Why Your Best Health Insurance policy never works the way you want

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When you buy anything, you expect to it to be functional in best possible manner immediately& every time you need it. Well there is nothing wrong in this anticipation as that’s what you purchased it for. But this ‘hope’ does get shaken when it comes to Health Insurance. Every person buying a policy thinks he has got the best health insurance plan as it is cheapest available but in this money-saving transaction, some of the critical points are often over looked & later you regret. Let’s have a look at these:

1.   Waiting Period is a common term now in health insurance. This isthe time stated in the policy which must pass before your health policy benefits can be reaped other than emergency situations like an accident. Thus in this period you cannot claim anything & so falling sick in this waiting period will make your savings equally sick. There is no way you can escape this mandatory stop-over point in your best Health insurance policy. These waiting periods usually range from 30 days or can go up to 90 days from the date of issuance of the policy.Some policies also have ailment- specific waiting periods up to 2yrs for dis-orders like hypertension, hernia.

Pre-existing diseases need to wait for minimum 2-4 years depending on the nature of the policy. Latest news is that Religare Health Insurance has now sought green signal from the Insurance Regulatory and Development Authority (IRDA) to introduce a product, which would allow covering declared pre-existing conditions

2.   Cashless option in a health insurance policy is seen as treasure waiting to be opened.  You feel that there is no need to arrange cash as it is cash-less & will take care of all eventualities at all times. Yes in most cases this is true but there are some important points to note here, it is possible to get cashless hospitalization only in network hospitals. Also delay in response from the TPA or lack of support can create dis-comfort in treatment or during discharge. Thus it is recommended to buy the policy from a trusted, experienced professional who understand the nits involved in this process& can come to your rescue when you need it most. I would also suggest keep some funds handy for emergencies, do not consider the cash less card as credit card.

3.   One of the recent trends is to buy best health insurance plan is based on List of network hospitals. Policies are bought because they have enlisted the preferred or ‘matching my standard’ hospitals. But the reality is that this list is upgraded/degraded as per the interactions of the insurance company with the hospitals. Basically, their mutual relations/understanding defines whether the list will remain as is or undergo a change. Now if you buy a policy considering this factor which is beyond your control you may suffer as the hospital may not be on the list after 2-4yrs or when you reach 50 when you really need your best health insurance to work. At that time, searching the so called ‘favorite’ hospital will itself be a painful exercise.

4.   Another aspect to note is Claim based loading. This basically means increase in premium after registering a claim despite of paying the premium due regularly. Unfortunately Health insurance in India is an annual contract & thus Insurance companies review the past performance of the policy & if any claim has been logged then the premium is altered basis this clause. So you cannot assume that premium amount would remain same always under any situation. Below are some criteria’s on which loading may be ascertained:

◦Claims to sum insured ratio

◦Depending on chronic or non-chronic ailments

◦Depending upon the amount claimed

5.   Co-pay basically means a portion of the Health insurance claim that you have to pay, & the remaining amount is paid by the insurance company. Thus for example: if the claim is for Rs 1,00,000  & co-pay is applicable, then you have to pay Rs. 25000 & the policy will rest.It is important to note that not necessarily allthe claims will be under co-pay clause, usually certain pre-conditions are required to be met before the clause comes in to force. These could be in situations like opting for high-end hospital for a treatment, choosing a hospital which is not part of the insurer's network of hospitals or could be applicable when policy holder attains a certain age because as age increases, the chances of you  getting sick increases. 

As there is a financial consequence of this clause, it would make enormouslogic to knowthe policy's terms and conditions wellbefore buying your best health insurance policy. For the same coverage amount, a plan with co-pay should come with a much lower premium than one without co-pay however you have to keep some funds handy at all times.

Co-payment feature is nil in Apollo Munich Plan and the Gold variant of the Happy Family Floater plan of Oriental Insurance.

6.   It is often believed that Health Insurance policy from a Bank is the best policy to buy. Yes we agree buying a policy is pretty simple. The only requirement is to be an account holder in the bank. The most important benefit is the unbelievably low premium rates to cover your family, as compared to a private player. Some bank plans have very good benefits & features like no co-payment, no change in premium up to age 65yrs.

These are usually customized & uniqueplans like SyndArogya (Syndicate Bank and United India Insurance), which charges the same premium for a 30 year old and a 60 year old for the same cover.  Below is a chart depicting the tie ups & Premium range for these tailor made polices:


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The problems associated with these plans are that maximum coverage you can get is Rs 5 lakh, apart from the regular exclusions and a 3-year claims-free waiting period on pre-existing illnesses; some plans also don't cover primary diagnostic treatment charges. An important point to note here is that policy is approved by the bank, but the claims settlement process is done through a TPA or the insurance company. There is also risk associated of dis-continuance of the plan or partnership of the insurance company & bank

Considering the above factors, it is recommended to go through the terms & conditions of the policy, understand the terminologies & then select the right plan matching your needs. Usually, we believe that policy purchased by a friend will also be best health insurance for you but the reality is that each one of us is unique & so is our want.  It is advisable to opt for sum Insured of atleast 5 or 10 lacs to ensure your ill health‘if it happens’ does not leave a hole in your pocket & not make you wonder why your best health insurance did not work when required

In case you would like a Medimanage Expert to help you buy a policy, you can provide your details in the following link: 

Inquire for best health insurance policy!

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