plans they sell.

With nearly 30 insurance companies selling more than 200 health insurance plans in the Indian market, comparing the benefits availed by each health plan and buying the right healthcare product is not easy. Listed followed are essential tips and tricks that ease the process of health insurance buying from the web. Some of them include:-

Choosing the Right Sum Assured Amount

Healthcare expenses are increasing each year. Inflationary rates also have had an augmenting effect on the prices of medical treatment. The amount spent on hospitalization and treatment of critical illnesses can burn a hole in your pocket. Hence, it is important to choose the amount of sum assured that would be adequate to pay towards the cost of treatment. Be it an indemnity plan or defined benefit plan, choose the health insurance policy that promises a higher amount of sum assured at nominal premium charges.

Providing Accurate Information

Many people tend to mislead insurance companies by submitting fake details regarding their age or health conditions to avail health coverage that otherwise would not have been available. Any kind of insurance policy is based on the principle of Utmost Good Faith, which means that in the absence of accurate disclosure, the insurer has the right to stall or deny the claim altogether. Submitting incorrect information or mismatch of details provided by the insured will result in claim rejection, thus, necessitating the customers to provide complete and correct details.

Understand the Factors Affecting the Premium

Not all health insurance policies cost the same. This means that the premium charges towards different health plans vary. There are myriad factors that affect premium charges including policyholder’s age, medical history, lifestyle, smoking and drinking habits, region, etc. Opting for cheap health insurance plans may prove to be disadvantageous in the long run. Also, not all costly plans providing health care coverage are unique. Take into account the premium determinants before zeroing on an affordable insurance plan for you and your family. It is important to remember that premium pricing is one of the vital factors for choosing a health plan, but definitely not the only factor. Contrast the premium prices with the benefits and features pursuant to each plan and buy your health insurance product accordingly.

Nature of Health Plan

Though family healthcare policies cost less than the medical insurance plans for individuals, it may not be always wise to choose health insurance policies based on premium prices or for the added services they promise. Not all add-on covers may be useful, so choose wisely. If your family members are already covered under a certain plan, it makes no sense to opt for family healthcare product options. Understand the extent of your needs before selecting the kind of plan you need.

Co-Payment Clause

While making health insurance claims, policyholders have to bear the claim amount in the ratio of the predetermined ratio or percentage. Many health insurance companies selling health plans mandate their customers to conform to the co-pay clause, thus, mandating them to make payments towards the definite amount of claim amount on each and every claim amount made during the policy tenure. Health insurance companies requiring their customers to bear a major portion of the co-payment clause will charge lower premium amounts while those offering low or zero co-payment clause will have higher premium charges as the onus of risk is greater on the insurer.

Sub Limits

This is actually a kind of restriction barring the insured from claiming too high from their health insurers. This limitation on the claim expenses is determined by the insurance company to put a cap or sublimit on certain charges to do away any scope of raising the charges. The health insurance company may apply sublimits on room rent charges, the amount paid as consultation fees to doctors, ambulance fees, admission charges to the Intensive Care Unit (ICU) of any hospital. The charges may be restricted to roughly one or two percent of the total amount of sum assured. However, there are some health insurance policies that include sublimits on surgeries so that the claim amount on surgeries does not exceed 50 percent of the total sum assured.

Waiting Period

Policyholders suffering from pre-existing disorders will have to go through a waiting period. The waiting period is essentially a prohibitionary phase wherein the insured are not allowed to make any claims on the health insurance policies they have bought nor are the insurers to accept the claim made towards the treatment of the pre-existing health problems. The waiting period varies across different health insurance companies. Hence, opt for health plans with minimal waiting periods.

No Claim Bonus (NCB) Provision

Many health insurance policies in India come with the No Claim Bonus provision. The benefit of this bonus is evident if the insured does not make any claim in any particular year. As per the provision, the insured benefits from the bonus in the form of increased sum assured or reduced premium rates at the time of policy renewal. The amount of NCB varies among health insurers. While reading the terms and conditions of the various health insurance companies, make sure that you read the maximum extent of NCB given by each of them.

List of Network Hospitals

Some of the best health insurance companies in India offer cashless hospitalization facilities to the insured getting admitted to any of the hospitals listed in its network. Before opting for any health insurance policy, it is important that you look at the list of hospitals included in its network and check if the preferred hospital near your place is included in the list of the intended insurer. This may prove fruitful in the event of emergencies where you might require to rush your loved ones to the nearest hospital providing the best facilities and avail the cashless treatment facility available.

Policy Renewal

You are more prone to illnesses and debilitating ailments with advancing age. This implies that one must opt for health insurance companies that allow policy renewal to many more years in the future as opposed to some that limit the plan renewability only to a certain period. Discard plans with limited renewability option as the need to purchase health insurance from an altogether different insurance company refrains you from buying a plan of your choice coupled with higher premium charges owing to buying the plan at a later stage. Also, if you wish to include your aged parents under the health plan, then it is preferable to opt for lifetime renewable health insurance cover.

Insurer’s Reputation

The credibility of your insurance company matters. First, check the list of health insurance companies selling the kind of plans you are looking for. Find out how long your health insurance company has been in business and its increasing consumer strength. Keep the following parameters in mind before choosing your insurer:

Incurred Claim Ratio (ICR)

This is one of the most determinants while comparing health insurance companies in India. The ICR may be evaluated as under:-

ICR = Total amount settled in claims / Total premium amount collected

Compare the ICR of all companies and prefer to choose with the highest ICR value.

Customer Review

Like all other products or services, check the reviews about your insurer too. Many customers share their experiences over the web, thus, making it easy for prospective policyholders to gauge the quality of the various insurance companies and their health plans. An increasing number of unhappy customers reflects the insurance company’s attitude towards its existing customers in addition to the quality of its customer care department and after-sales service.

Ease of claim settlement

Ease of the claim settlement process is essential to the credibility and reputation of any insurer. The aim of buying any kind of health insurance policy is an easy to claim settlement. Find out the claim settlement ratio (CSR) of each insurer. Opt for the one with a higher CSR value as it reflects the efficiency of the insurer’s claim processing department.

Final Note

Having a health insurance policy is important as without it one would incur heavy financial expenses towards medical treatment. Before buying any health plan, understand the factors that label it good or unsuitable. What suits your friend may not be in sync with your need or the requirements of your loved ones. Understand how you would want your health insurance policy to benefit you and your family in case of sudden need. Read the fine print of each insurer’s plan details before deciding to pay for the one in tune with your medical needs and budgetary limits.