Ideal Cover Amount

This is the most basic question you can have when buying health insurance. “How much health insurance cover is good for me and my family?”

A good rule of thumb is to link it with your annual income. You can opt for a cover amount which is equal 2 to 3 times of your annual income. So if your annual income is Rs. 5 Lakh, a Rs. 10 Lakh cover should be ok for you.

You also need to check the cost of medical treatments in the city where you reside. If you are in a city like Mumbai or New Delhi, the cost of treatment of the same disease is likely to be higher than other parts of India. So if you are living in any of the Tier 1 cities, opt for a little higher cover.

Coverage for Consumables

Consumables are items which are used during any medical treatment and discarded after a single use. These include syringes, gloves, masks, cotton, PPE kits etc.

Some health insurance plans do not cover the cost of consumables while some others have a list of consumables which are covered. Expenses related to any consumable item outside this list will have to be borne by you.

It is good to have a health insurance plan which covers all consumables without any limits.

No Copayments

Some health insurance plans have a co-payment feature which is built in the product. Co-payment is usually 10%, 20% or 30% of the hospital bill.

Why spill the bill when you are spending money on buying a health insurance policy? Just because it comes a little cheaper? No, that is not what you would want to have.

Make sure you buy a health insurance policy with zero copayment so that it covers your entire bill at the time of need.

Lower Waiting Periods

Health insurance plans come with some waiting periods. These are time bound waiting periods which apply for a certain period when you buy your health insurance policy for the first time.

Most plans come with a waiting period of 2 to 4 years for pre-existing diseases. If you already have any illness, make sure you declare your existing illnesses at the time of purchasing your health insurance plan for the first time.

Opt for a plan which offers a lower waiting period for PEDs. Some plans offer to lower your waiting period for PEDs if you buy an add-on by paying a little extra premium. Make sure you check out all these options before you buy your policy.

A 3 or 4 years of waiting period for any PED is a bit too long to have. If possible, try to restrict it to 1 to 2 years.

Same Coverage throughout the country

Some health insurers offer plans which provide zone wise cover. The zone you fall in will depend on your residential address and pincode you provide at the time of buying your policy.

Premium will be charged to you based on the zone you reside in. But the catch is that claims can also be settled based on the zone in which you take the treatment.

If you are falling in a lower zone and hence paying a lower premium than those falling in a higher zone for the same amount of cover, you might be charged a copay of 10% or 20%
you happen to take your treatment in a hospital which falls in a higher zone. This is not at all desirable.

Do not opt for such plans. It is always a good idea to buy a policy which provides the same coverage throughout the country.

Separate Policy for Elderly Parents

Buying a family floater policy is good as it is easy to manage, covers all members of the family under a single policy and it also comes at a discount.

But most family floaters calculate premiums based on the age of the eldest member in the family. If you have elderly parents or parents-in-law at home and you want health insurance cover for them, do not include them in the family floater which you buy for yourself, your spouse and your kids.

Buy a separate policy for your parents which suits the needs of elderly. Also, you will save on the premium which you pay for yourself, your spouse and children.

Network Hospitals

Opt for a health insurer which has a decent network of tied up hospitals throughout the country. And it is even more important to see the network of hospitals in the city where you reside.

An insurer with a good network of hospitals means that you have better chances of availing a cashless facility at the time of hospitalisation.

Claim Settlement Ratio

Having a health insurer with good operational metrics by your side is as important as having a good health insurance plan. Claim settlement ratio of a health insurance company says a lot about the way the insurer settles claims when they are registered.

It is a good idea to shortlist a few health insurers which have a decent claim settlement ratio and then check out the plans they offer.

If you are still not sure how to find them, you can talk to us.