Sunday, September 25

How to evaluate best health insurance policy in India

A health insurance policy is an agreement between insurance provider and policyholder whereby the insurance provider commits to pay a predetermined amount towards the medical expenses of the policyholder for treatment of predetermined illness or accident. The policyholder pays a premium to the insurance provider to get this medical coverage.

Having a health insurance policy is considered to be an essential part of all financial portfolios, as most often the savings of an individual are drained in the treatment of medical illness. For those without sufficient savings, medical treatments get compromised.

To be able to fulfil all other financial goals, a health insurance policy is a must.

There are over hundreds of health insurance policies offered by 30 IRDAI approved Health Insurance companies, this creates a problem of choice for new policy buyers. 

New buyers wanting to know how to evaluate and compare various health insurance policies and select the best health insurance in India should follow the steps mentioned below:

  1. Decide on the sum assured and the cost of coverage:

Sum assured is the maximum amount that the insurance provider will cover you for predetermined medical expenses. Premiums are the cost of coverage that policyholders pay to the insurance provider to get the health insurance. 

  • The sum assured should be decided by taking into account the rising medical inflation. 
  • Since the sum assured and premiums are directly related, you get lower sum assured for lower premiums and vice versa.
  • People tend to save cost by opting for lower sum assured and remain under-insured or pay premiums that are more than their insurance needs. 
  • As a general thumb rule, paying up to 10% of your monthly income towards insurance premiums and having a sum assured equal to 50% of your annual pay is ideal. However, depending on your insurance needs you can decide how much you should pay for a certain sum assured.

You can evaluate the best health insurance in India by comparing the premiums offered by the insurance provider for a certain sum assured and then select the health insurance policy which offers a certain sum assured at lowest premium.

  1. Check the scope of coverage:

It is very essential to check the scope of coverage of the health insurance policy you buy as it contains details related to specific inclusions and exclusions within the policy like pre- and post-hospitalization coverage, COVID-19 coverage, day-care treatment, etc.

You can evaluate the best health insurance in India by comparing their scope of coverage and select the health insurance policy which offers limited exclusions or specific exclusions that you want an insurance provider to cover in a policy you buy. 

Example, few health insurance policies have exclusions for maternity and pregnancy which a newly married couple may not want to be excluded from their policies.

  1. Check the sub-limits for specific diseases:

The health insurance policy might have sub-limits on certain treatments. A sub-limit means the insurance provider will provide partial coverage for treatment of a predetermined illness, even though your sum assured is higher than the total cost of treatment.  

For example, if a policy has a 50% sub-limit on cataract treatments, then irrespective of your claim amount being under the total sum assured limit, the settlement amount will be for 50% of the cost of treatment.

You can evaluate the best health insurance in India by comparing the predetermined medical treatments they cover under a sub-limit clause and select the health insurance policy which has no sub-limit for specific diseases you want a full medical coverage.

  1. Check the waiting period for specific diseases: 

Health Insurance policies don’t cover you against all illnesses from day one. For a few predetermined diseases, you need to wait a particular period (days/months/years) to be eligible to raise a claim for treatment. 

For example, a health insurance policy may have 2 years of waiting period for any treatment of cancers, so if the person insured is diagnosed with cancer a few months after buying a policy, the cost of treatment shall not get covered.

You can evaluate the best health insurance in India by comparing the predetermined medical treatments they cover under the waiting period clause and select the health insurance policy which has no waiting period for it. 

It’s important to note that all Health Insurance providers in India have different scope of coverage, certain sub-limit and waiting period clauses – additional riders can be purchased at the time of taking health insurance to cover the treatment cost for a few predetermined diseases that are in excluded list, have sub-limits or longer waiting periods.

  1. Check the list of Network hospitals:

Health Insurance companies in India have tie ups with a list of national and international hospitals for providing cashless medical treatments to the policyholder.

You can evaluate the best health insurance in India by comparing the network hospitals that have tie ups with the Health Insurer and select the policy having a long list of network hospitals, including prominent medical facilities. Also, make sure that you have hospitals in your vicinity in the network hospital list.

  1. Check the room rent limit: 

The room rent limit is the maximum amount an insurance provider would cover on the hospital room booked during the medical treatment. It is mentioned either as an amount or as a percentage of the sum insured on the policy documents. It’s important to note that these limits have a direct effect on the premium charged, coverage offered, and the claim settlement amount. 

You can evaluate the best health insurance in India by comparing the room rent limits of different insurance providers for the premiums they charge and select the health insurance policy which offers the highest limit at lowest possible premium.

  1. Buy any additional riders wisely:

Additional riders help in enhancing the scope of coverage of a health insurance policy. However, you should buy these add-ons only after reviewing the main policy documents as most often new buyers purchase add-ons which are already covered in their health insurance policy. 

You can evaluate the best health insurance in India by comparing the add-ons and its cost offered by different insurance providers and select the health insurance policy which offers more relevant add-ons as per your insurance needs.

  1. Comparing customer service and online reviews:

It’s difficult to evaluate the quality of customer service before you have purchased a health insurance policy. You may view the ratings and read reviews of the customer service experience on the internet for any Insurance company, however that does not guarantee a good customer service.

Hence, it’s recommended that you buy a health insurance policy from an insurance agent or advisor who can be your point of contact for most of your customer service requirements and also guide you in choosing the best health insurance in India.

Below is the list of best health insurance policies that are evaluated based on above parameters:

Sr No.Health Insurance PolicyFor
1Aditya Birla Activ Health Platinum Enhanced PlanIndividual
2Star Family Health OptimaSelf & Family
3Care Senior Citizen InsuranceSenior Citizens
4HDFC Ergo My: Women SurakshaWomen
5Care Youth Health InsuranceYouth
6Bajaj Allianz Criti care policyCritical Illness
7IFFCO Tokio Personal Accident InsurancePersonal Accident
8NivaBupa Health RechargeTop-Up

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