Comparing different health insurance plans offered by multiple insurers can be a very confusing affair. Instead of subjective factors, rely on objective numbers and figures when finalising your choice. Make sure you analyse these eight figures very carefully before buying the policy.
Number of Networked Hospitals
Your health insurance policy will be valid in all hospitals. However, networked hospitals will offer additional benefits like:
1) Incurred Claim Ratio
2) Claim Settlement Ratio
The claim settlement ratio is the proportion of claims approved or settled as against the total claims received by the health insurance company. Approving claims worth Rs. 90 crores out of total claims received of Rs. 100 crores indicate a Claim Settlement Ratio of 90%.
It also indicates a more robust claim settlement process with established procedures as compared to a health insurance company with a very low ratio.
3) Waiting Period and Survival Period
Certain benefits like maternity benefits along with cover for pre-existing conditions come into force only after a specific waiting period. A shorter waiting period is always preferable, even if it involves a higher premium. Health insurance plans have an initial waiting period of 30-90 days where claims are accepted only in case of hospitalisation due to accidents. Then, there are disease-specific waiting periods where cover for certain diseases will get activated only after a specific time.
Further, there may be a longer waiting period for pre-existing ailments. To know more, read Pre-Existing Medical Conditions.
In case of critical illness plans, insurers impose the requirement of survival to differentiate the plan from a life insurance policy. The claim will be approved only if the individual survives for a specific period after the operation or treatment. Like in the case of waiting period, a policy with a short survival period requirement is preferable.
4) Room rent and other sub limits
Policies have a sub limit for the room rent. So, a 1% room rent sub limit on a Rs. 1 lakh policy means the policy will cover room rent up to Rs. 1000 only per day.
If you opt for a room of Rs. 3000 per day, then the policy will reimburse just 1/3rd of not just the room rent but all covered expenses like nursing expenses, tests, specialist fees, surgery charges etc. All limits are calculated based on proportion of the coverage amount to the room rent.
In case of a Rs. 3000 room, the policy will cover 1/3rd of not just the room rent but of all other covered expenses as well.
5) Number of Pre-Existing Medical Conditions and Critical Illnesses Covered
Individual health insurance plans don’t cover pre-existing conditions without a mandatory waiting period. However, the number of pre-existing conditions may vary. A plan covering higher number of conditions is a better choice, especially if you are buying a single plan for the entire family.
Similarly, buy plans that come with a rider covering a large number of critical illnesses over other plans. Enhancing the value of coverage by paying more for the rider may be cheaper as compared to buying a specialized plan for critical illnesses alone.
6) Pre-and Post-Hospitalisation Expenses
If the ailment is covered by the policy, then certain pre-andpost-hospitalisation expenses too will be taken care of buy the policy. When considering this, make sure you focus on
7) Co Pay or Deductible
This refers to the policy holder’s share of the total cost of treatment. A 20% co pay means that the policy will pay Rs. 80 out of the total cost of treatment of Rs. 100. The balance Rs. 20 will have to be paid by the policy holder.
The numbers may not tell the entire story but it certainly will help you identify the best 2-3 policies that offer best value for money. You can then finalize the plan that seems to be the best option to secure your health and the health of your family.
A pre-existing medical condition should not be a deterrent for buying your family health insurance and securing their financial future. However, proper disclosure and some precautions ensure that in case if any unfortunate event, you have a smooth and hassle free experience.
A steep rise in maternity expenses over the years is forcing couples to look for options to fund this expense. Those buying maternity policies should understand the terms of these policies.
Though both Individual and Group Health Insurance Plans provide similar coverage, they do differ in various aspects, such as cost and customisation.
With age, your needs increase for this its important to pick the right cover for your life stage. Reviewing your plan at different stages can ensure you get 360° protection.
Health and critical illness are separate categories and each has its own place in a consumer’s insurance requirement. Here’s a simple guide to knowing how to choose between the two, or decide if you need both.