Choosing a health insurance plan can be complicated. Choosing a health insurance plan can feel like an overwhelming task. Here are five things to keep in mind when choosing health coverage for you and your family. Knowing just a few steps to take before you make your choice can make it simpler.
Step 1: Finding the right plan
Once you have zeroed in on the right insurance company, the next, and also the most important, step would be to select the plan. With multiple insurers offering multiple plans, you have a lot of choices. However, choosing the right policy is important.
As such, here are some factors that would help you with the same –
1. Coverage benefits
The first thing that you need to check is the coverage benefits that are offered by different plans. While most plans offer the basic coverage benefits, look for plans that have unique features.
First, assess your coverage needs and then look for plans that offer those. For instance, if you are planning to have a child in the near future, look for plans that offer maternity coverage. Alternatively, if your family is complete, skip such plans.
Second, look for other additional features that might enhance the scope of coverage. For instance, sum insured restoration, high no claim bonus, value-added benefits, annual health check-ups, etc. are some of the features to look for.
Choose a plan which has the most comprehensive scope of coverage. This would minimise your out-of-pocket expenses during claims and give you better financial security.
2. Customization option
Look for plans that allow you to customize the coverage features as per your requirements. This is possible through add-ons that health insurance plans offer. The add-ons help you to opt for additional coverage features as per your needs and make customisation possible.
3. Premium amount
Of course, the premium amount is important. Check the premium charged vis-à-vis the coverage offered. To get a better idea, compare. Compare the premium across other plans of different insurers that have similar coverage benefits. See if the premium is competitive or inflated given the coverage.
Choose a plan with the most competitive premium rate for the same coverage benefits, even if it means selecting another insurance company.
4. Sub-limits
Health plans might have sub-limits on different expenses like room rent, ICU room rent, AYUSH coverage, domiciliary treatments, etc. These sub-limits limit the scope of coverage and might result in out-of-pocket expenses.
As such, choose a policy that has no sub-limits so that you can enjoy the maximum possible coverage.
5. Co-payment clauses
Health insurance plans might have co-payment clauses for different reasons. Co-payments mean that in every instance of a claim, you are supposed to pay the specified part of the claim from your pockets. For instance, a co-payment of 10% means that 10% of every claim would be borne by you.
Common co-payment clauses are applicable in the following instances:
- If the insured is aged 61 years and above at the time of buying the policy
- If you buy the policy in a city belonging to a lower Tier and avail of treatments in a city in a higher tier
- In the case of specified illnesses and/or treatments
Look for health insurance plans that do not have the co-payment clause. Even if the clause is unavoidable, like in the case of senior citizen plans, opt for plans with a lower co-payment rate.
6. Waiting periods
The waiting period is when specific coverage is not allowed by the health insurance policy. Once the waiting period is over, coverage is allowed.
Health insurance plans impose waiting periods in various instances. These include the following:
- First 30 or 60-day waiting period for the coverage of illnesses. This is also called the cooling-off period during which illnesses are not covered. Accidental injuries, however, are covered from day 1
- Waiting period for specific illnesses or treatments like hernia, fissures, hydrocele, tonsillectomy, cataract, joint replacement, etc. This waiting period is generally 24 months. In some plans, however, the tenure might vary
- Pre-existing waiting period ranges from 12 months to 48 months. This waiting period is for illnesses or medical conditions that you might have when buying a fresh policy. Complications arising out of existing conditions are not covered during this period.
- The maternity waiting period might range from 9 months to 48 months
- Waiting period for the coverage of OPD expenses, bariatric treatments, etc.
Waiting periods are inevitable. However, you can find a plan where the period is low. This is especially relevant if you are looking for maternity coverage or if you have pre-existing conditions and you want coverage for them at the earliest.
7. Discounts available
Health insurance plans allow various types of discounts to lure customers. Some of the commonly available discounts include the following:
- Discount for buying a two or three-year policy
- Discount for covering two or more members under the policy on an individual basis
- Discount for buying the policy online
- Discount for paying the premium in a lump sum rather than in instalments
- Discount for the existing customers of the company
- Discount for maintaining a healthy lifestyle
- Renewal discount if you have not made a claim in the last policy year
- Discount for choosing a voluntary deductible
- Discount for availing of treatments at a network hospital
Look for the available discounts. Choose a plan that offers the highest discount so that you can get the best deal on the premium.
Now that you have found the best company and the most suitable plan, you might think that your work is done. It is not. You should keep in mind another aspect – choosing the right sum insured.
Step 2: How To Find the Right Coverage Amount?
An optimal sum insured is important to ensure that your health plan sufficiently covers your medical expenses. A low sum insured defeats the whole purpose of investing in health insurance and is a strict no-no.
Selecting the right sum insured is easier than you think. You just have to consider the following factors:
- The number of members being insured under the policy
- Whether you or any other member suffers from any pre-existing condition
- The basic cost of hospitalisation and medical treatments
- The rising medical inflation
Most insurers help you calculate the ideal sum insured based on your income, expenses, existing coverage and members to be insured. You can also estimate the optimal requirement through a simple formula which is as follows:
Sum insured = 50% of your annual income + total hospitalisation costs incurred during the last 3 years
Step 3: How To Afford a Health Plan
The premiums of health insurance plans are affordable. Moreover, insurers offer you the facility of installment premiums wherein you can pay the premium monthly, quarterly or half-yearly. This makes the health plans affordable.
Furthermore, if affording a high sum insured poses a challenge, you can opt for super top-up health plans. Super top-up plans help in enhancing the coverage while keeping the premium low.
