Let us start with a simple fact that health insurance is like a shoe and as different shoe sizes fit and work for different people. Similarly, a single health policy cannot not cater to the needs of different people.
This is the reason that different insurance companies have come out with different products for different people depending on their demographics and requirements.
In this blog we will talk about a very interesting and important decision that one should make very carefully, which is choosing a health insurance plan.
Mr Raju bought a family floater health insurance plan for Sum insured of Rs 3 lacs covering his family of 4. Unfortunately he met with an accident and filed a claim for Rs. 2 lacs. He was shocked and saddened to know that his claim got settled for Rs. 1.2 lacs. This happened as his policy has a room limit of 1% i.e. Rs 3000 which he was not aware about. The hospital charged him Rs 5500 per day as room rent due to which almost 40% of his claim was deducted in proportionate charges.
This can happen with you as well and to avoid this, the most important factor before buying a health insurance is reading the policy coverage along with terms and conditions. Insurance is a technical product and you should be aware about the details before finalizing a plan. In case you feel confused or indecisive, we recommend that you consult a licensed insurance agent who can explain the same to you in detail.
Factors to be considered
- Age: Age is an important factor to be considered while taking a health insurance plan. Although a disease can affect anyone, the chances of falling sick increase as the age increases. Thus, one should take a higher sum insured as the age increases. Also, a plan with a lower waiting period should be opted for people of higher age.
- Geographical area: The place where you reside is important as medical expenses vary from place to place. A metro city has a higher cost of any treatment as compared to in a B or C class city. Thus, a plan with no room limits with higher sum insureds should be opted for if at a metro city as the room rents can be much higher.
- Medical History: Although a PED has a waiting period, in case you or your family has a medical history, you should disclose the same and opt for a higher sum insured. A person with no medical history can opt for a policy with higher waiting periods and low premiums.
Choices to be made
Individual vs Family floater policy: A major decision to be made by you is whether to buy an individual Mediclaim policy in which individuals with different sum insureds are covered or to buy a floater policy in which all the members share a combined sum insured. This decision has to be made on the basis of size of family, sum insured required, medical history etc.
- Restore benefit: Helps in restoring the policy sum insured after exhaustion of initial sum insured. Insurers also allow for unlimited restoration, which is beneficial for those who think that due to various diseases or multiple hospitalizations, they might need restoration of Sum insured multiple times in a single policy period.
- No room limit capping: To be opted where insured feels that room rents in their nearby hospitals is very high and such capping can lead to their claim’s deductions.
- Daily Cash Benefit: This cover allows you to get a cash benefit for each day of hospital admission which can be helpful for out-of-pocket expenses which are not covered by health insurance.
- NCB Safeguard: This benefit ensures that the accumulated NCB bonus does not get exhausted even if you put up a claim.
As rightly said, health insurance can provide complete peace of mind against unfortunate medical emergencies and expenses but it is imperative to choose the correct plan with an apt sum insured for yourself and your family . By understanding your needs, exploring different policy types, and thoroughly researching options, you can make an informed choice.
If still in doubt, you can reach out to a licensed insurance agent who can guide you on what is right for you.
For any kinds of Insurance claim rejections, delay or short settlements, please contact Insurance Samadhan.
By- Chirag Nihalani
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