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Decoding How to Choose the Ideal Health Insurance Policy
Health Insurance Policy

Decoding How to Choose the Ideal Health Insurance Policy

| @indiablooms | 01 Jul 2024, 12:01 pm

Choosing the right health insurance policy can feel overwhelming. This can especially be the case with so many options available. You can start by understanding the key factors that influence your decision. This could help you select the best mediclaim insurance policy for your needs.

1.Evaluate Your Health Needs

Personal Health Assessment

Start by assessing your personal health needs. Consider the following:

  • Age: Younger individuals may need basic plans. Conversely, older adults might require comprehensive coverage.
  • Medical History: Check if you have any pre-existing conditions that need coverage.
  • Family Health History: Anticipate potential health issues based on your family's medical history.
  • Lifestyle: Your habits and occupation can impact your health risks.

Family Health Needs

If you're looking for a family plan, evaluate the health needs of each member:

  • Children: Consider frequent pediatric visits and vaccinations
  • Spouse: Include regular check-ups and any specific health concerns
  • Elderly Parents: Look for senior citizen health insurance with coverage for age-related ailments

2.Understand Different Health Insurance Plans

Types of Plans

Familiarise yourself with various health insurance plans:

  • Individual Health Insurance: Suitable for single individuals without dependents
  • Family Floater Policy: Covers the entire family under one sum insured
  • Senior Citizen Health Insurance: Designed for older adults, covering age-related health issues
  • Critical Illness Insurance: Provides a lump sum on diagnosis of specific critical illnesses
  • Group Health Insurance: Usually offered by employers, covering employees and sometimes their families

Coverage and Benefits

When comparing plans, focus on the coverage and benefits:

  • Hospitalisation Expenses: Ensure the policy covers room rent, ICU charges, and nursing fees
  • Pre and Post-hospitalisation: Check if it covers expenses incurred before and after hospitalisation
  • Daycare Procedures: Some treatments don't require a 24-hour hospital stay. Ensure these are covered
  • Ambulance Charges: Look for policies that cover transportation costs to the hospital
  • Maternity Benefits: Important if you plan to start or expand your family
  • No Claim Bonus (NCB): Policies with NCB provide a discount on the premium for each claim-free year

3. Compare Policies and Providers

Network Hospitals

Check if your preferred hospitals and doctors are part of the insurer's network. Network hospitals offer cashless treatment, where the insurer pays the hospital directly. This feature is crucial for hassle-free medical care.

Sum Insured

Choose a sum insured that covers potential medical expenses. Consider factors like the rising costs of healthcare and the size of your family. A higher sum insured provides better financial protection. However, may come with higher premiums.

Co-payment and Deductibles

Understand the terms related to out-of-pocket expenses:

  • Co-payment: A fixed percentage of the claim amount you need to pay
  • Deductibles: A fixed amount you must pay before the insurance kicks in

Policies with higher co-payment and deductibles usually have lower premiums. However, they can lead to higher out-of-pocket costs during claims.

Exclusions and Waiting Periods

Review the exclusions and waiting periods in each policy:

  • Initial Waiting Period: Usually 30 days from the policy start date
  • Pre-existing Conditions: Typically 2-4 years
  • Specific Treatments: Such as maternity benefits or critical illness cover

Understanding these terms helps avoid surprises when you file a claim.

4.Evaluate the Financial Aspects

Premiums and Payment Options

Compare the premiums of different policies. While lower premiums are attractive, they should not mean inadequate coverage. Check for flexible payment options like monthly, quarterly, or annual payments. Consider how premium amounts fit into your overall financial planning.

Claim Settlement Ratio

Research the insurer’s claim settlement ratio (the percentage of claims settled). Moreover, read reviews from existing customers. A high claim settlement ratio and positive reviews indicate a reliable insurer. Understand the claim filing process, required documentation, and the timeline for claim approval.

5.Utilise Add-on Covers and Tax Benefits

Add-on Covers

Enhance your policy with add-on covers:

  • Critical Illness Cover: Provides a lump sum amount upon diagnosis of severe illnesses
  • Accidental Death and Disability: Additional cover for accidents leading to death or disability
  • Hospital Cash Benefit: Daily cash allowance during hospitalisation
  • Maternity and Newborn Cover: For maternity expenses and newborn care

Tax Benefits

Health insurance premiums are eligible for tax deductions. This is applicable u/s 80D of the Income Tax Act, 1961. The deductions are as follows:

  • Self and Family: Up to ₹25,000 per year
  • Senior Citizens: Up to ₹50,000 per year
  • Additional Cover for Parents: Up to ₹25,000 (₹50,000 if parents are senior citizens)

Ensure you take advantage of these tax benefits while planning your health insurance.

6.Assess Portability and Customer Support


Portability allows you to switch from one insurer to another. This can be done without losing the benefits of your existing policy. This feature is useful if you are unhappy with your current insurer’s service or find a better plan. Ensure the new policy offers at least the same benefits and coverage as your existing one.

Customer Support

Good customer support is crucial for resolving queries and issues. Check if the insurer offers 24/7 customer support. Additionally, ensure they have multiple communication channels, such as phone, email, and chat. Responsive customer service can make a significant difference during emergencies or claim processes.

7.Leverage Digital Tools and Services

Digital Tools

Many insurers offer digital tools and services for convenience:

  • Mobile Apps: For policy management, premium payment, and claim tracking
  • Online Portals: To access policy documents, network hospitals, and health resources
  • Telemedicine Services: For online consultations with doctors

These tools can help enhance the overall customer experience. They also help make managing your health insurance easier.

Choosing the ideal health insurance policy involves several steps. First, carefully evaluate your health needs. Then, understand the different types of plans available. Compare the coverage and benefits of each plan.

Assess the financial aspects, including premiums, co-payments, and deductibles. Take advantage of add-on covers and tax benefits. Ensure your chosen policy has a good network of hospitals. Look for reliable customer support and convenient digital tools.

By following these steps, you can select the best mediclaim insurance policy. This will provide comprehensive coverage and peace of mind.

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