How to plan for a Good Health Insurance Plan?

Comprehensive Coverage

When buying health insurance, it is important to plan it in such a way that all members of the family are covered. Even if one or both of the spouses are covered by employee insurance, it is important to have health insurance cover of one’s own because a job is subject to change and one may remain unemployed for certain periods. A family floater plan can ensure that all members of the family are covered under an umbrella plan.

If a family floater plan has a sum assured of Rs 10 lakh, single member of the family can utilize that amount in case of a medical event. You can buy a family floater plan that covers your parents and in-laws too.

Coverage Amount

The first thing to plan for is the coverage amount. For a nuclear family of 4 with young kids, a coverage of Rs 5 lakh is adequate in non-metros while in metros where the cost of treatment is higher, a sum of Rs 10 lakh is recommended. Since the premium for family floater plans depend on the age of the eldest member of the family, it is important to increase coverage if elderly parents are to be covered.

Cashless Claims

Health insurers have tie-ups with hospitals to give cashless claim facility. This means that you do not need to pay anything at the time of admission and there is less paperwork. The insurer directly settles the bill with the hospital. When choosing a health insurance plan check if the insurer has tie-up with good hospitals in your city, especially the ones near you.

No-claim bonus

Health insurers provide a no claim bonus (NCB) which is a certain percentage of the sum assured. It basically means that the sum assured goes up by a certain amount every year when there is no claim made. However, the NCB comes with a limit. Let us say your sum assured is Rs 4 lakh and there is a NCB of 10 % with a limit of 50 %. This means that if you do not make a claim, your sum assured will go up by Rs 40,000 every year till it reaches 6 lakh.

Waiting Period

Health insurance policies come with a waiting period for pre-existing diseases. This could range from 2 to 4 years and include conditions like diabetes and hypertension. So, if you are a patient of hypertension and need to undergo a heart surgery, the waiting period will kick in. This is what it is important to buy a health insurance as early as possible. Otherwise, opt for policies that have a minimum waiting period.

Co-payment and Deductible

These are features of health insurance policies you should be aware of as these affect your premium. Co-payment means that the insurer agrees to pay a certain percentage of the expenses from his own pocket. If your policy has a co-payment of 10 per cent, it means that if your medical bill is Rs 5 lakh, then you have to pay Rs 50,000 lakh from your own pocket. A deductible, on the other hand is a fixed amount.

If your policy has a deductible of Rs 20,000, you pay that from your own pocket irrespective of the total bill amount. While a co-payment is common in health insurance policies for the elderly, deductibles are meant to ensure that people don’t raise a claim for very small amounts. When planning for a health insurance policy you should read the fine print and know how it will affect payment in case of a claim.