While surprises, in general, make life more exciting, things can also take a nasty turn at any given moment. Even though nobody anticipates situations like unfortunate accidents or illnesses while envisioning their future, they can still befall anyone, anytime.

The least we can do to counter these mishaps is remain armed with contingency measures, which can allow us to stay prepared to deal with them financially.

With medical care becoming more expensive day by day, the financial repercussions for accidents or treating any disease can be quite grave. In such situations, a comprehensive health insurance policy can be the only saving grace that can proceed to ease your disconcertment.

In India, there are a total of 34 insurance companies in India which are registered with the IRDA. These companies, primarily, offer two types of insurance plans, namely - indemnity plan and defined benefit plans.

Out of these, indemnity insurance includes - Mediclaim, Family Floater, Individual and Senior Citizens Health plans. On the other hand, defined benefit plans include Critical illness plans, Hospital cash cover, etc.

So, how to choose Health Insurance?

More importantly, what does comprehensive medical insurance entail? Let’s take a look!

While it is impossible to plan when to get sick, it is quite easy to remain prepared to stave off the financial liabilities that come with it. So let’s review the factors to look for in a health insurance policy that can help to minimise the financial consequences of illnesses, accidents and as such.

1. Compare between the Policies and look through the Policy Coverage

When it comes to choosing the right health insurance, it is always pertinent to settle for one that provides the maximum benefits. Few policies secure you against the treatment of a host of maladies, with the addition of:

• Sum Insured options available with Refill option
• Waiting period for Pre-existing illness
• Pre and post hospitalisation expenses 
• No room rent capping
• ICU room rent
• Complimentary Annual Health check-ups
• Road ambulance charges
• No claim bonus

Hence, before choosing a cover, consider your requirements, compare the benefits of the plans and proceed to apply for one with due diligence. 

You should further compare the available policies to get the one best suited for your needs.  Some of the additional benefits you should look for include: 

• Critical illness cover
• Daycare procedures covered
• Cover surgeries like Bariatric Surgery
• Home hospitalisation coverage, etc.
• Addons like Zone Upgrade & Maternity cover
• Organ donor expenses
• Domiciliary care
• Psychiatric Illness Cover

2. Make sure the Health Insurance Plan is Affordable

Affordability is among the first factors to look for when it comes to selecting a health insurance plan. While it is essential to choose a plan with maximum coverage, you will have to ensure that it suits your budget as well.

Your budget is one of the primary factors to consider while choosing a policy cover. Make sure the premiums you pay towards the policy are affordable and do not impose a financial burden for you to bear.

3. Check if you can choose between Individual and Family Floater policies

Health insurance plans are indemnity covers that helps to cover the cost incurred to seek treatment for the diseases included under it. 

Now, when you choose a health insurance policy, you can opt for either of the two:

• Individual health insurance
• Family floater health insurance

Under individual health insurance, there is an individual sum insured for each member of a family. But, a family floater health insurance policy covers all the covered family members under one single sum insured. 

4. Check out the Cashless Hospitals Network

Cashless treatment is one of the more crucial benefits offered under a health insurance plan. With this benefit, the insurance policy covers the expenses that are incurred in due course of your hospitalisation. 

With cashless treatment plans, insurance policies pay your treatment expenses directly to the network hospital covered under it. Therefore, to maximise your benefits under your insurance plan, you will need to check the number of network hospitals covered under your insurance provider.

Know more about Cashless Health Insurance.

5. Go for ones with Minimal Documentation and an Easy Claim Process

While it might seem insignificant, documentation requirements are one of the key factors. It is crucial to seek a policy provider that requires minimal documentation because it reduces the hassle of applying for the cover to quite an extent.

For instance, insurance providers like Digit insurance are providing a fully online process to buy the health insurance policy. 

Further, when it comes to choosing a health cover, the claim settlement process needs to be reviewed in your part. 

Usually, a health insurance claim can be settled in the following 3 ways. 

• Cashless claims
• Reimbursement claims
• Pre-approved claims with Advance Cash

Irrespective of the type of claim settlement process you need to follow as per your requirements, it is crucial for you to check the process before availing the policy.

A complicated claim settlement policy can be cumbersome and lead to the consumption of both time and resources. This claim process has been further simplified with insurance providers shifting the process online.

For instance, with Digit health insurance’s digital claim process, you can streamline the entire process.  

6. Take note of the Claim-settlement Ratio

A high claim settlement ratio is one of the most important factors you should keep an eye on. Claim settlement ratio refers to the total number of claims settled by the insurance provider against the total number of claims received.

If you avail your policy from an insurance provider with a high claim settlement ratio, you can ensure that your claim will not get rejected, unless for a valid reason.  

7. Seek policies with a lower Waiting period for Pre-existing Illness

When it comes to covering pre-existing illnesses, every health insurance policy has its own own separate offerings.

In most cases, for pre-existing ailments, you have to serve a specific waiting period before you can make any claim against it. That is why, to avail the best policy, it is crucial to opt for the one with a low waiting period. 

In this respect, it is also important to remember that buying a health insurance policy when you are young is much more beneficial as the chances of getting any illness in young age are very low and you can easily pass the waiting period. 

Know more about:

• Waiting Period in Health Insurance
• Pre-existing Illness

8. Look for covers that provide Special benefits for Senior Citizens

It is perhaps redundant to say that with old age, the chances of incurring higher expenses to treat diseases increases exponentially.

On the flip side, our ability to bear these expenses capsizes. To help you counter these expenses, insurance companies have brought various tailor-made health insurance covers for senior citizens. 

These insurance policies provide the following benefits:

• Critical illness coverage
• Pre-existing illness coverage 
• Cashless hospitalisation
• The additional sum assured along with refill sum assured option
• Organ donor expenses
• Psychiatric Illness Cover 
• No room rent capping
• No medical test before availing the insurance
• Fast and hassle-free settlement

On top of this, you can also avail added benefits like domiciliary care, daycare procedure coverage and more with Digit’s health insurance policy, which has been specially customised by doctors. 

Know more about Health Insurance for Senior Citizens.

9. Check the Exclusions under the Health Insurance Policy

This is one of the points which most individuals neglect to review while seeking a health insurance plan. This often leads them to opt for a policy which comes without a comprehensive cover.

Most of the time, health insurance plans do not cover illnesses like cataract, gastric, hernia, sinusitis, etc., right after their commencement.

Again, very few policies cover the expenses incurred in due course of treating HIV/AIDS, dental treatments, STD, eye-care, etc. So, before opting for a policy, make sure it provides you comprehensive coverage, and ensure that there are fewer exclusions.

10. Look for plans which do not have Co-payment feature

Co-payment is one of the major factors to look for opting for the best health insurance policy. The co-payment feature of a plan requires an individual to pay a part of the total claim amount out of their pocket. Sometimes, the co-payment part of a policy can range from 10% to 15% for health policies.

That is why it is best to avail a policy that does not mandate co-payment on your part. Further, if your plan demands co-payment, make sure that the percentage is minimal. 

11. Know about the Add-on covers with the Health Insurance

Another crucial feature to look for when choosing the right health insurance policy is to check for add-on covers. These add-on covers are available on the payment of an extra premium. 

Following are a few types of add-on covers that you can opt for with your insurance policy:

• Critical illness cover
• Daily Hospital Cash cover
• Zone Upgrade cover
• Maternity and new-born baby cover
• Alternative treatment care cover or AYUSH which includes Ayurveda, Unani, Yoga and Naturopathy treatment, etc.

12. Review the Company’s Reputation

As we end our list of factors that you should check, we must mention about reviewing a company’s reputation. With the number of insurance providers steadily increasing in the Indian market, it is crucial to ensure that the company you choose provides you with the highest transparency regarding your insurance policy.

To ensure this, you must research a company’s reputation thoroughly, especially with respect to its claim settlement ratio. Nowadays, with the advent of various social media platforms, it has become much simpler to conduct a background check on the company. 

You should check the company’s rating reviews on Facebook, Google and read customer testimonials etc. you can easily verify the credentials of your insurance provider and verify their genuineness. You can proceed to avail the cover only after making sure that the insurance company has a spotless record.

13. Make sure you get Tax Benefits with the Health Insurance Policy

Under Section 80D of the Income Tax Act, 1961 individuals and HUF can claim a deduction of up to Rs. 25,000 on the premium paid for their health insurance policies. 

An additional deduction of Rs. 25,000 is available on the premium for the insurance if the policy is for your parents below 60 years of age and Rs. 50,000 if it is for your parents above 60 years of age. 

So make sure your insurance company has the provision to provide you with the tax benefit certificate for your health insurance policy before you avail it.

With these few points, we have tried to sum up the key factors that you must be aware of before availing an insurance policy. If you bear these in mind while opting for a cover, you can ensure that your finances are secure from the substantial medical expenses incurred in the future.