MASTERING IN CHOOSING HEALTH INSURANCE

Most financial planners say that having a health insurance plan is the starting point of all financial plans. Even before one starts investing in one's goals, getting adequate health insurance cover for self and family helps. Here, we look at the various important features and factors of a health insurance policy that may help you zero-in on the right policy.

A health insurance policy covers the medical & hospitalization expenses depending on the amount to be paid by the policyholder for a contract of insurance. While selecting the best health insurance policy, you must look into the various factors including health insurance riders, benefits, coverage, network hospitals, etc.

Nowadays, Coronavirus cases rise in India & you need to pay around Rs 5-8 lakh for Coid-19 treatment in top-class hospitals. The situation will be worse for you if more than 1 family member gets hospitalized, so you need to buy an adequate health insurance plan. Needless to say, it is imperative to buy the best health insurance policy, as it helps you to keep up with the ever-soaring healthcare costs and assures you and your family of a healthy future without having to worry about the medical bills and hospitalization expense. And, when it comes to buying good health insurance plans, you might get confused about which plan is best to buy out of many.

WHY YOU SHOULD GET HEALTH COVER:

According to a few studies done in the past, the medical inflation in India is around 17 percent annually, much above the general inflation level. The need for adequate health insurance is increasingly becoming important and so is choosing the right health insurance plan.

Now, at the moment you might be in the pink of health, however, health insurance is not only about illnesses and diseases. It's a universal truth that accidents may occur anytime and at any age. A health cover could come in handy in such an event.

Further, at times, certain ailments remain unknown to us until their symptoms are visible later on in life. Although, not a mandate, a policy bought at an early age and renewed for quite some years without any claim, may help in better claim experience as and when it arises.

SEE WHAT KIND OF HEALTH COVER IS REQUIRED:

Health insurance plans are broadly categorized as 'indemnity plans' and 'defined-benefit plans. While indemnity plans reimburse the hospital expense, defined-benefit plans pay a lump sum amount irrespective of the actual hospital expense.

The 'indemnity' plans, which could be individual health insurance (popularly known as Mediclaim or family floater policy), should form the core of one's health insurance portfolio. Top it up with a critical illness plan which is a defined-benefit plan and thereafter one may add a Hospital Daily Cash plan to meet incidental costs during hospitalization.

BENEFITS OF BEST HEALTH INSURANCE PLAN IN INDIA:

If you think that health insurance covers medical expenses only in the case of hospitalization, then you’re wrong. Apart from providing financial assistance during hospitalization, the best health insurance policy in India comes with other more benefits as well. Let's have a look:

CASHLESS TREATMENT:

With a good health insurance plan, you can avail of cashless treatment at a network hospital. It is a boon as you don’t need to pay out of your pocket best. The insured just needs to complete the paperwork with the hospital authority and avail the facility while the health insurance company will take care of the bill.

DAILY ALLOWANCE:

Some health insurance companies offer a daily amount for each day of hospitalization. This doesn’t affect the actual sum assured. This amount can be availed up to a certain daily limit and can be spent on medicines or other health-related requirements.

TAX BENEFITS:

Section 80D of the Income Tax Act says that the insured can claim a tax deduction against the premium paid for health insurance. An individual can claim a deduction of up to Rs. 25,000 on health insurance premium. If one is paying the insurance premium for his/her elderly parents, then a deduction up to Rs. 30,000 is permissible.

COVERS LIFE-THREATENING ILLNESSES:

Lifestyle diseases are deadly and expensive at the same time. A person with an average income may not be able to afford the treatment required for these diseases. If one owns a health insurance plan with critical illness cover, then a lump sum amount will be paid towards the medical expenses incurred in the treatment after the diagnosis. As this comes as a rider cover, one can cover critical illnesses under his/her health plan on the payment of an extra premium.

AVAIL ALLIED BENEFITS:

Some health insurers in India have come up with preventive check-ups and enhanced diagnostics, which usually are not included in a basic health insurance plan. Obviously, this is a smart move and includes the following benefits:

Free medical check-ups

Free health consultation with doctors

Consultation with nutritionists

Tie-up with health service providers

Lucrative offers on healthcare services.

SEE WHICH INDEMNITY COVER SUITS YOU:

Once someone gets convinced that a health insurance plan is a must-have even before starting to invest in life goals, the conundrum to either go for an 'individual health plan' or a 'Family Floater' (FF) arises. "One should consider an individual plan over a family floater cover if one wants an extensive coverage. This also ensures that adverse experience in one policy does not affect others in the family. The balance sum insured for other members may not be adequate at a time in case of a family floater policy,".

The 'individual health plan' has to be bought in the name of each individual spouse, children, parents, etc. This means, the premium will be as per each individual's age and respective sum insured. Insurers, however, provide a 10 percent discount on the total premium if more than one member of the family is insured simultaneously. In case of a claim by one member, the sum insured of other members remains intact.

In a 'Family floater' health insurance plan, more than one member can be covered under the same plan. For instance, both parents and their children can be covered together and only one single premium is to be paid. Under an FF health plan, the entire sum insured can be availed by any or all members and is not restricted to one individual, as is the case in an individual health plan. An FF plan takes advantage of the fact that the possibility of all members of a family falling ill at the same time or within the same year is low.

ESTIMATE HOW MUCH OF COVER IS REQUIRED:

Although there is no fixed rule as to how much health insurance you should have; the coverage should ideally depend on one's residential city, history of family illnesses, etc. "For people living in Class A cities, the cover amount should at least be Rs 10 lakh given the high cost of living in metro cities. Not only the standard of living, but medical treatment is also quite expensive in metro cities compared with smaller towns. For people living in Class B and C cities, the sum insured should be at least Rs 4- 5 lakh," expert says.

CHECK SUB-LIMIT IN THE PLAN:

Nowadays, most health insurance plans have sub-limits in them. Sub-limit refers to capping the reimbursement limit under each or some of such cost-heads. For example, the room-rent may be capped at 1 percent of the sum insured. So, irrespective of the total sum insured of the policy, one may have to pay out-of-pocket hospital bills unless one sticks to the limit. Some health plans do not have any such sub-limits while few others offer an option to add sub-limits at the time of buying the plan.

SEE FROM WHEN PRE-EXISTING AILMENTS ARE COVERED:

All health insurance plans cover pre-existing ailments but after a period of 48 months. Few covers them even after 36 months or lesser. However, at the time of buying, it is equally important to disclose the pre-existing ailment, for a smooth claim’s settlement process. Further, coverage of certain defined and specific ailments has a 'waiting period' of 12 or 24 months, post which they are covered for the claim.

CHECK FOR CO-PAYMENT FEATURE:

It's not necessary that there will be a co-payment feature in all plans but in a senior citizen's health insurance plan it could be a mandatory feature. In higher age groups as the premium rates are higher, a co-payment may provide some relief in terms of affordability, as it helps to keep the premium low. Some plans, however, ask for as much as 20 percent co-payment if the treatment is done at a non-network provider or in a city different from where the plan was bought.

WHAT YOU SHOULD DO:

While choosing a health cover, one should ideally start by comparing plans from 2-3 preferred insurers. Have a close look at the inclusions and exclusions in the most basic plan being offered by them. Do not base your decision solely on the premium, instead prefer simple plans with fewer conditions and restrictions. And remember, every member of the family, irrespective of the age, needs health insurance cover to tide over unforeseen medical exigencies anytime in the future.

HOW TO CHOOSE THE BEST HEALTH INSURANCE PLAN?

Choosing the right health insurance plan is imperative to fulfill your insurance needs. As the health insurance market is flooded with plenty of insurance plans, it is confusing for one to settle with the best health insurance policy in India. However, thanks to various websites where, we’ve got insurance calculator, using which, one can compare the health plans online. Online comparison can help you find the best plan in case you are not happy with your existing one. It compares the plans on parameters such as coverage, features, benefits, incurred claim ratio, premium, etc. This way, you can compare different plans and opt for the one that best suits you as per your requirements.

CONCLUSION:

When it comes to health insurance, the decision to zero on one policy is not a child’s play. With so many insurance companies in the market, buying the best health insurance plans requires you to put in great efforts. Take help from experts/professionals who strive to help you make a well-informed decision by picking the most suitable health insurance plan in India. We hope you will be able to take your best pick.