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6 Key Points to Check when Comparing Health Insurance Plans

Neha Gadoo Neha Gadoo 09 February 2017

Buying a health insurance plan is a process which involves a lot of planning if you do not want to end up investing in a plan which does not offer the best available coverage or does not pertain to your particular requirements and needs.

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In recent times, the health insurance market has seen an upsurge through an introduction of newer and better insurance plans each offering additional attractive features and benefits. Add to it the common man’s ignorance about the technical know how involving health insurance plans and you find lower takers of the newly developed plans. The reason is not that the masses are averse to the idea of not buying newer products; it is simply a lack of understanding.

While buying any health insurance plan, you should check what the plan has in store for you. It does not involve checking the technically complicated list of the policy wordings but checking certain important points and comparing them with the corresponding points in the other plans and you are good to go. Below is a list of 6 important points that should be taken into consideration while you are planning to buy a health insurance plan.

1. Scope and extent of coverage

Look for the expenses that form the list of coverage benefits in the plan. Some benefits like doctor’s fees, ICU room rent, pre and post hospitalization, ambulance charges is common in all plans but other benefits like domiciliary expenses, OPD expenses, cost of alternate treatment like Ayurveda, Homeopathy, Unani, maternity coverage, etc. should be looked into. Besides considering the scope of coverage, you must also check up to what extent the plan provides the mentioned coverage in absolute terms.

Moreover, check for the sub-limits on room rent which is capped under some plans and unlimited in others. Look for plan where the coverage list is exhaustive so that no aspect of the medical treatment is excluded and even the extent of coverage is reasonable enough to obtain treatment in a standard hospital of your choice.

2. Exclusions

Another important factor that we usually overlook while comparing health insurance plans is the list of exclusions. Unfortunately, your health plan is not universally applicable to meet all and every type of medical costs. Some costs are excluded from the scope of coverage. Some common exclusions include pre-existing illnesses, cost of dental or cosmetic treatments, congenital defects, etc. Pre-existing illness clause is the most important exclusion that needs to be checked. Illnesses which exist at the time of entering into the insurance contract are excluded from coverage for some time called the waiting period. Check the waiting period mentioned in the plan you are considering. The period usually ranges from 2-4 years and the lower the period, the more advantageous it will be for you.

3. The discounts and bonuses allowed

Quite pleasing to the ears, every health insurance plan offers discounts and bonuses. Some plans offer a family discount if more than one member of the same family is included in the cover, while some plans offer discounts if the premium for two years is paid in lump sum at the commencement of the plan.

There is also a concept of No-Claim Bonus in most health insurance plans. The No Claim Bonus feature is applicable if there has not been any claim in the previous year. The usual bonus granted under this context is a percentage increase in the Sum Assured at the existing rate of premium. The Sum Assured is increased for every claim free year up to a certain maximum limit.

Other discounts that may be granted by health insurance plans are discount vouchers redeemable against the purchase of medicines or pathological tests, etc. So, before buying a plan, check for the relevant discounts that the plan promises as it would help in reducing the amount of premium payable

4. Claim Settlement policy

Currently, health insurance claims are settled either through cashless facility or through reimbursement. Under the cashless facility, the insured, upon being admitted to a network hospital, can receive cashless treatment where the claim is settled through a Third Party Administrator (TPA). Under the reimbursement clause, the insured first bears the expenses himself and later gets it reimbursed from the insurer. Different plans offer different policies of claim settlement. Cashless facility is the most convenient method because under the reimbursement method, the costs incurred may not be affordable for the customer to bear. So, you should look for a plan with easy cashless claim settlement facility. You can check with your agent about the claim settlement record of the insurance company before signing the dotted line.

5. Network hospitals

As mentioned above, cashless claim is the better alternative but to avail this facility, you should be admitted to a networked hospital which has a tie-up with the insurance company to provide you with the cashless settlement facility. Check the list of network hospitals tied-up with the insurance provider. See whether your preferred hospital is in the list and whether the list contains a hospital in your vicinity for those emergency cases.

6. Company history

The last and also an important point to check is the credibility of the company you are investing in. The company’s credibility does not lie in its foundation history but in its claim settlement history which is the most pertinent factor for you. Check the company’s Claim Settlement Ratio which indicates the proportion of claims honoured by the company against the total number of claims raised. Higher the ratio, the better your claim stands a chance to be settled.

All said, comparing between the various plans in the market to settle on the one that is the best is not a daunting task once you know which points are relevant and demand your attention. Look for the points mentioned above and trust your broker / agent to guide you with the rest of the formalities and your health insurance plan will be according to your requirement.

Recommended Read: How to compare health insurance

Neha Gadoo
Written by Neha Gadoo
Daring and Bold, Neha loves philosophy, trekking and walking bare feet in the rain. Loves talking and can stare out of a car window for hours continuously.