5 Tips to consider before buying a health insurance plan

2024-08-02

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Health insurance plans offer relief by reimbursing the costs incurred in hospitalization. This frees you from the burden of financial worries so that you can focus on yourself or your loved ones when they need maximum care and attention. But when you log on to the internet to search for the best health insurance policy, you will end up seeing several options that may leave you confused.

All policies may or may not suit your requirement because each person and family’s circumstances are different. A one-size-fits-all approach will not work in the case of health insurance. The cost, network hospitals (for cashless treatment), payment terms, ease of application/claim process, renewal bonuses, illnesses covered, etc vary from insurer to insurer.

These 5 tips may make your decision-making process smoother to buy the best-matching policy:

1. Type of Coverage

Healthcare insurance is a broad term and therefore understanding the finer difference between conventional Mediclaim policy vs Critical Health Covers is important.

Some conventional policies require co-payment which means the insurer will not bear 100% of the bill. You have to pay some portion. There could be maximum limits on room rent, ambulance charges, medicines, pre-hospitalization expenses, post-hospitalization expenses, etc. In cashless hospitalization, the hospital receives covered expenses directly from the insurer after admission.

Critical Health Covers, on the other hand, for listed illnesses or conditions such as Cancer or Heart Treatment may offer a direct fixed cash benefit without considering the expense incurred.

Mediclaim Cover	Critical Health Cover
Covers a majority of hospitalization expenses regardless of disease, including pre- and post-hospitalization to some extent	Covers specified diseases, usually life-threatening ones with high treatment cost and low survival rates
Benefit disbursement depends on the cost incurred	Benefit disbursement is fixed regardless of the cost of treatment
The policy usually continues after a claim with reduced sum insured (SI), until renewal, when the SI is restored	The policy terminates after a major claim, in case of a minor claim the future premiums are waived off (e.g., Health First Plan from Canara HSBC Life)
Includes no claim bonus in the form of increased sum insured	Has growing sum assured
The benefit amount is in the form of reimbursement and usually covers a large part of the cost	The benefit amount can include a sum payable as regular income to your family

2. Sum Assured or Insured

Sum Assured defines the amount that is assured to the policyholder irrespective of expense incurred. This helps cover even incidental expenses that may not be directly related to hospitalization. Look at the simple example tabulated below.

This illustrates the Health First Plan of Canara HSBC Life Insurance. Say, Ramesh, aged 40 years, is diagnosed, with a minor Cancer condition, at the age of 55 years. Ramesh has the following cancer cover with him and will get a lumpsum amount of Rs.7.5Lakhs irrespective of the expense incurred.

Plan	Sum Assured	Policy Term
Cancer	30Lakhs	25 years

All future premiums for this policy will be waived off thereafter. If Ramesh is, unfortunately, again diagnosed with a major Cancer condition at 58, he will receive Rs.22.5Lakhs and the policy would terminate.

Such policies are also very pocket-friendly because one can opt for an “increasing cover option” wherein your Sum Assured would increase year on year with a very nominal increase in premium. This option beats the rising costs of healthcare treatment due to inflation.

Mediclaim policies will define what kind of costs are covered and would reimburse the actual amount spent on the treatment. Of course, there is an upper limit just like in any policy. There may be exclusions too such as pharmacy consumables, disposables, incidental expenses even during hospitalization, etc. Therefore, Mediclaim policies reimburse costs to the extent of what is insured and spent.

3. Right Time to Buy

Insurance premiums are calculated mainly based on age. Therefore, the earlier you start, the more you save in your annual cash outflows. If you have started earning, you must consider buying insurance first. If you are a homemaker looking for medical insurance you can be a part of the family health plan that most insurers offer. These family plans are good bargains and money savers.

If you are a senior citizen exploring senior citizen insurance plans, choices may not be vast, but you must act quickly. Youngsters should not delay buying insurance because as you age you risk falling ill and paying a higher premium for the same coverage. Preventive health checks are important at all ages and some policies bundle annual health check-ups as part of their offering.

4. Claim Process

After a hospitalization, the only thing you want is peace of mind as you move on with life. Look at settlement percentages of insurers. The ones that process claims quickly and have a high settlement ratio are the ones to look out for. The claim process for Mediclaim could be simple as connecting with a TPA who will take care of your claim.

In case of critical health policies, you will need to file the claim with the life insurer either through their website, customer support or advisor. Once you have done so, the insurer will release your applicable benefit amount after completing the paperwork.

5. Renewal Age

This is the age until when the policy can be renewed. This is different from the minimum and maximum age of entry. Renewal age can also be termed as the upper age limit for any policy to mature. For example, the health first plan can continue till you reach the age of 80, which is higher than the average life expectancy of the subcontinent. However, it is better to read the fine print of the product before you sign on the dotted line. As there are a lot of myths surrounding this, it is always better to stay on clear grounds.

Learn these 5 myths about a health insurance plan.

Healthcare costs are rising due to inflation, newer technologies, and also the emergence of newer ailments and illnesses. You must factor in all these points in addition to your personal needs while signing up for a health insurance plan. This will help you live stress-free because you know there is someone to take care.