In India, there are so many types of health plans available ,it is very difficult to find the right one for you . Your health should come first, and you should carefully select a plan that fits your needs and budget. We’ll lead you through the necessary stages in this guide to assist you in finding the ideal health plan that protects your wellbeing and financial stability and enables you to make an informed decision
Table of Contents
What is Medical Health Insurance Plan?
Each time we visit a doctor for a cold or cough, we are not bothered about the cost. We can choose a doctor of our choice and affordability.It does not affect our monthly bill.But if something serious happens, like a heart attack or some serious injury requiring surgery, the cost would be very high, and we normally do not budget for such incidental extra expenditure.
Medical coverage entails a contractual agreement between an individual and an insurance provider, wherein the insurer agrees to bear a significant portion of the medical expenses in exchange for a regular premium. This ensures that policyholders can avail themselves of medical treatments without facing exorbitant costs
Why is a Health Insurance Plan required?
One way is to use our savings for these emergencies.The second way is that we keep a small premium year after year and get cover in case of need.It is needless to say how much stress we avoid if we have proper cover for family.Our financial planning can go for a toss if we don’t have a suitable health insurance plan.
Even though it is constantly changing, the Indian healthcare system can be expensive, particularly in cases of unplanned medical emergencies. Financial limitations won’t prevent people from receiving timely, high-quality medical care, thanks to health insurance.
Benefits of Having Health Insurance Plan
-Financial Security: Medical coverage offers a safety net against unexpected medical expenses.
-Access to Q1uality Care: Policyholders can avail themselves of treatments at some of the best hospitals and medical facilities.
-Preventive Services2: Many plans include coverage for preventive check-ups and screenings.
-Cashless Treatment: Insurance providers often have tie-ups with hospitals, enabling cashless treatment for policyholders.
-Tax Benefits: Premiums paid towards medical cover are eligible for tax deductions under Section 80D of the Income Tax Act.
Types of Medical Cover
1. Individual Health Insurance
Individual health insurance covers a single person’s medical expenses, offering a personalized approach to healthcare coverage.
2. Family Floater Plans
Family floater plans extend coverage to the entire family under a single policy, making it a cost-effective option for families. These policies provide coverage for a large number of family members. You may receive coverage for
Yourself
your spouse
children
parents
3. Group Health Insurance
Group health insurance is provided by employers to their employees, offering comprehensive coverage to a large group of people.
4. Critical Illness Insurance
Critical illness insurance provides a lump sum if the insured is diagnosed with a critical illness listed in the policy.
How To Choose A Health Insurance Plan For Your Family?
Before we decide to buy a health insurance plan, we need to ask the following questions to ourselves and any agent if we are engaging one.Buying a medical insurance policy is a long term decision, and one wrong step can undermine all efforts and cost money.All such decisions are not easy to reverse.
Step 1 : How much cover do we need?
Before this question can be answered , we need to know what lifestyle we are leading and in which city we are living.What kinds of hospitals are we comfortable with or used to.There are five star hospitals and OK-type hospitals in our neighborhood.But a rule of thumb can be worked out to make the choice easier. 5–15 lakh in medical cover would be sufficient in most cases.If we are staying in smaller cities, ,cover of 4-6 lakhs could be good enough, and if we are staying in Delhi or Mumbai and we aspire to take treatment in posh hospital , a cover of 10-15 lakhs would be OK depending on the area of Delhi or Mumbai we are staying in.
Step 2: How much does it cost?
It is important to know what the policy premium is now and how it will change with age in the future.This price is to be compared with similar plans from other companies.Inquire with the company or agent about the premium in 10 years.
A high insured amount is preferred because to rising medical inflation and expenditures. A high sum insured, though, also means a hefty premium. Therefore, if cost becomes a concern, you can choose top-up or super top-up health insurance policies to increase the coverage limit without incurring a substantial monthly expense.
Step 3: Check that policy should not have CO PAY option
Before you buy a health insurance plan,you must ensure that the policy does not have something called CO PAY clause.It means every time a claim arises, a certain percentage of the claim policy holder has to bear,even if claim amount is less than insured amount.You may call it ridiculous, but if you do not check at the beginning,there will not be any escape.Take one example,suppose you have a cover of Rs 5 Lakh.Your hospitalization bill is Rs 3 Lakh.Co pay clause is 10 % then you have to pay 30000/-; the rest of 270000/- will be paid by the insurance company.I repeat again ,before buying a policy,please ensure that it does not have CO PAY clause.
Step 4: Check for pre existing disease clause
Pre-existing diseases are conditions that you or any member of your family has upon purchasing a new health insurance coverage. There is a waiting period before the cover is permitted for them because the ailments are already present. This waiting time, which is known as the pre-existing waiting period, lasts between 12 to 48 months.
While taking up a policy,do not hide anything,it is better to take refusal or a higher premium than get shocked at the last moment at the time of settlement of the claim.You should also check if the policy has any disease waiting periods. Have a discussion with your agent or search online on this point before taking up any policy.
Step 5: Check if policy has Limits and Sub-Limits
I know a person who was admitted for surgery in a posh Delhi hospital, and he had a 5 Lakh cover and was very confident about the expenses.When the time for settlement of the bill came, the insurance company refused to pay room rent more than 5000 rupees, which was 9000 rupees.Later on, it was revealed that there was a limit on room rent of 1% of the sum insured.And it did not end with just room rent,because of the limit of Rs. 5,000 on room rent; ,there were other caps that were linked to room rent.While purchasing a policy, ,enough care should be taken to research the sublimit on room rent.It can be in terms of rupees, categories, or subcategories. It can be on a single-occupancy or double-occupancy basis.Ideally, you should have a policy that has no sublimit.
Step 6: Check the Exclusion List
A health plan may be all-inclusive, but there are specific situations where it is not permitted. Every health plan has a list of such circumstances, which are referred to as policy exclusions. Examine the policy’s exclusion list before purchasing a family health insurance plan.
When you are aware of the exclusions, you can determine what is and is not covered by the plan.Dental treatment, pregnancy, and cosmatics are standard exclusions.
Step 6: Check for daycare procedures and No claim bonus features
There are certain treatments or procedures that do not require hospitalization for more than 24 hours.You should get a list of such procedures and find out if there are any sublimit on them.Catract surgery is one such example.You should ask what will be covered and what will be excluded, and how long one needs to stay to make a claim.
Check with insurance company what is policy in regard to no claim bonus.It means if any year if you do not make any claim what benifiet you get.Normally companies increase your cover by 10 % for same premium but you need to reconfirm.
Step 7: Check the Hospital Network of the Insurance Company and its claim history
Examine the network of participating hospitals before purchasing a family health plan. Check to see if the preferred local hospital has a relationship with the insurance company. Examine the strength of the Indian network as well. Stronger is better because it makes it easier to find a networked hospital no matter where you are.Insurance providers list the number of networked hospitals with which they have affiliations. The website of the insurance provider also lists the hospitals in your city.
Before you buy any medical cover,do some research on its claim history.The company should treat its policyholders well, and the complaint resolution mechanism should respond fast.Just do some research on internet on this if you find some data.You should ask what the claim percentage is that is settled.It should be above 95 %.
Step 8: Look for additional Value-Added Benefits
Be sure to compare the value-added advantages that each health insurance plan offers when comparing policies. Value-added benefits are extra advantages that come with the coverage characteristics. Typical advantages include the following:
- Sum insured restoration
- Free health check-ups
- Medical second opinion
- Telemedicine facilities
- Free doctor’s consultations
- Loyalty programs at partnered wellness outlets
- Assessment of your health
Critical Illness Cover and Personal accident cover
Check with health insurance plan wheather it provide rider of critical illness and accident cover.There are around 20 critical illness like kidney failure,liver failure ,cancer etc where cost of treatment is huge and person may be away from employment for some time.These cover pay lum sum pay to insured to deal with critical situation. If such rider is not available ,you are advised to take a separate cover for this which is not very costly but make your protection more robust. Also ask what are options available for top up plans.In future if there is need for larger cover ,top up facility may be utilised.
Conclusion
It is not easy to find right health insurance plan for yourself.Insurance company is in always mood to deny claim on flimsy ground.But there is no option but to have right medical cover.Otherwise it might derail any one financial journey.After reading above you must be wondering one needs to be a financial,legal expert to reach on some conclusion . Every one can not be so.So some basic guideline will help you out. Do some research based on ratings of plan.You can do this on Policy Bazar website.Note down above steps one by one and try to find out answer to these questions.If you taking plan fromk some agent,put these questions to him and see if he has answer to these .At least you will come to know wheather he knows more than you or not.
Which health insurance plan is best for the family?
The best option for covering your complete family under one policy is a family floater insurance plan. From a reputable insurance provider, you may get family floater plans that will enable you to offer emergency medical coverage for your entire family.
What factors should I consider when comparing health insurance plans?
Consider factors such as coverage, network hospitals, premium, waiting periods,exclusions,top up plan and additional features like riders.
How can I calculate the ideal sum insured for my health insurance plan?
Assess your family’s medical needs,city of residence, lifestyle, and potential healthcare costs to determine the appropriate sum insured
What is a cashless claim process?
In a cashless claim process, medical bill is settled directly with the network hospital, eliminating the need for immediate payment
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