Essential Facts to Consider Before Purchasing a Healthcare Insurance Plan
In the ever-changing landscape of healthcare, having the right health insurance plan is crucial. When choosing a health insurance plan in India, the common factors to consider include:
- Personal and family health needs: Assess current health conditions, including any pre-existing diseases, lifestyle risks, and family medical history. If you have such conditions, choose plans with shorter waiting periods for pre-existing diseases.
- Coverage amount (Sum Insured): Ensure the sum insured is sufficient to cover the expected healthcare costs based on your city and family size. For example, ₹10 lakh is considered a minimum for individuals, while families may need ₹15-20 lakh or more, especially in tier-1 cities where treatment costs are higher.
- Type of coverage: Decide whether you want individual coverage or a family floater plan, and consider add-ons like critical illness riders, outpatient (OPD) and dental coverage, maternity and newborn cover, or international coverage if applicable.
- Premium affordability: The plan should fit within your budget to avoid lapses. Balance comprehensive coverage with affordable premiums to ensure sustainability.
- Claim settlement ratio and insurer reputation: Pick insurers with high claim settlement ratios (above 95%), positive customer reviews, and a good track record of reliability and service.
- Network hospitals: Check that the insurer has a wide network of cashless hospitals in your city and locations relevant to your family, including tier-2 and tier-3 cities, to facilitate easy claims.
- Policy features: Look for benefits such as annual health check-ups, restoration benefits (which recharge sum insured if exhausted), no-claim bonus, and flexibility to customize or add riders as your health needs change.
- Exclusions and sub-limits: Review policy exclusions carefully (e.g., cosmetic surgeries, dental treatment exclusions) and avoid plans with co-payments or sub-limits that may increase out-of-pocket expenses during claims.
- Waiting periods: Verify the waiting periods for coverage to begin on specific diseases or treatments, especially if you have pre-existing conditions or are purchasing for elderly parents.
It's important to note that a No-Claim-Bonus (NCB) is a discount offered by insurance companies for claim-free years, increasing the coverage amount at policy renewals. However, plans without sub-limits are preferable, but insurers may have co-payment clauses for those with pre-existing medical issues or who have crossed a certain age limit. The co-payment clause is the percentage of the amount that the policyholder needs to pay at the time of claim, with the rest paid by the insurer.
Before buying a health insurance policy, check if there is any co-payment clause that might impact the claim amount. Additionally, check the coverage limit for preventive health check-ups. The reduced premium should not be at the cost of insurance coverage. The waiting period can range anywhere between 24 months and 48 months depending on the insurer and the plan. The waiting period clause in health insurance policies refers to a period during which the insurer will not accept any claim arising out of pre-existing illnesses or specific illnesses.
In summary, choose a plan tailored to your health profile and financial capacity, focusing on sufficient coverage, a reliable insurer, good hospital network, and policy features that match your needs. This approach helps ensure you receive seamless financial protection and healthcare access in India.
- In the process of buying health insurance, it's essential to review the co-payment clause to understand the percentage of claim costs the policyholder will cover, as some plans may have this requirement for individuals with pre-existing medical issues or certain age limits.
- The importance of science and medical-conditions in selecting a health insurance plan is evident when considering the need for comprehensive coverage, an insurer's reputation for reliable claim settlements, and a wide network of hospitals addressing various health-and-wellness needs.
