Mar 08, 2013 12:13 PM IST | Source:

Key factors to understand in a health policy

With health costs escalating at a rapid pace every year, it is imperative for every individual to have a health insurance policy.

With health costs escalating at a rapid pace every year, it is imperative for every individual to have a health insurance policy. There is a plethora of options available in the market offered by both public sector and private players. Due to the multiplicity of options available in the market, it is often difficult to pick a policy. The following are some important factors to be considered while choosing a health insurance:

Floater Size: One of the most important aspects, look for the flexibility of including the maximum number of members in your family under your policy and compare premiums across policies to get the best deal.

Scope of coverage: Choose a policy which has a comprehensive cover, which includes not only the sum insured, but also other benefits like ambulance services, critical illnesses coverage, OPD coverage and pre-existing diseases (PED) waiting period. In some cases, premium is very low, but most of the above mentioned benefits are not covered, making it a costly proposition in the long run.

Premium: Premiums should not be the sole factor in choosing a policy. However, it is important to understand the trend in annual premium loading. There are many cases when insurance companies hike premiums without prior notice after a claim is made, and the insured is forced to pay a high premium to retain the sum insured. Most companies also charge premium based on age. So compare policies to ensure that your premium remains affordable even in your retirement days. It is advisable to check past trends.
Maximum renewal age: This is the age on which the coverage of your insurance will discontinue. The maximum entry age and renewal age are critical aspects, as healthcare costs shoot up after 70 years. Some plans offer lifetime products, covering you throughout your life. Choose a plan which covers you and your family for the maximum lifetime.

Sub-limits and Co-pay: Most insurers specify limits on expenses under various heads like ambulance expenses, room rents and treatment-specific limits. Check for the insurer with minimum such limits and avoid insurers who impose sub-limits on important expenses like doctor’s charges and day-care procedures. Further, check for the co-pay clause, wherein the insured is asked to pay a certain percentage of the claim amount as co-payment. Such policies are best avoided.

Credibility check: The insurance company you choose should be credible and have a good track record. It is a good idea to discuss with existing policyholders on online forums to know about responsiveness, service levels and turnaround time. A company which introduces changes frequently may not be very reliable and is best avoided.

Claims Settlement History: Before choosing your policy, check the claims settlement history of the insurer. Look at policies with a high claims settlement ratio track record.

No-Claim Bonus: Choose a policy offering No-Claim Bonus only if premiums are not inflated. No-Claim Bonus can be in the form of an increased cover, a discount in premium or free health checkups after claim-free years.

Comparison of Key Features among Top Players in the Health Insurance market:

The below comparison is for a family of four (self, spouse, 2 dependent children) for 1 year, with age of the primary holder in the age bracket 30-35 years and for a Sum Insured (SI) of Rs. 3 lakhs.

Company NameHDFC ErgoBajaj AllianzUnited India InsuranceOriental InsuranceICICI Lombard
Name of planHealth SurakshaFamily Floater Health GuardFamily Floater CoverHappy Family Floater- Silver Complete Health Insurance
Maximum entry age of proposer65 years65 years; Renewal 80 years80 years55 years; Renewal 65 yearsNo limit
Sum InsuredRs.2-5 lakhsRs.2-10 lakhsRs.1-10 lakhsRs. 1-5 lakhsRs. 2-10 lakhs
Medical check-up exemption upto45 years45 years45 years60 years46 years
Annual PremiumRs.8,837Rs.8,860Rs.6,110Rs.5,440Rs.11,390 (without sub-limits)
PED waiting period4 years4 years4 years4 years4 years
Sub-limits and Co-payNo sub-limits except for Ayurvedic/Homeopathic treatment;Ambulance charges: Rs. 1,000;Room, boarding charges - 1% of SI/day10% compulsory co-pay;Sub-limits can be opted for a lower premium
Ambulance charges: Rs. 2,000Sub-limits applicable for cataractICU Expenses: 2% of SI/dayAmbulance charges - Rs.1,000
  Specific sub-limits for certain diseasesRoom, boarding charges - 1% of SI/day
  10% deductible for claims for persons above 60 yearsICU Expenses: 2% of SI/day
  Medical checkup: Upto 1% of average SI of preceding 3 yearsSpecific sub-limits for certain diseases
Additional benefits5% bonus on SI for every claim-free year.5% bonus on SI for every claim-free yearNo Claim Discount of 3% after three continuous claim free years.Personal Accident cover for self and dependants.No co-payments for any disease or any hospitalisation expenses
Free health check up after 4 claim free years Free health check up after 4 claim free years.Free health check up after 3 claim free years.
 Discount on premium available on voluntary deductiblesPersonal accident cover can be added


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