6 points to remember while buying a health insurance plan

Health Insurance is an emerging sector in India. Though the growth is encouraging but a study in 2014 found out that, more than 80% of Indians are not covered under any health insurance plan, and only 18 % (government funded 12%) of the urban population and 14% (government funded 13%) of the rural population was covered under any form of health insurance. (Source: Wikipedia)

But We believe it is important to get health insurance. And if you are planning to get one please keep these points in mind.

While, it is easy and economical to buy health insurance online, there are certain things which also need to be considered.

  1. Go with adequate coverage– The fierce competition in the health insurance segment has worked in favor of customers as various insurance companies are offering a wide range of health insurance policies with features like pre- & post hospitalisation, day care expenses, cashless hospitalisation, hospital daily cash, and much more.


So, while choosing a health insurance policy, go with an adequate sum insured. Factors like your age, current health state, market inflation, etc.; can help you decide the right sum insured. Further, if you have a family history of ailments like hypertension, cancer among others.; choose a health insurance policy which is sufficient to deal with these diseases. Considering the current medical inflation, you should have minimum Rs 5 lakh health insurance cover for a family of 4, father, mother and 2 children. If you have elderly living with you, then it would be wise to look for policies that have better acceptability for existing conditions.


Tip: While choosing a health insurance policy, don’t go just by premium only, but carefully compare all the features to get the best possible coverage at a price which you can easily afford. Further, keep increasing the cover limit from time to time to take care of inflation.


  1. Check lifetime renewability clause– Though, our current lifestyle has made even younger citizens susceptible to health issues, one can’t deny the fact that as we grow old, our body becomes more prone to diseases.


Therefore, while choosing a health insurance policy, go with that policy which comes with a lifetime renewability clause. There is no point in having that kind of medical insurance, which ceases to exist once you cross the age mark of 50 or 60.


Tip: Go with a health insurance policy that comes with a lifetime renewability clause, even if it has a higher premium.


  1. Pay heed to restoration feature– Opt for a health insurance policy which comes with a restoration feature,e., it restores your sum insured in case it gets exhausted in the middle of the year. This feature would come handy in case of multiple hospitalisation in one policy tenure.


Tip: Go with restore feature in your health insurance policy even if it means paying the extra premium.


  1. Go through co-payment clause=-In every health insurance policy, there is a co-payment clause which says, that you would have to pay a portion of the claim at the time of claim settlement. In certain medical policies, the clause is there for some particular ailments only.


For instance, you have a health insurance policy which comes with 20% co-payment clause. It means, if a claim is Rs 40,000, you would have to pay Rs 8,000 and the remaining Rs 32,000 would be borne by the health insurance company. A higher co-pay also lowers your premiums. Therefore, if you are young and healthy with no past medical history, you can think of going with a high co-payment to save on premium costs.


Tip: Before going with a high co-payment, don’t forget the fact that a certain premium portion would have to be borne by you, so think twice before opting for a high co-payment clause.


  1. Go with a family floater health insurance plan– If insurance premiums are going beyond your budget, you can consider buying a family floater health insurance plan which covers all the family members under one single plan. As all your family members would be covered under one plan, it leads to a reduction in your medical insurance premium costs as well. Under most of the family floater health insurance plans, you can include self, spouse, dependent kids, brothers and sisters.


Tip: Under a family floater plan, as the sum insured is divided among all the insured members, make sure it is sufficient enough to cover all of them. Also, ask for a restoration feature in the policy so that even if one family member exhausts the entire sum insured, the insurer restores the cover for the other insured members.


  1. Check exclusions-While; it is necessary to understand the coverage available under a health insurance policy; it is equally important to know what is not covered. For instance, most of the health insurance policies cover pre-existing ailments after a waiting period of say, 3 or 4 years. So, it is essential to have a complete understanding of the exclusions to avoid a situation where the insurer rejects your claim just because it falls under the exclusion head.


Tip: Read the policy document carefully or talk to the health insurance company to seek clarification on exclusions in order to avoid nasty surprises later.

Considering the rising inclination of people towards the natural treatment in recent times, you can also look for AYUSH coverage in your health insurance policy. It will cover hospitalisation expenses incurred on natural procedures like Ayurveda, yoga, homeopathy, etc.

Then some health insurers reward you with wellness points if you maintain healthy living. These points can be redeemed to avail such services which are usually not offered by health insurers like OPD consultation, diagnostic expenses, dental expenses, etc. Check whether your insurer offers wellness reward points or not.

Then various health insurance companies are offering online health plans with tenure up to 2 years. It means, you only need to pay a premium for once to enjoy the coverage for two years in one go. Remember, the purpose of health insurance is to insulate you against soaring medical expenses, so be vigilant while choosing the mediclaim insurance. After all, your health is the real wealth!




Dr. Vikram Venkateswaran

Management Thinker, Marketer, Healthcare Professional Communicator and Ideation exponent

This Post Has One Comment

  1. SurgeryXchange

    While this is can grow. I believe the 80% of India is uninsured story has been doing the rounds for years now. What is important is the % of Indians who can afford to buy Insurance. This itself is a big number. I think the Medicaid( or govt. provided insurance schemes) system is working in several tier 2 markets and is a good replacement for pvt. insurance in India

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