Health insurance is a type of policy that covers the medical costs of an individual or a group of people in case of illness or injury. It can provide financial protection and peace of mind for you and your family, especially during medical emergencies. However, choosing the best health insurance policy can be daunting, as many factors must be considered. To help you make an informed decision, here are the 11 most important things to remember while buying a health insurance policy –
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1. Your needs
The first thing to consider is your health needs and budget. You should assess your current health status, medical history, family history, lifestyle habits, and future health goals. Based on that, you should decide how much coverage you need, what kind of benefits you want, and how much premium you can afford. You should also factor in the inflation rate and the rising cost of healthcare in the future.
2. The type of policy
Next comes the type of health insurance policy. Various medical insurance policies are available in the market, such as individual plans, family floater plans, or group plans. Each type of policy has its own advantages and disadvantages. Individual health insurance benefits you if you are an unmarried working professional and your parents also work. But in case you have dependent parents or a spouse, go for family health insurance, as it provides comprehensive coverage for lesser costs.
3. Network hospitals
The network of hospitals is the list of hospitals empanelled with the insurer and offers cashless treatment to the policyholders. Cashless treatment means you do not have to pay anything out of your pocket during hospitalisation, as the insurer will directly settle the bills with the hospital. You should check the list of empanelled hospitals of the insurer before buying a policy, and ensure that it includes reputed and quality hospitals near your location.
4. Settlement ratio
The claim settlement ratio refers to the proportion of claims a medical insurer has successfully settled out of the total claims received within a specific time frame. A high ratio indicates that the insurer is dependable and proficient in processing and resolving claims. Always review this ratio before purchasing a policy. Avoid insurers with low or unsatisfactory claim settlement ratios.
5. Waiting period
This refers to the timeframe during which the insurer will not cover certain pre-existing diseases or specified conditions. The waiting period can vary from one policy to another and range from a few months to a few years. You should check the policy’s waiting period before buying it and opt for a policy with a shorter or reasonable waiting period.
6. The sum insured
It is the maximum amount that the insurer will pay for your medical expenses in a policy year. The sum insured must be adequate enough to cover your expected and unexpected medical costs without straining your finances. You must also consider the possibility of increasing the sum insured at the time of renewal based on your changing health needs and inflation rate.
7. Co-payment clause
The co-payment clause is a provision that requires you to pay a certain percentage of the medical expenses from your pocket while the insurer will pay the remaining amount. The co-payment clause can reduce your premium amount but also increase your out-of-pocket costs at the time of claim. You should always review this policy clause before buying insurance and opt for one with a lower or no co-payment clause.
The sub-limits are the limits the insurer imposes on certain expenses or treatments under the health insurance policy. For example, there may be sub-limits on room rent charges, doctor’s fees, ambulance charges, etc. The sub-limits can reduce your coverage amount and increase your out-of-pocket expenses at the time of claim. Go for a policy with higher or no sub-limits.
9. Policy exclusions
The exclusions are the conditions or situations not covered by the health insurance policy. For example, some common exclusions are cosmetic surgery, dental treatment, self-inflicted injuries, etc. The exclusions can vary from one policy to another and affect your coverage and claim eligibility. Invest in a health insurance plan with fewer or reasonable exclusions.
10. Check Add-ons
The add-ons are the additional features or benefits that you, as a policyholder, can avail of by paying an extra premium when buying fresh insurance or during renewal. For example, some common add-ons are hospital cash benefits, personal accident policies, daily allowance benefits, restore benefits, etc. The add-ons can enhance your coverage and provide extra protection for you and your family. Before deciding on an insurer, check the list of add-ons they offer and evaluate how it could benefit you.
11. Customer service
The level of customer service represents the insurer’s ability to offer assistance and support promptly and efficiently to policyholders. It significantly influences your overall experience and satisfaction with the policy and the insurance company. It’s crucial to assess the quality of customer service before purchasing a policy.
Prioritise insurers with positive online reviews and high ratings. These reviews can offer useful insights into the actual customer experience with the company.
These are some of the most important things to keep in mind before buying a health insurance policy. By following these tips, you can choose a policy that meets your health needs and budget and provides adequate coverage and benefits for you and your family. Make sure your health coverage is in line with your needs and dependents. If you are choosing family health insurance and have multiple dependents, you may buy an add-on cover, like a critical illness plan or an additional personal accident policy.