How to choose the right India health insurance?

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What Does one look for in Best Health Insurance Plan in India? What factors affect the Policy premium?

When an individual plans to buy a good India health insurance plan, they normally need to take a few things into consideration while deciding the most suitable plan to buy. Should one go for an individual plan or a family floater policy? What about the sum insured for the policy and other coverage which one should opt for? Should one evaluate the waiting period or look for an insurance company which offers coverage is maximum number of network hospitals?

Some of the important features for an individual to keep in mind include:
  • The insurance partner’s stability is extremely important – their financial strength and claim settling capability
  • Evaluate the plans of all insurance players to decide on the most suitable plan for the individual – coverages, sum insured options, other terms and conditions
  • Has high ratings from industry experts. You can also check customer reviews
  • Has the widest network of doctors and hospitals available for treatment. Always check network hospitals in one’s city
  • Sub - limits / co-payments / Waiting periods to get complete understanding of the coverage
  • Transparent and hassle free claim settlement process

The Key Factors That Affect Affordable Health Insurance Premium

There are several factors that influence Indian health insurance premium which include:
  • Age - The younger one is, the lower their health insurance premium will be. This is because when one is younger, they are less likely to have adverse and pre existing health conditions which need medical treatment.
  • Occupation -The medical insurance premium is likely to be higher if one is in a high risk occupation like manufacturing, construction, mining, working with hazardous substances etc.
  • Location – Some insurers have a differential premium rating for the insured’s place of residence/domicile. Persons residing in metro cities are likely to pay a higher premium given the higher propensity for a health hazard that ones’ residing in Tier II/III cities.
  • Consumption of Injurious substances - Health insurers also take in account detail of person’s regular habits pertaining to alcohol consumption and smoking. A non smoker is likely to have a lower premium than one who is a heavy smoker even if they are of the same age. Regular Alcohol consumption is also likely to draw an increased premium.
  • Medical history – Anyone with pre-existing medical conditions is likely to pay a higher premium than one without such conditions. However this should not prevent the insured from declaring their true medical history, because due to a non declaration, there could be a situation where a claim could be denied in the future.
  • Body Mass Index (BMI) - Medical insurance providers also take into account your Body Mass Index of the applicant. A higher body mass index may result in an increase in the premium than an applicant with a normal BMI. High BMI is indicative of a higher risk for obesity-related diseases such as high blood pressure, high cholesterol, cardiac conditions and type 2 diabetes.

What are some of the Key Tips for buying right health insurance in India?

While there are many pieces of advice most experts share on India Health insurance, we have tried to consolidate the most relevant 7 best tips for purchasing right health insurance which will always be relevant to all categories of buyers. They are:
  1. Understand ones’ Requirements Clearly – Different individuals, even though are part of the same family have different requirements from their health insurance plan. A younger person can afford to go for a higher sum insured, an elder family member may need a plan with minimal waiting periods for pre existing conditions, a young woman may look for a maternity coverage, the head of the family may be an occasional drinker/smoker and will need to still be insured. Such health insurance requirements will need to be kept in mind when they choose their coverage requirement and this will depend on factors, age of the family members, their existing medical condition, their genetic or lifestyle-related conditions and healthcare costs in their city. Basis this, the family should opt for a strong and comprehensive plan with a floater sum insured or individual sum insured.
  2. Choose Adequate Sum Insured (Coverage Limit) – According to many studies and health experts, more than half of the Indians with health insurance policy are underinsured. This means that not only are almost 80% not having the right Indian health insurance at all, more than half of them have not got themselves adequately insured, in terms of the coverage limits of sum insured. This could mean that at the time of a claim, they will end up paying a significant amount of the incurred medical expenses from their pocket. The thought process is still that have a minimum cover rather than no cover as well as why spend too much money on health insurance premium, when one believes they are healthy otherwise. Consider all the family priorities and liabilities, while keeping in mind factors like age of all family members, healthcare costs, etc to arrive at an optimum coverage amount. One can also opt for additional add on covers like Maternity, Critical Illness etc.
  3. Buy Health Insurance when Young and Relatively Healthy – Further to the earlier point, it is important for one to realize early that health insurance is mandatory for everyone at any age and not only when one gets old and more likely to have health conditions that need to be treated and hence health insurance becomes important. With the increase in the incidence of lifestyle diseases and infections rising to pandemic proportions like the Swine flu, Dengue, Covid 19 outbreaks, it becomes critical to have insurance even at a young age. There are specific advantages also while buying insurance at a young age that include 1) One has to pay a lower premium at a younger age and can hence opt for a higher sum insured plan; 2) can serve the waiting periods while being healthier; 3) At a younger age, the likelihood of one carrying a pre existing illness is limited and 4) Avoid being rejected by health insurance companies due to ones’ health condition. The other advantage is one can also opt for an increase in sum insured limits as the policy progresses.
  4. Clearly Understand the Terms & Conditions of the Chosen health insurance plan – It is of utmost importance that one reviews the terms and conditions / policy wordings and other policy documents carefully so as to understand what is covered and what is not. It will help gain a thorough understanding of the claim process, document requirements, payment options, special conditions, coverage and exclusions. One should check with the insurance company/intermediary for any clarifications before going ahead and buying the policy.
  5. Understand Financial Parameters like Sub-limits and Co-payments – In all top India health insurance policies, there are financial parameters like sub-limits and co-payments which one needs to be aware of and also understand their implications. A brief insight is as follows:
    • Sub-limits: Most health plans have sub-limits on room rent, surgeries, ICU charges, operating charges and other medical procedures. This means that for these specific procedures/illness/features, the sum insured is as mentioned on the policy and not the overall sum insured under the plan. (For example eventhough one has an overall SI of ₹5 lacs, there may be a surgery sub-limit of ₹1 lac, which means for a surgery the maximum limit available is ₹1 lac only as against a policy limit of ₹5 lacs) . It is safe to assume that a health insurance plan with lower premium has sub-limits that one with a higher premium.
    • Co-payment: In a co-payment scenario, the policyholder bears a pre-defined percentage of the claim amount from their own pocket while the remaining amount is borne by the insurance company. Again, thee co-payment options vary and one can choose their option depending on their financial capability.
    • Sum insurance companies also offer health insurance with no sub-limits or co-payments as an option to the individual. Needless to add, this will have a direct impact on the applicable premium for the plan.
  6. Fill up the proposal form yourself – Filling a proposal form is an important step while purchasing ones’ health insurance policy. This step requires one to provide information on their health habits, medical history and pre-existing diseases and hence it is recommended that one fills up the proposal form themselves. For the insurer to underwrite the policy appropriately, all the details furnished need to be correct and true. Inadequate information or incorrect information can lead to a delayed or non-payment of claims.
  7. Hospital Network of TPA/Insurance Company – While selecting the best health insurance plan, review the list & details of the hospital network of the insurance company both in your city of residence as well as across India. It is important that ones’ insurance partner has a wide hospital network.

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