Steps to buy the best health insurance plan
When it comes to selecting a policy, buyers often forget to keep crucial factors in mind, for example: If you knew that getting medical bills reimbursed from your insurer is likely to fetch you only half the sum as compared to a cashless claim settlement, it is unlikely that you will opt for the former. In fact, the Insurance Regulatory and Development Authority of India seconds this and if that wasn’t enough, opting for the cashless facility also saves you the trouble of collating all the documents, submitting them to the insurer and following up.
Insurers often dispute that the average claim payout in case of reimbursement settlements is just half that of cashless claim disbursals for the same ailment category and doing due research about the insurance provider’s network of hospitals that offer cashless claim settlement is the best option. The information is usually available on the insurer’s website.
However, cashless facility is not the only thing you need to look for and there are many factors that will affect the kind of coverage you receive and the premium that you will have to pay. First and foremost, the insurer's experience, financial strength and service record is quite crucial. An insurer with a lower claim settlement ratio is best avoided. If possible, you should also take into account solvency margins or an insurer's ability to pay out claims and also premium growth registered by insurers.
The type of health insurance policy you need won’t be same as that of your neighbor. The best health insurance policy for you should be determined by your family's needs. The number of family members and their age is critical. To illustrate this further, a young family can do with a basic cover of around Rs 5 lakh, while a family with senior citizens should opt for a larger floater cover, say experts.
Another example could be that if the parents are too old, opt for separate cover for them, and not include them in your floater cover. Similarly, if you are planning a baby within two years' time, you will be better off without the maternity cover which comes with a long waiting period and almost doubles the policy premium. Be careful when opting for a maternity cover as part of your health insurance policy. Currently, this may get you a private room, unless you insist on high-end corporate hospitals, and you need not stretch your resources to buy a premium variant, without a room rent sub limit.
If you prefer access to high-end hospitals with better rooms, then plans with room rent sub-limits will not be a good option for you. Given healthcare inflation, these room rent sub limits may not even suffice for a good hospital room a few years from now. All the other expenses are linked to room rent eligibility, bringing down your entire claim eligibility. Go through the fine print to understand the limitation and exclusions of the plans. Most basic plans carry sub-limits for specific treatments. Ordinarily, a cover of Rs 5-lakh could restrict the daily room rent to 1% of the sum insured.
You should neither focus on buying the cheapest policy nor one that offers a plethora of benefits. The best health insurance plan should simply be a policy that fulfils your specific medical requirements. Several health insurers have come out with premium variants that offer services like doctors' second opinion, vaccination cover, wellness benefits, etc. Paying higher premiums for benefits you may never use is not advisable just like it is not advisable to buy a high-end cover merely for availing tax saving schemes that offer greater rewards.