Ultimate Guide to Choose the Best Health Insurance Policy

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All insurances are mitigation of risk. Simply put, you put up a fraction of the sum or sums to buy a product that would financially take care of all the liabilities if you incur the unwanted event happens to occur.

Thinking or speaking about the probability of an unfortunate event is traditionally and culturally shunned in our part of the world. Even if it is so it would be foolish to not think about and especially plan for such events. Any cost that one or one’s family may incur can be taken care of by buying health insurance. 

We here intend to guide you through the process of choosing a health insurance policy

1. Comparison of policies and the coverage they provide

Since health issues arise out of the blue you cannot predict the kind of ailment you should get covered against. It is of primary importance to get a policy with maximum coverage and benefits

You should look for

  • Ambulances Charges
  • Cover for periodic health check-ups
  • ICU rent 
  • No capping on hospital room rent
  • Refill option on insured sum
  • Waiting period for pre-existing room rent
  • Pre and post-hospitalization expenses
  • No claim bonus
  • Cover for critical illnesses
  • Cover for psychiatric illnesses
  • Organ donor expenses
  • Domiciliary care
  • Zone upgrades & maternity cover (these are add-ons)
  • Home hospitalization cover
  • Day care procedures cover
  • Cover for surgeries like Bariatric Surgery

The points may be many but so will the bills you might have to face so it is vital to include these clauses. If you can’t afford a policy that includes all, most of these must be included.

2. Choose an affordable plan

A plan that you can afford has to be chosen. A plan you might not be able to sustain is as good as not having a plan. There will always be a plan with the maximum possible cover in your budget. You have to scrutinize and compare to find yourself a suitable plan with the maximum coverage you can get. All these policies are premium oriented and have to be sustained with periodic payments, those payments should be well within your budget so as not to become a financial burden for you.

3. Choose between individual or family floaters plans

  • Individual health insurance – These insurance plans have a single sum insured for an individual person. In a family, each individual can choose to have individual schemes.
  • Family Floater health insurance – These insurance plans have a single sum insured for all individuals in a family.

4. Cashless Hospital Network

You will have to check and get to know the hospitals that are in a cashless network for your scheme, the more the number of hospitals the more your probability of visiting them in case of encountering a medical problem.

These hospitals would relieve you of your immediate payment and other process-oriented burden and have a more hassle-free service. This benefit ensures your insurance policy covers the expenses incurred due to hospitalization.

5. Easy Claim Process

The claims can be pursued and settled in the following ways

  • Cashless Claims
  • Reimbursement claims
  • Pre Approved claims with Advance Cash

You need to check the process before applying for the policy. The complex claims process often lengthen the claim settlement. You need to have a policy where claim processes are easy and quick.

6. Claim settlement ratio

 Before applying for a policy you should look at the claim settlement ratio of the policy provider. 

The claim settlement ratio is the number of claims that are settled from the number of claims that were made. A high claim settlement ratio is always good for the policy buyer because it denotes that claims are settled unless it isn’t for a valid reason. 

7. Pre-existing illnesses should have a lower waiting period

If you have a pre-existing medical illness policy providers often have their own separate and varied offerings.

Most generally provide an insurance policy for a pre-existing condition as well but often stipulate a time period before claims for that illness can be made. Through this, they guard against policy being bought for the specific purpose of unloading medical expenses for the particular illness that has already come to light and is being hidden from the policy provider.

Since you are the buyer you should look for a policy that has the least denoted time before which you can make a claim for an illness that was disclosed and suffered from when you bought the policy

8. Special benefits for senior citizens

It is obvious that the body tends to fall ill more often with age. On the contrary, the ability to meet such expenses also reduces with age. 

Insurance companies often keep tailor-made schemes for senior citizens. The factors or clauses to look out for in such policies are

  • Coverage for critical illness
  • Coverage for a pre-existing illness
  • Cashless Hospitalization
  • Fast and hassle-free settlement
  • No medical test before availing of the policy
  • No room rent capping
  • Psychiatric illness cover
  • Organ donor expenses
  • Additional sum assured along with refill sum assured option

These factors should also be kept in mind when buying family floaters health insurance. There either must be an aged person or some individuals will be getting into the senior citizen age earlier.

9. Exclusions under Health Insurance Policy

These often overlooked or neglected factors while overlooking an insurance policy lead to the purchase of a policy that lacks comprehensive cover.

Most of the time insurance companies do not cover claims on illnesses like gastric, sinusitis, hernia, etc right after their commencement. While there are also policies that cover expenses incurred in the treatment of diseases like STD, HIV/AIDS, etc. The fewer the exclusion the more comprehensive a policy is supposed to be. That is why it is necessary for you to review your policy for comprehensive coverage. For an expert review of policies and purchases, you have SDK Investments. 

10. Choose a policy that does not mandate co-payment

They are policies that come with a co-payment feature that often mandates the policyholder to pay a part of the claimed amount. These amounts are generally in the range of 10%  to 15% of the claimed amount.

It is recommended to not avail of a policy that asks for co-payment but if entirely necessary to buy such a policy for other reasons. Make sure the co-payment percentage is as minimum as possible.

11. Add-on covers with health insurance

Most health insurance covers come with add-on features on payment of extra premium.

These add-ons are

  • Critical illness cover
  • Daily hospital cash cover
  • Zone upgrade cover
  • Maternity and newborn baby cover
  • Some even provide cover for alternative treatments like Ayurveda, Yoga, etc.

12. Claim tax benefits with insurance cover

Under Section 80D of the Income Tax Act, 1961 individuals and HUF can claim a deduction of up to Rs. 25,000 on the premium paid for their health insurance policies. 

An additional deduction of Rs. 25,000 is available on the premium for the insurance if the policy is for your parents below 60 years of age and Rs. 50,000 if it is for your parents above 60 years of age. 

So make sure your insurance company has the provision to provide you with the tax benefit certificate for your health insurance policy before you avail it.

13. Reviewing your insurance company’s reputation

This is basic, it means one should conduct a background check of your insurance provider. With a growing number of insurance policies with attractive schemes, one should conduct their own homework on how genuine these are.

You should look into their transparency and claims settlement ratio to get an understanding of their genuineness and transparency. In the age of social media platforms, one should read reviews, testimonials, and ratings.

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