Factors to Consider Before Purchasing Best Medical Insurance Plans in India
There are few factors that you should consider closely to make the right decision and choose the best.
Caps and sub-limits:The amount you pay for a health policy has impositions of co-payments, sub-limits, and other caps, which would alter thebenefits in the long run. To make the most of your health insurance policy, you must understand these factors before you pay for a plan.
Claim settlement record:This is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. Thus, you can ensure that your claims would not be wrongly withheld. Always ask for the companys claim settlement ratio before purchasing their health plans and save yourself from unnecessary harassment.
Scope of cover:Dont buy a plan by just comparing health insurance cost. Less cost does not necessarily mean a good plan. On the contrary, such a plan might not consider your needs properly. Closely look at what the plan includes. Buy a comprehensive plan.
Renewability:It is important to see how many years the plan proposes to protect you. You should not be left without a safeguard when you need it the most, say during your old age. Mediclaim policies are usually annual contracts. The automatic re-establishment of in-force status affected by the cost is known as renewal. In other words, issuing a new policy or the continuation of the current policy, once the old policys plan year ends, is termed renewal. At the end of the policy term, the policy has to be renewed by the insured. There should be continuous renewal of the policy because if there is a break, then the person will lose thebenefit of insurance, in the event of a contingency.
Cashless Hospital Network:Check if a hospital around you is included by the company you are considering to buy from. You and your family wont be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator has a tie-up with a range of nursing homes. The insured can get admitted in any of these nursing homes and medication for a disease covered by the policy. However, cashless mediclaim resolution is subject to limits and sub-limits, which are subject to the sum assured of the policy.
Premium Loading:Loading is an additional cost built into the insurance policy to consider losses, which are higher than anticipated, for an insurance company, arising from insuring a person who is prone to a form of risk. Premium Loading is the amount an insurer needs to consider its expenses and generate profit. We strongly recommend you check the terms and conditions pertaining to premium loading. This will save you from paying a high incremental premium post making a claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment later. The best practice would be to verify the cost fluctuation data of the plan for the previous 5 years at the very least.
Internal Team:Check for plans from firms, who have a dedicated internal team for handling Mediclaim. This comes in handy while expediting the Mediclaim resolution process. Most of the players use a third-party administrator to process the claims and do the paperwork. Even though most of these Administrators provide great services, the fact that they are a third party slows down the process. There are certain rules and regulations to be followed when an administrator processes a claim before it is handed over to the insurance company. These affect the turnaround time.
Floater (family) Size:Everyone has a different family size, so you should always look for the family size allowed under the plan before purchasing it. If you are a person in your late 20s and your parents in their 40s, 50s or 60s, then purchasing foryourselfdoes make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings etc., then a family health plan is best for you. Checking the cost, family size covered, critical illnesses or other benefit will ensure that you are able to purchase the plan you need.
Health Insurance Portability:It is wise to choose a health insurance company that offers health insurance portability. Earlier, policyholders had to stick to a policy just to retain the advantage. Now,the policies allow you to switch from one insurance company to another without losing the waiting period advantages earned in your current policy. Moreover, with insurance landscape changing so regularly, insurance companies regularly come up with better policies and it may make sense to opt for health insurance policy portability. Although health insurance portability is free, some companies may charge you a certain fee if you are to port out of their plans to those of some other players. Therefore, make sure you do not pay any charges for medical insurance portability. Health insurance portability is a good thing to check when you are finding the best health policy or mediclaim.
Restore Benefit:With ‘restore benefit’ facility in your health care plan, you can restore your basic sum assured, in case you have already spent the same or the multiplier advantage during your policy tenure. Mostly, the benefit cannot be obtained on the same ailment, if you exhaust the limit.
Restoration assistance proves to be helpful for a family floater health plan, where the entire sum assured is used in the treatment of only a single family member. This leaves the remaining policy members with zero policy cover in case of hospitalisation for the remaining policy year. In such a case, the other family members can avail policy coverage for the illness other than the one for which the expenses have already been compensated by the insurer.
Well, while finalising your health insurance plan, you should consider other influencing factors such as waiting period, sub-limit, claim settlement procedures etc. You can replace restore benefit with a super top-up plan at an affordable price. Moreover, top-up plans are more comprehensive since it comes with less or no restrictions.
Top up Plans:With the rise of medical inflation, having a large medical cover is prudent. But not all can afford it, due to the high premium. This is where a top-up plan comes into the picture. A top up plan reduces the deductibles cost i.e. the portion of claim you pay willingly for the damages before the insurer compensates the rest or up to the sum assured. With a top up policy, you dont pay until a hospital breaks its defined limit. A top up plan is considered far cheaper than a standalone medical policy.
For instance, if the medical bill is 6 lakh with a deductible of 2 lakh, you are required to pay only the latter amount and the remaining 4 lakh will be paid by the insurer. But you can utilise your health policy to pay the liable amount. Again, the blending of a top up plan with a medical cover is helpful as the premium you pay is much more affordable than the single plan. For example, if you pay 6,500 as a premium for Rs. 5 lakh regular cover, a top up coverage of Rs. 15 lakh will entail to an additional premium of 5,000, which is anyhow cheaper than a separate policy of identical cover.
Waiting Period:As per the insurance norms, every insured must serve a defined waiting period for any pre-existing illness. It is usually a 30-day period from the day your health insurance policy is initiated. If any claim falls during the waiting period, the insurer has the right to reject the claim for any hospitalisation, except in the case of an emergency. A hospitalisation that arises out of an accident can be registered as a claim and the insurer will compensate the hospitalisation cost. However, the insured is not required to serve the waiting period for subsequent years.
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