How to get the best Health Insurance Plan?

So when was the last time you bought an insurance policy and how much of it made sense to you? What factors helped you reach a decision or did you just agreed to buy the policy that your agent advised?
Health Insurance is the most effective mechanism known and available that can ensure you to get the best healthcare at affordable prices. Also with rising medical costs, it has now become imperative for everybody to get Health Insurance coverage.
1. Sum Insured or Coverage Amount
With rising inflation levels, healthcare costs are expected to soar at 17-20% p.a. for the next few years. It is essential to buy policy that ensures sufficient coverage amount when required. In case you have dependents or live in metros, the cost of a surgery can be as high as 3 lakhs. Estimate your future requirement accordingly and also don?t forget to take into account inflating treatment costs. Also take into account the time value of money, as in the value of Rs. 3 Lakhs today might not be the same 20-30 years down the line.
Considering the cost of living, GDP, no. of metros, cost of healthcare in various parts of India,
The above recommendations are based on the average amount of policy coverage amounts bought across cities ranging from Tier I to Tier V.
Also as published in a recent survey, the national average of health insurances bought online falls in the range of Rs. 4-4.20 lakhs with more than 50% of the population looking for policies in the range Rs. 3.50-4.50 lakhs. Around 80% of online shoppers are looking for family floater schemes which provide coverage to themselves and their dependents.
Don?t forget that as your grow older it will become difficult to upgrade or buy a higher coverage policy as there will be a requirement of medical test. So don?t leave it for later and buy an adequate coverage amount today.
2. Renewal Age
Renewal Age is the age when your insurance policy expires. As medical technology progresses and becomes more accessible to common man, life expectancy in India is set to grow in future. A product which ceases to provide benefits when you need it the most is not at all recommended. It is easier and cheaper to enter into a health insurance policy at a younger age rather than at a later stage when you will be more prone to diseases and no insurance company will be willing to insure your health expenses. Given below is a snapshot of what the top insurance companies are offering.
3. Limits and Co-Pay
To prevent customers from reimbursing heavy bills of treatment in unusually expensive hospitals, insurance companies ask you to pay a portion of the total expenses incurred. For Eg- if a policy has cover of 5 lakhs with 20% co pay limit, then for a claim of any amount (like Rs. 3 lakhs) you would have to pay 20% (Rs. 60000) of the total amount.
Also companies have introduced treatment-wise and day-wise limits. Treatment-wise limits basically cap the amount you can reimburse/claim for a particular treatment. For eg ? Even if your policy coverage amount is Rs. 5 lakhs, but if your policy can only insure Rs 3 lakhs worth of Cardiac Treatment, then you would have to burn a hole in your pocket to pay the rest of the amount over and above Rs. 3 lakhs. Like ICICI Lombard Comprehensive Health and Bajaj Allianz Health Guard have caps for Cataract treatment.
Some health insurance products offer a daily cash benefit for the no. of days a person has been hospitalised. For eg ? if you have under gone a surgery and have been hospitalized for 8 days then at Rs. 10000 per day, you will be entitled to a claim of 8*Rs. 10000 = Rs. 80000 for the surgery. But for other expensive treatments which requires only 1-2 days of hospitalization, you will have to pay the residual amount from your own pocket.
A policy having a Co-Pay option and Treatment-wise limits does not mean that the policy is bad. Such policy will have lower premiums and also the insurer will abstain from overspending on room rents and other costs. Although, policies with day-wise limits is not recommended as many expensive treatments does not necessarily need the patient to remain hospitalized for longer durations.
4. Pre Existing Diseases
This is a very common grey area between the insurance companies and insurance holders which provide ground for a lot of disputes. Make sure to disclose each and everything to the insurance companies when applying for cover otherwise there is a risk of policy getting cancelled or renewal denied if such an illness is discovered at a later stage.
Generally companies provide cover for pre-existing diseases only after a specified waiting time (Eg- 2 or 4 years). The definition of pre-existing disease as put forward by companies is not just the disease you are suffering from the time you took the policy but also any other disease that is caused due to any such diseases. Like Heart Problems caused by Diabetes.If you do not disclose such diseases beforehand, reimbursement may not be provided even at the end of the waiting period.
5. Cashless Facility
Most insurance companies have cashless card facility for re-imbursement based plans that allow you to simply present the card at the time of admission and an administrator would take care of settling your hospital bills directly from the insurance company. Although this facility is provided by a number of companies but this facility may not be applicable for all hospitals. In 2010, several public sector insurers withdrew support for the cashless facility. So don?t forget to check whether the hospitals in your area are covered under the cashless scheme of your insurance provider. Cashless facility is an added advantage but should not be considered as the sole decider for choosing a policy. As mentioned earlier, the coverage amount and other features hold more significance.