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8 Things to Consider While Rating Your Health Insurance Policy

Neha Gadoo Neha Gadoo 09 February 2017

We consider several features while buying things like electronic equipment or even a piece of clothing. Then why we don’t look beyond premium rates when it comes to health insurance?

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Buying a health insurance policy is a complex affair. It is further complicated by the sheer number of health insurance plans available in the market and the coverage they promise. Thanks to the internet, this process has eased somewhat with a host of blogs and websites detailing the features, including the premium rates, of various insurance plans.

But it is important to know how to sift through all the available information, and locate the key factors that should influence your choice.

So, here are the 8 Key Points you should consider while comparing health plans:

  1. Coverage: Besides the regular coverage features like in-patient hospitalization, pre and post hospitalization, ambulance expenses, etc. look for other features like maternity benefit (if needed), AYUSH or Ayurvedic treatments, list of Day Care treatments, etc. Accordingly choose the most comprehensive plan that best suits your requirement.

  2. Room rent: This is covered under the in-patient hospitalization category, where the cost of the hospital room – to which you are admitted – is covered. All polices cover room rent, but some policies have a cap on the limit of coverage. The sub-limit is usually 1% - 5% of the Sum Assured, subject to a maximum absolute amount. Check the limit mentioned in your plan and find out if it is at par with the choice of room you would choose to be admitted in. Otherwise, you would either have to compromise on your choice of hospital room or pay the extra rent from your own pocket.

  3. Deductions and other limits: There is a concept of co-pay, where you are supposed to pay a part of the claim from your pocket while the remainder is paid by the insurer. Particularly check for this limit, since a higher limit may prove to be a financial strain in future. Other limits include limits on ambulance expenses, certain surgeries like cataract, etc. These restrict the amount of claim allowed under the plan. Needless to say, you should opt for a plan with a higher upper-limit, so that maximum amount of claim can be availed.

  4. Waiting period: If you are suffering from a pre-existing diseases at the time of buying the plan, coverage for such illnesses will be provided after a waiting period of a few years. The concept of waiting period is applicable in all health policies without exception. The only difference is the tenure of the waiting period that can range from 1 to 4 years.

  5. No claim Bonus: All health plans reward you if you have not made any claim in the previous year. This reward is called a No Claim Bonus and accumulates for every claim-free year. Most of the insurers allow an increment in the amount of Sum Assured for every claim-free year up to a certain limit. Others give discount vouchers or other benefits.

  6. Network hospitals: Hospitals which have a tie-up with the insurer can provide a cashless claim settlement facility, which involves less hassles during claim settlement as compared to reimbursement (where you would have to pay the bills initially). Your health plan’s network hospitals should be suitable to you in terms of their location, services and trustworthiness.

  7. Claim settlement ratio: This is something which we usually overlook because of our lack of understanding. The ratio indicates the proportion of claims settled by the insurance company against the total claims raised. The higher the ratio, the better are the chances of your claim being honored.

  8. Cost: No matter what we say, premium is also something which needs consideration although it is not the only thing. The premium you are paying for your health plan should be in proportion to the features it offers because paying a high premium for limited coverage is unwise.

The easiest way to rate a policy is by scoring each of the above mentioned factor on a scale of 5, depending upon your personal needs, and summing up the points to get a comprehensive score. On the basis of what you score each of the options under consideration, you can easily compare and choose the best plan for yourself and your family. If you are unable to rate your health insurance policy or find the task very daunting, then your health insurance broker could be assist you short-list the best options.

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.