You have decided to buy a health insurance policy and have opted for the online mode since you get multiple choices, instant results and you can make the final choice without being pressurized by ‘friendly’ agents or whoever. But there is a glitch… When you started out, you thought it would be an easy decision to make but with 21 insurance companies selling health insurance and so much of data available, you are finding it difficult to make a decision. Also with the different parameters available, there are some policies which are great in one aspect but bad in others, then how to compare health insurance plans ......
Firstly, get the advice of a Health insurance Broker-
The reason that we are asking you to do this is because even with all the options available, it is not very easy to compare health insurance in India. A health insurance broker has the expertise and the knowledge to give you the most neutral advice to choose a product suitable to your needs. Even when all the policy conditions are mentioned in the policy, finer insights (for ex., some health insurance companies have increased their premiums three times in the last 2 years) is something only a broker can provide you with. Unlike agents/financial advisors who represent a given insurance company, brokers represent you and deal with all insurance companies; therefore, their advice is unbiased. What’s more, this service is rendered free of cost to the customer! So consult a health insurance broker to help you compare health insurance plans and choose a product suitable for you.
Now, we give you the important parameters you must focus on while comparing health insurance policies.
Insurance Co pay:
- Please pay attention to this term in your health insurance policy since it can be an important differentiating factor in policies. ‘Co pay’ means there will be a division of allowable expenses between the customer and the health insurance company. If there is a 10% co pay on all claims, you have to pay 10% of the expenses and the company will pay 90% of the expenses. Generally senior citizen and some floater plans have ‘co pay’. It is wise to check if the product you choose has a co-payment condition.
Limits on certain Medical treatments:
- There are many treatments which have been capped by health insurance companies to reduce their outgo in event of overcharging by hospitals. For example in Star Health’s Family Optima, Cataract is paid upto a limit of Rs.12000 and to Rs.10,000 in National’s Varishta mediclaim So you need to check the policy to see if the policy has such limits and which are the diseases which are capped.
Waiting period for Specific diseases:
There are many diseases like hernia and procedures like tonsillectomy and knee replacement surgery that are covered only after 2 years of buying the policy and continuing cover without a break with the same insurance company. You need to check the policy wordings of the policy online to find out. Dedicated Health Insurance brokers with a website of their own make wordings of all health insurance policies of all insurance companies available in one website.
Pre-existing diseases are those which you might have been afflicted with before buying the policy and are generally never covered at the onset of the policy. These are covered after a waiting period of 1 to 4 years. You must choose a policy with the least waiting period for pre existing diseases to make sure that you are not denied insurance claim when you need it most.
Hospital Room rent:
In many policies there are sub limits or limitation on the amount that can be claimed for a particular expense. In this case, many companies cap the maximum amount charged for room rent. If you have a 1% limit on room rent on a policy of 1 lakh, you can only claim room rent upto Rs.1000 per day. This can be especially limiting if you live in a metro with high hospital room rent costs.
A further variation of this is that, while some policies limit only the room rent, some others limit all expenses dovetailing the room rent limit. Hospitals charge different fees for same service depending on the grade of room one is admitted in. The same X-ray will be charged less for someone in a twin share room vis-à-vis someone in a deluxe room. The more restrictive polices not alone limit the room rent, but pay other expenses only to the extent applicable to an room occupancy as per limit. Thus, consider your cover amount and ask yourself if the limits are reasonable for you. There are many policies that do not have room rent limits, or which have a greater percentage, you can choose from one of these.
Insurance Claims Loading:
- This is another vital parameter that you should know about. For every year you claim, in some policies you will be charged an additional amount (loading) at the time of renewal, depending on the percentage of the cover amount that you claimed. You may face even a 5-200% hike in your premium based on the loading rates of your policy. So before choosing a policy, check whether it has claims loading.
Maximum Renewable age:
- This is a very important parameter that you must pay attention to. It indicates the age beyond which the insurance company will not offer you renewal of your policy. Many policies have a maximum renewable age of 65 or 70 after which finding a new policy would be extremely difficult. So choose a policy that either has a lifetime renewal option or a higher renewable age.
- Network Hospitals: Network hospitals are those which have a tie up with insurance companies to provide cashless service. You can avail treatment on valid hospitalizations in these hospitals without paying money by showing your health card issued by your TPA (Third Party Administrator). The TPA will directly pay the allowable expenses to the hospital. You need to check the list of network hospitals available under different policies to ensure that the ones you would go to, especially in case of emergency treatments, are there in this list.
- Day Care Treatments: These treatments are covered in spite of requiring less than 24 hour hospitalization which is otherwise a mandatory condition for a claim to be admissible. Any policy with an extensive list may seem better but there are chances that many treatments that are completed with less than 24 hours’ hospitalization due to advancement in technology may be missing in this list. So between a policy which covers all day care procedures and one which just gives an extensive list, the former is a better option. For e.g. Max Bupa does not have a list and covers all Day Care Procedures.
Other important criteria:
- Other sub limits: There are many other sub limits in different policies like ( doctor’s consultation +Expenses for Blood, anesthesia, oxygen cylinder +cost of medicines, diagnostic tests exceed a specified percentage of your total coverage amount. You need to choose one policy with least number of sub limits or sub limits which are more reasonable.
- Waiting period for all illnesses: There is also a waiting period before which no claims can be made except in the case of accidents. Generally the waiting or the cooling off period is for 30-90 days. Choose a policy with the least waiting period.
- Medical check-up after: Some policies require those over the age of 45 years to undertake a compulsory medical checkup before buying a new policy. Check other policies in case you are reluctant to undergo the medical test.
- Discounts/Bonuses/Free health Check-up: Many policies offer discounts on premiums or bonuses on the cover amount for every claim free year. There are also free health checkups on 4 continuous claim free years of the policy. Choose a policy with such features which will benefit by decreasing your premium or increasing cover amount free or giving you a free health check up.
- Other important features: Some other features found across all the policies like cover for Pre hospitalization (30 days in most cases) and Post hospitalization (60 days in most cases) expenses also need to be checked in all policies.
Now that you shall pay more attention to parameters that are most relevant to you, you can make a better choice among the available alternatives and choose the right health insurance product.
If you feel it all the more difficult to choose, now that we have provided with such a huge list of factors to consider, we repeat, take the help of a dedicated health insurance broker’s website. As stated, not only is their advice free of charge, there is no compulsion to buy the policy through them.