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Things to Know Before Buying Health Insurance

We're here to help you make the right choices while purchasing health insurance!

  • 21 Feb 2021
  • min read

Medical costs have been increasing at an alarming rate in India. As per reports, healthcare inflation in our country is rising at double the overall retail inflation rate. At such times, not having adequate medical insurance cover for yourself and your family members can prove to be a significant financial drawback for you.

In the absence of health insurance, even a single medical emergency in the family has the potential to wipe years' worth of savings. Health insurance policies provide a protective shield against the hefty medical expenses you may incur if you or your family member needs hospitalisation.

However, with many insurance companies offering a wide array of mediclaim policies in India, selecting the right health insurance plan can sometimes become difficult. To tell you how to buy health insurance for yourself, we've collated some critical factors regarding health policies in this article.

By being aware of these factors, you can make an informed decision while purchasing a medical insurance policy. Let's get started.

Types of health insurance plans

The first thing you need to know before buying a mediclaim policy is the types of health insurance plans available in the market. Typically, there are two types of health insurance policies:

  1. Individual health policy
  2. As the name suggests, this type of health insurance policy caters to an individual. The premium amount for these health plans is calculated based on an individual's age, medical history, present health condition and inherent risks. You can choose to purchase a standalone individual health policy for yourself or buy separate individual health policies for different family members.

  3. Family floater policy
  4. Also known as a group health insurance plan, this policy is designed to cover the entire family under a single medical insurance plan. The sum insured of a family floater policy is shared by all family members covered under the policy. A family floater plan usually covers the policyholder, his/her spouse, dependent children and parents.

The sum insured

The sum insured is the maximum amount of money the insurance company is liable to pay to the policyholder in a year. It means that if a health insurance policy offers a sum insured of Rs. 5 lakhs, it's the maximum claim amount that you'll get in a year. In case your claim amount exceeds the sum insured of the policy, you will have to bear the extra expenses out of your pocket.

It would be best to opt for the right combination of premium and sum insured while buying a health insurance policy. A policy with a lesser sum insured can prove inadequate during a medical exigency whereas, a policy with a very high sum insured may lead to a higher premium.

The waiting period clause

Being aware of the waiting period clause can help you make the right decision while purchasing a health insurance policy. The waiting period refers to the period you have to wait for before the insurer can cover your existing health conditions. Usually, the waiting period ranges between two to four years, depending upon the insurer and policy type.

This waiting period applies to all pre-existing illnesses, including thyroid, diabetes, blood pressure, etc., that the policyholder may have before buying the policy. Some policies may also extend the waiting period clause to certain specific treatments and illnesses such as cataract, arthritis, varicose veins, etc.

Hence, you must check the policy document's waiting period clause while buying a health insurance plan. It's best to choose the policy with a minimum waiting period.

Cashless treatment facility

Generally, all health insurance plans offer cashless treatment facility to the policyholders. The policyholder is not required to pay anything out of his/her pocket during hospitalisation at a cashless facility. All he/she needs to do is show the policy document at the hospital, and the bills are settled directly between the insurance provider and the hospital.

However, this facility may not always be available at a hospital of your choice. Health insurance companies have tie-ups with the network hospitals where the policyholders can avail this facility. Thus, while buying a health insurance policy with a cashless treatment facility, you should always check for the network hospitals in your vicinity.

It goes without saying that you should opt for the insurer which has partnered with the maximum number of hospitals and all major hospitals in your city. For instance, you can go for health insurance, which offers cashless treatment at more than 6500 network hospitals across the country.

Also read:

Additional sum insured

Additional sum insured (ASI) refers to the extra sum insured given to policyholders for every claim-free year. Usually, the insurers increase the sum insured by a fixed percentage as ASI at renewal, if there were no claims in the previous year. The maximum increase in the sum insured depends on the limit specified by the insurer.

For example, if you've purchased a health insurance policy with a sum insured of Rs. 5 lakhs and the insurer offers a 10% increase as ASI, your sum insured after the first claim-free year would be Rs. 5.5 lakhs and Rs. 6 lakhs after the second claim-free year.

Opt for the policy which offers maximum ASI for subsequent claim-free years.

To Conclude

With so many alternatives available in the market, you need to know how to choose the ideal health insurance for yourself. Apart from the points mentioned above, it would be best to consider some other factors such as the insurer's claim settlement ratio, co-pay clause, and other hidden terms and conditions to make an informed choice.

It's also beneficial to buy a health insurance plan at a young age to get maximum coverage at a minimum premium amount.

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