Buying Health Insurance in India? 10 Things You Must Check Before You Buy

10 Things to Check Before You Buy Health Insurance

A health insurance policy has several components worth examining. We’re sharing a list of the 10 key things everyone must check before buying a health insurance policy.

1. What the Policy Actually Covers

Start by checking the core coverage rather than assuming that every medical expense will be paid during treatment. Read the clauses related to permissible in-patient hospitalisation, day care procedures, pre- and post-hospitalisation expenses, ambulance charges, etc.

It will give you a realistic picture of what’s actually covered in a particular policy. For example, room rent is covered in a health insurance policy, but there are limits tied to the coverage.

If you’re buying Shri Health Suraksha Insurance, there’s a limit of ₹5,000/day for room rent, boarding, and nursing expenses. ICU/ICCU charges also have a limit of ₹10,000/day. Being aware of the applicable coverage limits and sub-limits will help you choose the right policy for self and family.

2. Sum Insured

Whether you’re buying health insurance for family or yourself, check whether the policy’s sum insured is sufficient to cover the present and lifetime healthcare needs.

You can assess your family member’s age (if buying family floater), medical history, location, current health profile, medical inflation, etc., to determine an ideal sum insured. Use it to determine if the policy’s sum insured is adequate.

3. Waiting Period for Different Conditions

Every health insurance policy has a waiting period for particular health conditions or diseases. You cannot claim treatment expenses for these conditions or diseases unless the specified waiting period is over.

Hence, if you or your family members have any pre-existing health condition, ensure it’s covered under the policy and has a relatively shorter waiting period for convenience.

4. Room Rent & Other Sub-limits

While room rent is covered under health insurance plans, limits apply as per the policy terms. If you choose a room that costs more than the daily room rent limit, you’ll have to pay the difference from your own pocket.

Besides room rent deduction at the time of claim, the insurer may also apply a proportionate deduction across the hospital bill, increasing your share of out-of-pocket expenses. So, read the policy’s room rent limit and other sub-limits to minimise your out-of-pocket expenses during hospitalisation.

5. Co-Payment & Other Deductibles

Before you buy a health insurance plan, read the policy’s co-payment terms and clauses related to other deductibles. It’s important to understand how much you’re expected to pay during claim settlements.

Prioritise a policy with lower co-payment terms and deductibles if you don’t want to pay a higher out-of-pocket share during medical emergencies.

6. Disease or Treatment-Specific Limits

Even if the required diseases or treatments are covered under the policy, check whether they have a maximum payable amount.

A policy may provide a sizeable overall sum insured while restricting how much it will pay for certain procedures. These limits matter when the actual treatment cost is substantially higher than the specified sub-limit.

7. Cashless Hospital Network

It’s the most crucial aspect if you plan to avail the cashless hospitalisation facility during medical emergencies. Check the insurer’s network hospital list to see how many multispecialty hospitals are included.

You can also check how many hospitals are near your location, the range of treatments they provide, specialists available in those hospitals, etc.

8. What is Excluded from the Coverage

Every policy has certain exclusions specified in its health insurance terms. Reading the exclusions helps you identify which expenses won’t be covered by the insurer. You can use this information to plan for potential treatments accordingly.

9. Renewal Terms & Long-Term Affordability

Health insurance is something you ideally keep for years, so don’t assess the policy’s affordability based solely on today’s premium.

Explore whether lifelong renewal is available, how premiums may change with age, and whether the coverage remains practical as your healthcare needs and expenses increase over years. This is crucial because it determines the policy’s long-term sustainability.

10.Available Add-On Options

If you want enhanced coverage in your health insurance plan, check the add-on options available with your plan. You should ideally look for a co-payment waiver in a policy or a policy with no co-payment as it can significantly lower your out-of-pocket expenses during claim settlements.
 

Understanding Health Insurance Policy Terms and Exclusions

You should never buy any health insurance policy without understanding its terms and exclusions. These details often reveal what an insurer won’t cover during hospitalisation or treatments specified in the policy.

To better understand the exclusions, carefully review the policy’s coverage, waiting period, sub-limits, co-payment clause, and other key policy aspects. It will help you choose the right policy and prepare accordingly for potential medical emergencies in the future.
 

How to Compare and Choose the Most Suitable Health Insurance Plan

Choosing the most suitable health insurance plan can become confusing when you’re exploring multiple similar policies. The best way to identify the right policy is by evaluating each option against the following factors -

● Overall Coverage, Not Just Sum Insured

Two policies having a similar sum insured can provide widely different protection because of the applicable sub-limits, exclusions, co-payment, and other key health insurance terms. Hence, compare what each policy actually covers and the conditions attached to those benefits before comparing their premiums.

● Waiting Periods & Exclusions

Check how long you must wait before specific health conditions and treatments become covered under the policy’s health insurance terms. This is a key consideration point, especially if you or someone in your family has a pre-existing health condition.

Also, check the exclusions specified in the policy. A health insurance policy with fewer exclusions and shorter waiting periods can be a better choice for many people.

● Insurer’s List of Network Hospitals

Those taking a policy to avail cashless treatment facilities should always check the insurer’s list of network hospitals. Go through the list to determine the total number of hospitals present in your city. Most importantly, check how many of those network hospitals are near your residence.

Having a network hospital nearby is crucial because it facilitates faster admission during medical emergencies, rather than finding hospitals or traveling far during times of need. A larger list means nothing if the hospitals you trust, prefer, or those nearer to your location are not included.

● Claim Settlement Process

The claim settlement process matters as much as the policy’s coverage and exclusions. Look for a policy with a smoother claim settlement process. Check what documents are needed during claim settlement, how long it takes for claim approval, whether prompt customer support is available throughout the claim process, etc.

These questions may appear insignificant initially, but they’ll influence how supported you feel during claim settlements.
 

Health Insurance for Family: Coverage Tips

If you’re buying health insurance for a family, the coverage preferences become quite different from what you would prioritise in an individual policy. We’re sharing some practical coverage tips to help you choose the right plan for your family.

● Consider the Number & Age of Each Family Member

Since coverage in a family health insurance plan is shared among all insured members, choose a sum insured that’s sufficient for everyone. You can do so by evaluating the total number of members you plan to insure and assessing their healthcare needs.

Their age deserves equal attention. More members and increasing age generally translate to a higher chance of simultaneous or high-value medical expenses.

● Account for Their Existing Health Conditions

If any family member has a pre-existing condition, choose a policy that covers it after a short waiting period. You must also check whether the condition is included in the policy or if any limits apply to its payment.

● Don’t Put Everyone in the Same Policy

Although family health insurance is easier to manage, you shouldn’t force everyone into the same policy. This is especially important when a few members have severe health conditions and need higher coverage tailored to their needs.

Try to club family members into one plan when they broadly share similar health conditions or health profiles. Those with higher healthcare needs can benefit more from an individual health insurance plan.

● Review the Coverage as Family Size Changes

You shouldn’t choose coverage once and leave it static throughout the policy period. Make it a habit to reassess coverage every year or whenever a major life event, such as marriage or childbirth, occurs. This will help you realign your policy coverage with your current healthcare needs and family size.
 

Common Mistakes to Avoid When Buying a Policy

Some people make common mistakes when buying a health insurance policy that costs them in the long term. Ensure you don’t repeat any of the following mistakes –

● Choosing a Policy Because of Low Premiums

Health insurance premiums are a recurring commitment, which is why some people are attracted to policies with lower premiums. It may seem like an economical choice at first, but it can prove costly in the long run, especially during claim settlements.

If a policy is quoting substantially lower premium than market standards, you should check if the policy is providing adequate sum insured and coverage, or are there additional terms & clauses, co-payment, sub-limits, etc., that may eventually lead to higher out-of-pocket expenses during claim settlements. If you’re buying a policy for financial support during medical emergencies, choose a policy based on coverage, not premium.

● Providing Incomplete or Fabricated Medical History

Since a person’s medical history and current health profile influence premium calculation, some people make the mistake of withholding key information.

Even if the policy gets approved for any reason, your claims can be rejected once the insurer discovers the true medical information. Depending on the severity of the case, the insurer may also choose to terminate the policy. You can avoid this by disclosing your true health information when you buy a policy.

● Assuming Every Medical Expense is Covered

Never assume that a health insurance policy will cover every hospitalisation or treatment expense. For example, consumables like gloves and syringes are not covered unless you purchase a consumables add-on.

Similarly, room rent, ICU charges, and some surgery costs have approval limits. Review all these aspects, especially exclusions and applicable sub-limits, before purchasing a policy.
 

Waiting Period Clauses You Should Read Carefully

Multiple waiting period clauses deserve a thorough read. You’ll usually find waiting period clauses designed for 30 days, 24 months, and 36 months after policy activation. Each clause lists different health conditions and treatments specified in the policy.

You must read all these clauses to identify which health conditions and treatments become eligible for coverage after the said period. This awareness will prevent unexpected claim rejections and enable you to prepare for any medical emergency that may arise before the waiting period ends.
 

Network Hospitals: Why They Matter in Your Policy Choice

Network hospitals are crucial in a health insurance plan because they settle eligible hospitalisation bills directly with the insurer. This cashless treatment facility brings immense financial relief to policyholders, especially when hospitalisation lasts longer.

People should ideally choose a policy with a larger network of approved hospitals. The network should have reputable hospitals near your location, multiple specialists, good facilities, a wider range of treatments, advanced diagnostic infrastructure, etc.

It ensures you and your family members receive quality treatment without requiring a substantial upfront payment.
 

Conclusion

Choosing a health insurance policy isn’t as simple as comparing the premiums against coverage. You must assess multiple other aspects of the policy as discussed in this blog. It may be time-consuming, but it will help you find the most suitable health insurance plan for yourself and your family.

If you’re looking for a dependable health insurance plan with adequate coverage and personalisation options, you can explore Shri Health Suraksha Insurance.
 

FAQs

1. Will every healthcare expense be covered from day one of the policy?

No, certain treatments and health conditions are covered only after their respective waiting period ends.

2. Why does a network hospital matter in a healthcare policy?

A network hospital matters because it has partnered with your insurer to provide a cashless treatment facility.

You can avail treatment at your insurer’s network hospital without paying an upfront amount. Only ineligible expenses should be covered by the policyholder; the rest is settled directly between the insurer and the network hospital.

3. Do all health conditions and treatments have a similar waiting period?

No, the waiting period varies significantly. Some conditions may have a waiting period of 24 months, while others may have a higher waiting period of 36 months. Read the waiting period clauses specified in your policy for clarity.

4. What things should I check before buying a health insurance plan in India?

You must check multiple things, including the policy’s coverage, exclusions, waiting period, co-payment clause, sum insured, and list of network hospitals.

5. How to choose the ideal coverage for a family health insurance policy?

When deciding on the policy’s coverage, evaluate your family members’ ages, medical history, healthcare needs, and pre-existing health conditions.