five factors

It’s always a better idea to be well-aware of what you are going to get in a package before deciding on a health insurance plan. Getting a health insurance in the early life is an integral decision of your financial planning. Investing in one of the best health insurance plans will help you be sure about and stable with your finances if something untoward happens. There are different types of health insurance plans available such as individual mediclaim, unit-linked health plans, family floater policies, senior citizen health insurance etc. However, you should choose the one that suits your insurance needs and the life stage you’re currently in.

Here’s a look into the 5 shortlisted parameters to be considered before you make the final decision to buy a health plan:

1.     Coverage Amount

Nonetheless, it is one of the most important parameters while buying a health plan. It’s crucial to evaluate and assess the coverage scope offered by the insurance provider. People normally emphasize on the premium rates as they assume that ‘cheaper is better’. However, it might lead to limiting their scope of coverage.

It’s important to get a health plan with a robust sum assured as it will eventually help you combat the rising medical costs by substantiating the medical claim amount. Also, make sure to take into account various factors such as your age, previous medical history, family size, etc. while deciding the sum assured amount you want to get.

Also, seek a comprehensive health insurance policy that offers benefits for specific cases. For instance, if you are going for a family floater plan, make sure it has the restoration benefit. Likewise, if you are looking for maternity benefits, make sure you buy a plan that has maternity benefits included in it.

2.     Cap on Room Rent

Checking and assessing the upper limits or restrictions in the form of capping and sub-limits on room rents is one of the major factors to consider before buying a health plan. As a policyholder, it’s important for you to understand that there are certain restrictions in a health plan with regards to the benefits paid under it.

Health insurers usually apply a cap on room rent, exceeding which will be borne by the insured. Normally, the capping of the hospital room rent is either 1 percent to 2 percent of your total sum insured.

However, health insurance plans these days are coming up with new concepts of “single private room” or “upgrade your room” or even “no capping” option on the room rent. Health insurance policies with higher sum assured offer the latter two options.

Thus, it becomes necessary to ascertain the benefits offered under the room rent option before finalizing a policy. With skyrocketing inflation rate, medical treatment has become super expensive and so are the related hospital room rents.

Make it a point to check and confirm the hospital room rents for your preferred hospitals. Next, tally it with the room rent eligibility conditions available under your shortlisted health policy to get a better idea.

3.     Claim Settlement Record

Although not considered much by the general public, this is an important aspect to get your hands on the best health insurance plan. It reflects the inclination of an insurance provider towards claim settlement as it highlights how many claims have been settled by the company.

A consistent claim settlement ratio gives an insight into the company’s ability to settle the claims and approach towards its customers. All in all, it gives you an assurance that your (genuine) claims and reimbursements would not be wrongly withheld.

4.     Cashless Hospital Network

Cashless hospitalization makes the hospitalization a seamless procedure in your troubled time. All you have to do is to represent the health card issued to you and the hospital admission is almost done.

Here, it’s important to note down that not all hospitals may necessarily be partnered with your insurance provider. Therefore, going through the list of cashless hospitals empanelled with your insurer is vital. Again, make sure to check if your preferred hospital is included in that list or not.

Depending upon different insurance providers, the list of network hospitals may include more than 6000 to 8000 hospitals. However, such an exhaustive list will be of no use to you if it doesn’t include the hospitals in your vicinity or your preferred ones.

Getting treatment in a non-network hospital can attract the condition of co-payment wherein you’ll have to borne a specified portion of the claim amount. In this case, you won’t be able to access cashless treatment facility. You will need to spend the cost of treatment from your own pocket initially. However, you can claim the reimbursement for the amount later on from your insurer by submitting all the relevant documents and original bills timely.

5.     Co-Payment

Co-payments are normally of two types:

       i.            Voluntary (opted by you)

     ii.            Mandatory (compulsive)

By opting for voluntary co-payment, you promise to bear the responsibility of sharing the claim amount. It is expressed as a predetermined percentage as decided by you at the time of buying the plan.

You can always go for voluntary co-payment if you are young and leading a healthy life as it significantly reduces the probability of claiming your insurance. However, it’s not necessary that your health insurance premium will significantly reduce by opting voluntary co-payment.

 Hence, it’s equally imperative to not to skip this clause to avoid any unpleasant surprise in the future

In a nutshell!

To conclude, make sure to assess the coverage amount appropriately based on the number of people you want to cover in the health plan. Estimate the approx. healthcare expenses. If you are covered by any group health insurance, consider the offered sum insured as well. Spend some time to research and compare the health plans before you finalize your best buy.

About Author:

Shruti Gupta is a writer, digital marketer and outreaching expert. She writes about technology, startups & other niches. She has contributed to a number of famous websites like Thenextweb deccanchronicle and Crazyegg. Stay tuned with her at: @shruti_gupta01 or via skype: shrutigupta2811


(1) comment


Thanks for sharing the five important factors to be looked upon before you, in fact, make a final purchase of a health plan.

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