Corporate Wellness

Ten Questions You Need to Ask Before Buying Health Insurance

Health insurance plans vary widely, both in cost and in benefits. From claim settlement records, to premiums, and restore benefits—finding an option that fits you perfectly can be wildly confusing. So, we reached out to our experts, seeking answers. And here they are.

By URLife Team
15 Sep 2021

1. Why do I need health insurance?

Health insurance cover is needed as a financial backup to meet the rising cost of healthcare in India. Medical inflation in India has been 15 percent over the past few years, and a health insurance policy helps people to pay for expensive medical treatments and hospital bills, in incidents of illness or accidental injury.

Health insurance policy offers financial security to you and your family in the event of an unanticipated serious illness or accidental injuries that could drain all your savings. Health insurance policy ensures that you do not bear medical bills and hospitalisation expenses out of your own pocket.

2. What are the benefits of having a health insurance policy?

The primary benefit of health insurance is that it takes care of healthcare expenses. It offers financial security to members in events of unanticipated serious illness or accidental injuries that could drain all their savings. It offers dual benefits of coverage against medical emergencies and assured tax benefits under section 80D of Income Tax Act, 1961. With the increasing risk of medical contingencies and a corresponding rise in hospitalisation costs, medical insurance is highly important for you and your family.

Let’s check why do you need to buy a health insurance plan in India:

  • A health insurance policy can cover hospitalisation expenses, medication and laboratory Investigation, cost of ambulance, doctor fees, etc. Some health plans also cover OPD expenses up to a certain limit.
  • It helps in minimising your out-of-pocket expenses with a cashless medical treatment facility at network hospitals.
  • Nowadays, amid the coronavirus outbreak, it is more important to have a medical insurance cover that covers the cost of treatment including the cost of PPE kits, masks, ventilators, ICU charges, etc.
  • Those who are planning a family can buy a health insurance plan, as well to get maternity and newborn baby coverage.
  • You can buy Corona Kavach and Corona Rakshak health plans if you do not have coronavirus health insurance plan cover and keep all worries at bay.
  • The cost of major surgeries like liver transplantation, open heart surgery and daycare treatments like cataracts, varicose veins, and likewise are also paid by the insurer if covered under a health insurance policy.
  • A health insurance policy helps you and your family enjoy their peace of mind without worrying about future hospitalisation or a medical emergency, which can otherwise drain a major portion of your savings.
  • If you cannot pay much premium and are confused about which health insurance you should buy, then you can opt for a standard policy i.e. Arogya Sanjeevani health policy, which covers modern treatments and COVID-19 treatments as well.

3. What are some essentials I should be aware of when purchasing health insurance?

There are few factors you should consider closely to make the right decision:

  • Aliment Capping and Sub-limits
  • Claim settlement record
  • Scope of Coverage
  • Renewability
  • Waiting Period
  • Co-payment
  • Room Rent Sub-limits
  • 1st,2nd and 4th year exclusions
  • Cashless Hospital Network
  • Premium Loading
  • Internal Claim Settlement Team
  • Family floater or Individual policy
  • Health Insurance Portability
  • Restore Benefits
  • Top Up Health Insurance Plans

4. Should I buy a health insurance plan for my parents? Will it give me any tax benefits?

Yes, you should buy a health insurance plan for your parents as the medical cost for parents might be taking away a huge chunk of income from your pockets. If your parents are not insured with a health insurance plan, you end up paying huge medical costs for their hospitalisation. To mitigate the financial expenses in this regard, you should avail a health insurance cover for your parents.

If you are paying the medical insurance premium for your parents out of your pocket, you can also apply for a tax exemption up to INR 30,000 under section 80D of Income Tax Act** (**depends on the current taxation policies)

5. Do health insurance policies provide cover for pre-existing diseases?

Any health problem faced by a person, prior to seeking an insurance policy is called pre-existing disease. Insurance companies are reluctant to cover such diseases as it is a costly affair for them. Every insurance company has its conditions regarding such illnesses. Generally, pre-existing diseases are excluded under a health insurance policy. However, some insurance companies may agree to cover your pre-existing disease at the usual premium but only after a specific waiting period. Any hospitalisation or medical bill related to a pre-existing disease that is incurred during this waiting period, will not be covered by the insurance company. After completing the waiting period, you can enjoy coverage benefits under the policy.

6. How is the policy premium determined?

There are certain factors that affect health insurance premiums such as your personal medical history, medical background of your family and so on. With the advancement in medical facilities, healthcare costs have also increased. Below is how the cost of your insurance premium is determined:

  • Medical History
  • Gender and Age
  • Lifestyle
  • Pre-existing Health Conditions
  • Geographical Location and Profession
  • No-claim discount
  • Policy Term
  • Type of Health Insurance Plan

7. How do I determine the correct insurance amount for me and my family?

The right amount of coverage depends on several factors like the type of coverage you prefer, current age and health conditions of yourself and your family members, your affordability etc. Healthcare costs vary significantly depending upon which hospital and facilities opted.

While there is no ideal sum assured for a health insurance policy for an individual, there are two market-broadly-accepted rules on its quantum. First, your health cover should be at least 50% of your annual income. And second, the insurance cover should at least cover the cost of a coronary artery bypass graft in a hospital of your choice. A health insurance floater policy of Rs 5 lakh is quite sufficient in most parts of the country. However, it may not be adequate if you live in a metro, where the cost of medical treatment is significantly higher. Also, this will not be of much use if the policyholder is diagnosed with a serious ailment. For such cases, a critical illness plan is more useful and critical illness policies cover comes at a higher cost and covers only specific ailments.

You need to decide the medical insurance coverage you need for yourself, and your family based on your lifestyle, pre-existing health conditions, medical background of your family, annual income, age, health risks and the premium that you can pay.

8.What makes the best insurance plan?

If you are looking for the best health insurance plan for you and your family, the best way is to compare some of the best medical insurance plans and ensure the good health of your loved ones. Almost all insurance companies offer different health insurance plans to meet the needs and requirements of its different customers.

Some of the most important points that you must keep in mind while selecting the best health plan in India,

  • Check the Sum Insured,
  • Coverage limit,
  • Entry age and renewability clause,
  • co-payment clause,
  • inclusions & exclusions,
  • waiting period,
  • room rent capping,
  • add-on benefits,
  • critical illness cover
  • no-claim bonus

You can check the claim settlement ratio of the health insurer. And any settlement ratio above 85% is considered good. After comparing different plans based on the above parameters you can select the right plan. There are critical illness plans that cover cancer and other life-threatening medical conditions like kidney failure, liver transplants. If you have parents, you can go for a senior citizen health plan. To cover your children and spouse a family floater will be the best. If you want individual sum insured cover then you can opt for individual health plans also.

9.Will my health insurance plan help me save money?

Healthcare expenses eat away a major portion of your take-home pay and savings, hence it is necessary to have a health insurance plan in place. Health insurance helps you save money by enabling you to transfer a big financial risk to the insurer in exchange for a (comparatively) small premium.

Health insurance plans are vital to your financial health by helping protect you from financial calamity. In fact, having the right kind and the right amount of health insurance is one of the smartest money moves you can make. You can also save from assured tax benefits under section 80D of Income Tax Act, 1961 for the premiums you make towards purchasing a health insurance plan.

10.If I am interested in alternative therapies, will I need a separate insurance plan?

Alternative healing therapies are healing methodologies that differ from the usual line of treatment. Ayurvedic and homeopathic treatments are usually covered by a few health insurers under group health insurance schemes but are unavailable for individual customers. By including traditional medicines in individual plans, health insurers are covering a niche segment. One has to be hospitalised for more than 24 hrs in a government recognised hospital to claim for the treatment taken. Ayurveda is most readily covered by new health insurance policies but the same is not true for other traditional medicines like naturopathy, Unani etc. Naturopathy is not covered under any health insurance policy. Standalone traditional medicine cover is not available presently but is only available with standard health insurance policies.

The coverage of alternative medicines depends on the insurer. Some health insurers cover only a few Ayurvedic treatments while some cover all of them. There is also a cap on the amount covered which usually ranges from 7.5% to 25% of Sum Assured.

Though traditional medicines are being covered by the new health insurance plans, there are still a few exclusions. One should verify the treatments covered before buying a particular health insurance policy.


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