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How to Find the Best Health Insurance Plan in India

— September 9, 2020

Finding the best health insurance plan is not an easy task. However, with the help of a few guidelines, one can choose the best health insurance plan with less pain.

With the rise in medical expenses, health insurance has become a necessity. It’s not just an investment, but an important step to ensure that you don’t end up digging a hole in your pocket in case of medical emergencies. The simplest way to find the best health insurance plan is to compare health insurance plans online. 

Comparing online is instant, and you get to see the quotes of different health plans provided by various insurers at no cost.

No matter how instant comparing health plans may be free and simple, finding the best health insurance plan is not an easy task. There are few key deciding factors that may help you to finalise among the plethora of available plans.

You need to ask and fix these things first:

  1. Decide whether you want to buy an Individual or a Family health insurance plan.
  2. Decide how much coverage (Sum Insured) you want.

Once you have decided these basic requirements, you can now directly head-on to compare health insurance plans. 

Essential Points to be considered when comparing health insurance plan

  • Individual Coverage or a Family Floater

It makes more sense to decide and choose the family members for whom you wish to buy a health insurance plan. Family floater plans are less invasive and offer a larger coverage that gets shared amongst yourself, your spouse, two children, parents or parents-in-law. Very rarely will all the family members fall sick at the same time. Therefore, the sum assured doesn’t get utilized completely. But watch out for that family member who recurrently falls sick or who is above 50 years old. You may then plan to buy an individual coverage for that particular family member and exclude him/her from the family floater plan.

  • Check what a particular health plan covers

You need to find out what each health insurance plan covers. This can be done by checking what type of ailments and treatments that are covered, medical expenses, number of days up to which the coverage is offered under each sub category:

    • In-patient hospitalization 
    • Pre-hospitalization
    • Post-hospitalization
    • Day care 

These are the few key coverage features. Each company may offer different coverage scheme. You must compare what each plan covers. After all, what good is that plan if it does not cover what you require or perhaps if it is of no real use at the time of claim. 

  • Compare room rent in hospital

    Hospital bed in room; image by Martha Dominguez de Gouveia, via
    Hospital bed in room; image by Martha Dominguez de Gouveia, via

Compare room rent because room rent is one of the critical factors in deciding the right plan. Most of us are not aware of how a room rent decides the amount we will get at the time of claim. 

All the medical expenses are based on the room rent. At the time of medical emergencies, if you opt for a room having a higher rent than your plan allows, the claim amount won’t be as per the claim amount lodged. Instead, the claim will be approved on the basis of the plan’s room rent. This means you may end up not getting a full settlement. Thus, you should always check for the room rent and if possible opt for a plan which provides the maximum amount for a room or has a set room like single private room.

  • Check if there is any capping on room rent or co-pay

Do not forget to check these terms – capping on room rent and co-pay. A capping on rent means an insurer will mention that the room rent is 1% of the sum insured, which means if you have a plan with a sum insured of Rs.3 lakh, with 1% of capping, the maximum room rent you can go for is Rs.3000.

A co-pay means percentage of the claim amount must be borne by the policyholder at the time of claim. It is advisable to always go for a health insurance plan with no co-pay or minimum co-pay.

  • Check for a waiting period

All health plans have a waiting period which is generally 30 days. A waiting period implies a duration up to which you have to wait before a claim is accepted. This is not applicable under emergency hospitalization due to an accident. Check for a waiting period specified for specific medical ailments, for pre-existing diseases, etc. See if a waiting period is acceptable or not. 

  • Hospital Network 

Check if the nearby hospitals are covered or not. Give preferences to the one which covers your nearby hospitals. It will help you to avail a cashless claim facility at the time of medical emergencies. However, it shouldn’t be the only deciding factor.

  • Exclusions 

You must check the exclusions mentioned in a plan. Keep those exclusions in mind when comparing. Some company may not cover AYUSH – Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. And some insurer may cover AYUSH but with sub limits. So, it is better to be aware of such exclusions beforehand. 

  • Are there any sub limits 

It is important to note and understand sub limits. Many treatments are covered but with sub limits. That is regardless of your plan sum insured, if there is a sub limit on a particular treatment, the maximum amount that an insurance company will pay, would be as per the sub limits.

  • Premiums 

Premium is the amount you pay for a health insurance plan to keep it in force. Once you find few plans that suit your needs, you may want to check their premiums. It goes without saying that it should be a pocket-friendly plan. 

Having a plan with some features that comes at a higher cost doesn’t mean it is the best. One has to see the budget and claim settlement ratio, which is discussed in the next point. As per the budget, one must opt for the optimum and feasible plan. Because having an optimum plan is better than having no health insurance plan. 

  • Claim settlement Ratio 

When all is said and done, and you are still in a dilemma of choosing the right plan, check claim settlement ratio of various insurers. 

When your requirements are fixed, coverage and exclusions are acceptable, authorized network of hospitals covers your nearby hospitals, but the question persists, check the claim settlement ratio of each insurer you have short listed. This way you can fix it and finally buy the best health insurance plan for yourself and family.

Finding the best health insurance plan is not an easy task. However, with the help of a few guidelines as discussed above, one can choose the best health insurance plan with less pain. And stay worry-free. I hope this post will be of some help to you.

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