Insure Health

8 Factors for choosing a Health Insurance Plan


In order to offer you choices, insurers create complex products, making it tough for you to compare them and choose. Policies are different from each other in terms of exclusions, conditions and fine print. If you slip on even one of the vital conditions, your claim may be rejected or cut down. Make sure you keep these 8 factors in mind.
Cover
Get Adequate Cover

Make sure you have adequate health cover considering future inflation and your family requirements, as you grow older. Your proposal may be rejected or loaded if you are old or have pre-existing diseases. Also, insurers are not bound to increase your sum insured at the time of renewal. Besides that, your insurance company may refuse an increase in your insurance cover in case you suffered from critical illness in the past. Moreover, increased sum insured will have waiting periods applied like a new policy. Family floater works well for young family. For senior citizens, individual cover is better due to higher chances of any illness/procedure.
Renewal
Look for Life Long Renewal

Lifelong renewal is an important product feature that you must consider. Don't get stranded without insurance cover at an older age. Indemnity health insurance products (mediclaim) offer lifelong renewal. So, once you buy mediclaim with utmost good faith declaration in proposal form you can expect to get lifelong renewal no matter how many claims you lodge. Life insurance companies cannot offer indemnity-based products. They can only offer fixed benefit products, which do not offer lifelong renewal feature. So, avoid buying health insurance products offered by life insurance companies.
Claims
Who Processes Claims

In-house claims processing is better than Third Party Administrators (TPAs). Some insurers offer discounts for not having a TPA, but you may have to give up cashless feature. It is better to have cashless feature along with in-house claims processing. While in-house claims processing may offer cashless approval at faster speed than TPAs, do not believe in advertisements about cashless approval within two or four hours. It can happen, but usually takes longer time. Health Insurance Regulations 2016 have limited the TPA role and stopped them from recommending claims payment amount to the insurer. The onus is on insurer to make claims settlement and give reasons for any denial. Insurer (not TPA) has to directly pay the policyholder for reimbursement claim.
Premium
Premium for Older Age Band

Check existing premium for older age band, which would give you a fair idea of the difference between younger and older customers. Some private insurers entice younger population with lower premium and increase it once you get old. There is no claims-based loading which helps the policyholders. But, IRDAI has allowed insurers to change premium every year, which does not help policyholders. Based on overall claims experience and future trends of medical inflation insurers can revise the premium. Senior citizens are at mercy of insurers and have no other option since portability is virtually impossible at older age.
Online
Discount for Buying Online

Some insurers offer discounts for buying online up to 15%. The discount will not be the difference you see between online and offline plans. If you don't need agent's help, buy online especially if it saves on premium. However, the onus of complete disclosures and process completion lies solely on you. Even if you buy through an intermediary, insist on filling the proposal form yourself. Get a copy of proposal form received by the insurer if you do not get it along with the policy document. It is important to know what details the insurer received from you as there have been cases of intermediaries manipulating it to get the proposal passed.
Expenses
Hospitalisation Expenses

Mediclaim also covers pre-and post-hospitalisation expenses such as doctor's visit, diagnostic tests, medicines, etc. Make sure you check out what is on offer. Pre and post hospitalisation is covered for specific number of days before and after the hospitalisation. So, keep the bills for the money you pay the doctor, investigation/diagnostic tests and pharmacy bills. Pre and post hospitalisation expenses claim is always in reimbursement mode even if the hospitalisation bill is covered under cashless. Insurers are sometimes lax about clearing pre and post hospitalisation claim on-time as they know the policyholder is more interested in getting hospitalisation bill claim cleared. But, do not give up on it as it is your right.
Tests
Take Medical Tests

It is always better to undergo medical tests, although the tests cannot capture all your health issues. Also, medical tests vary depending on your age and can thus, never be foolproof. Undergoing medical tests does not ensure that your claims would not be rejected for non-disclosure. Truthful self declaration is important since insurance is based on utmost good faith. If there is any confusion about anything in the proposal form then get it clarified. Do not fill it up casually or yourself decide if you want to reveal any previous ailment or not. Tell everything to the insurer even if it leads to rejection of the proposal as it is better than rejection of claim later.
Speed
Don't Expect Instant Cover

Since insurers require medical tests prior to insuring you, it is not possible to get an instant cover. Almost all insurance companies need medical tests depending on your age, health declarations and the insurance cover. Online products do not offer the support of an intermediary to help you through the process. If you are young and healthy then you may get instant cover especially if you are applying for a reasonable amount. There is a cooling off period of 30-90 days in every mediclaim policy when it is initially purchased (not applicable for renewal or portability). Hospitalisation due to an ailment is typically not covered during this time, but hospitalisation due to an accident is covered.
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