Five elements you can’t skip before buying Health Insurance Plan

Five elements you can’t skip before buying “Health Insurance Plan”

Health Insurance Plan.1
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Divyansh is a digital marketing person as well as teacher who is the very smart decision maker and guider when it comes to taking valuable decision for his company’s products. Lately, he has got dengue fever, due to which he is admitted to a private hospital nearby his location. The treatment cost came out to be Rs 75,000 which unfortunately has to be borne by him only as he did not have a health insurance policy. This insurance policy somehow saves him from the instant pressure of money/cash payment. However, this incident made his trust in health insurance policy and more understandable to him about the importance of a financial back up for his health in the form of a “Health Insurance Policy”. Now His trust in health insurance policy increase and he decided to buy a one for himself and his family. But Now the main problem he is facing is getting up the proper guidance, scope, behaviour and choosing the correct policy for his family. At present, he did not know what are the important things to be considered before buying a health insurance plan.

So Here is a guide which shows you 5 important parameters to be looked upon before going to buy health insurance or engage with any person/ agent/broker. Keep in mind about these 5 things. So you don’t feel helpless at any stage in life.

Life is fragile and unpredictable and you never know when your next parting is going to come”

1. Scope of Coverage – Health Insurance Plan

It is important to knowing everything covers under the policy (Basically those requirements because of them he/she buy a health insurance policy) scope of coverage. Many of Buyers not getting the proper clauses of insurance, they may assume that purely buying a health insurance is enough and now they secure their healthcare requirements. More Buyers buying a health insurance plan by taking the assumption, simply on the basis of premium, assuming “cheaper is the better” might end up limiting their scope of coverage.

I am not saying Cheaper health plan is not good but it not cover all aspect of health insurance that a person needs at the time of emergency. It is important to have a health insurance with a strong and healthy sum insured which ensure the maximum limit of getting a benefit under a health plan. Rising medical costs controlled or minimized by opting for a sum insured large enough to substantiate the claim amount without making you pay out of your pocket. It depends on your need how many sums insured you opted. But my personal choice is 15lac so that I cover my self completely in a health plan.

Also, the scope of coverage needs to be looked upon( for example If I am choosing the plan of 15 lakh, keeping in mind of my family and bonus of health insurance) as per your need, requirement, existing cover (if any), family size, previous medical history, etc. Look for the proper family history as well as keeping some critical illness in your mind.

Like for example, in case you are opting for a family floater plan, getting to know about the benefit of the sum insured refill or recharge top ups. (recharge of your sum insured in case it gets finished in a policy year), some people want to cover maternity in the health insurance plan, So look for a health plan offering maternity benefits and baby care after delivery and so on.

Health Insurance Plan
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2. Room Rent Capping- Health Insurance Plan

Room Rent Capping is per day cost of a room. I suggest go with Rs3500 to Rs 6000 per day private cost room in India. Especially in Delhi maximum hospital room range is Rs 3500 to Rs 5000. So, It is important to ensure and all the access, restriction or upper limits in the policy before finalising it.

There are certain restrictions with regard to the benefits payable related to the coverage under the health insurance plan. There is Room rent is the per day benefit is given to you when you are hospitalized as per the eligibility under your health insurance plan. Traditionally, the capping of the hospital room rent is 1% to 2% of the sum insured on a per day basis. Health insurance plans lately do offer “single private room” or the option to “upgrade your room” or some plans offer “no capping” on the room rent. Usually, health insurance plans with higher sum insured, offer the latter two options.

Thus, it is important to ascertain the room rent eligibility under your health insurance plan before you finalize the plan. With medical inflation skyrocketing, getting treatment in private hospitals has become expensive and so is the hospital room charges. Try and check the hospital room rents for your preferred hospitals and match up with the room rent eligibility under your shortlisted health insurance plan which will give a fair idea.

3. Cashless Hospital Network-Health Insurance Plan

Cashless hospitalization is a seamless procedure which makes the hospitalization easy in your troubled time to seek health care. You just have to show your health card issued by the insurance company and hospital admission is almost done. But all hospitals may not be partnered with the insurance company to offer you such hassle-free treatment. Thus, to have a look at the list of cashless hospitals empanelled with the insurance company is important. Out of the list, it is crucial to see your preferred hospitals. List of cashless hospitals may include 6000 or 8000 plus hospitals, but such an exhaustive list is of no use until it includes the hospitals, which are nearer to your vicinity or your ideal ones for treatment. Treatment in non-network hospital might attract co-payment (a specified portion of the claim amount to be borne by you) and cashless treatment will not be available. You have to spend the treatment expense from your own pocket and later claim reimbursement from your insurer by submitting all relevant bills and documents timely.

4. Claim settlement record-Health Insurance Plan

Claim Settlement means reimbursements of claim or settlement of policy. It is important to factor consider before buying Health Insurance. How Company works on policy and ratio of settlement is an important factor. Claim settlement record is an important aspect which cannot be skipped. How many claims have been settled by the insurance company is important to be known as it reflects the inclination of the insurance company towards claim settlement of genuine claims and assures you that your claims and reimbursements would not be wrongly withheld. A consistent and healthy claim settlement ratio in which one must look for before finalizing an insurance plan from the respective insurance company.

5. Co-Payment-Health Insurance Plan

Co-payment is your co-share in the claim amount. Co-payments are of 2 types voluntary and mandatory. As the name suggests, voluntary co-payment is opted by you as an insured and mandatory is compulsive, co-payment which is there in the health insurance plan. Co-payment is expressed as a specified percentage of the claim amount. By opting voluntary co-payment, your premium will tend to be reduced by the insurance company as you are bearing a responsibility to share the claim amount in the predetermined percentage. Voluntary co-payment must be chosen if you are young, healthy individual as then the probability of claiming from a health insurance policy reduces. Don’t fall prey to the fact, blindly that your health insurance reduces by opting voluntary co-payment.  But, the surprise comes when you are unaware of the co-payment clause in your health insurance policy at the time of claim. So, it is imperative not to skip this clause.

In a nutshell, the coverage amount needs to be assessed appropriately by the number of people that you want the policy to cover, your estimate of the health care costs and the existing coverage that you might have from other sources like employee provided group insurance. Healthcare inflation is increasing at a very high rate of 20% so go for a higher sum insured if affordable. Don’t fall prey to perceived value rather spend some time to compare plan and its coverage before you finalize your best buy.


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