It can be hard to figure out how to get health insurance in India. Demand for buying health insurance has increased many fold after the pandemic of 2020-21. But, confusion persists in picking the right plan because there are so many options, riders, and terms.
Don’t worry, if you are following my blog! This complete guide will provide every aspect and necessary questions that you must ask from your insurer or agent before buying it. After going through this guide, I can assure you that you will be able to choose the better health plan for you after comparing many plans. You will learn about your health insurance choices and pick the plan that meets all of your needs.
Types of Health Insurance Coverage in India
Before going into the features of health insurance plans, let’s discuss different types of health insurance by companies,catering to diverse needs and budgets in India.
Individual Health Insurance: This plan covers a single person or an individual, and comes with a low premium as only you are insured in this. You can decide features of your health insurance with low premium and later, you can add family members with payment of extra premium.
Family Floater Health Insurance: This plan provides coverage to your family i.e., you, your wife, 2 children, father and mother but usually to spouse and dependent children under a single sum insured. It’s a cost-effective option for families, and with the option, the whole sum insured is divided among different family members.
Senior Citizen Health Insurance: This plan gives protection to the specific healthcare needs of senior citizens, often covering pre-existing conditions and age-related ailments and due to this, it costs more premium.
Critical Illness Insurance: This plan provides coverage and financial protection upon diagnosis of a critical illness like cancer, heart attack, or kidney failure. It has certain conditions and a waiting period of 2-4 years depending upon the insurer. It helps manage the financial burden associated with such conditions. These critical illness
List of questions You must ask before buying Health Insurance
1. What is a room cap or limit: Room cap is the amount an insurer gives you. Now, many health insurance policies offer a “no room cap” feature which means your hospital room charges will be paid by the insurer without any limit. You must check before buying it.
2. What is the sub limit on illness: Many health insurance policies have a rider where a limit is imposed on expenditure on various critical illnesses and the remaining amount is borne upon you. This sub-limit rider can affect you financially if any critical illness happens to you as you won’t be paid the full insured amount by the insurance company. So, go through policy documents before buying one.
3. How the claim is processed: You check how the claim will be processed and what is the time period to get the claim. This will ensure to get medical claims on time and hassle free without calling customers or delay in getting medical attention.
4. Cashless hospitalization: Allows you to avail medical treatment at network hospitals without spending any amount from your pocket. The insurance company settles the bill directly with the hospital. Always check this condition and list of network hospitals near your area.
4. Family floater and how it is divided: Family floater plan usually allows you to claim any of your family members (covered in insurance policy) the whole insured amount. Some insurance companies divide the insured amount among family members. I would suggest going with the option of family floater in which the whole sum insured can be claimed by any family member in emergency.
5. Daycare Procedures: Many insurance companies offer at least 24 hour hospitalization of the policyholder to claim medical bills. I would recommend checking the option of day care treatments. Many treatments are there where you don’t need 24-hour hospitalization. So choose the option of daycare treatment so you won’t need to get admitted for 24 hours to claim medical bills.
6. Pre and Post-Hospitalization Expenses: Always include this option in your health insurance. It covers medical expenses incurred before and after hospitalization, like diagnostic tests and doctor consultations. It usually covers 60-days before hospitalization and 180-days after hospitalization bills.
7. Copay and Deductible: Copay option is when you and the insurer agree to the terms that some percentage of medical bills will be paid by you and the remaining will be debited from your insured amount. Now, many insurance companies provide a 100% copay option where they will only pay the full medical bills. So, check this option before buying. Next is deductible – It is a fixed amount you need to pay before the insurance company starts reimbursing you.
These copay and deductible options should be availed wisely as it lowers your premium amount but can affect you financially.
8. Inclusive of critical illness: Anyone can face critical illness at any point of time. Check the policy documents to know what critical illnesses are covered and how much amount can be reimbursed to you during treatment. There is also a waiting period to start getting the benefit of this option in your policy. Go through each and every point of the policy documents.
9. No claim bonus: It’s like getting a more insured amount. Suppose, you don’t claim any amount this year, the next year you get a bonus in your insured amount and your sum insured gets increased. This benefit helps you as your sum insured amount gets increased with no change in premium.
10. Restoration feature: It means your sum insured amount gets restored to the default value after utilization. Suppose, you have health insurance of Rs.5 lakh, and you utilize the full amount and after some time, you again need the health insurance but now your sum insured amount has already been exhausted. Through this option of restoration, you can restore your health insurance sum amount and avail the health insurance in the same year. Always prefer restoration features while purchasing health insurance.
11. Pan India or zonal policy: Ask your insurance company whether this policy covers all India medical expenses. There should not be any bar that in a specific state only you can take treatment. Choose Pan India cashless treatment plan and check all India list of networked hospitals before buying a policy.
12. Reimbursement option: Check the option of Non network empaneled hospital should be there with reimbursement. In case of an emergency or accident, you won’t see if the hospital is empaneled under your health insurance or not. At this time, you need only treatment. So, check the option of reimbursement of medical bills even if the said hospital is not under cashless networked hospitals.
13. Top-up Health Insurance: Let’s say you have a normal health insurance plan that covers up to ₹5 lakh. You now choose to buy a top-up plan with a ₹3 lakh deposit and a ₹10 lakh coverage cap. How it works:
Regular Health Insurance: You have to pay ₹4 lakh for hospital bills. Your main health insurance will pay ₹4 lakh, so you’ll have to pay the other ₹1 lakh yourself.
Top-up Plan: Now, let’s say you have a big medical problem that costs ₹8 lakh. Your top-up plan will cover the last ₹3 lakh since your main health insurance only covers ₹5 lakh. But, go through the terms and conditions as it varies from company to company.
14. Super Top-up Health Insurance: Super Top-up plans are like top-up plans, but there is one big difference: they look at all of your medical bills for the whole insurance year instead of just one claim. This means that the super top-up plan will start paying for medical bills once the total amount spent on them in an insurance year goes over the deductible amount.
15. What happens to policy if I die and will continue for my family: This option for health insurance is must for everyone. No one wants any financial burden to come on your family in your absence. Medical expenses are the biggest financial burden for every middle and lower class family in India. Take that health insurance which keeps your family covered even after your absence. .
How to plan your Health Insurance Plan
a. Assess Your Needs: Consider your age, health condition, family size, and potential medical risks.
b. Set a Budget: Determine how much premium you can comfortably afford to pay monthly or annually.
c. Compare Plans: Research different plans offered by various insurance companies. I have listed all the parameters which you should check before making any decision.
d. Focus on Coverage: Prioritize plans that cover your essential healthcare needs and offer features that align with your preferences (e.g., cashless hospitalization).
e. Read the Documents properly: Understand exclusions, co-pays, deductibles, and claim settlement procedures before finalizing a plan. opt for plans offering guaranteed renewal, ensuring continuous coverage even if you develop a medical condition.
Latest updates from IRDAI in Health Insurance (2024)
Conclusion
Don’t just settle for the cheapest plan. Choose one that offers comprehensive coverage while fitting your budget. One thing you should always check is the settlement ratio of the insurance company, and its review. This will help you in choosing a better insurance plan from a better insurance company.
By understanding health insurance coverage options and following these steps, you can make an informed decision and select the perfect health insurance plan to safeguard your well-being and financial security in the face of unexpected medical situations.
