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Mar 08, 2013, 12.13 PM IST | Source: Moneycontrol.com

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.

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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 Name HDFC Ergo Bajaj Allianz United India Insurance Oriental Insurance ICICI Lombard
Name of plan Health Suraksha Family Floater Health Guard Family Floater Cover Happy Family Floater- Silver  Complete Health Insurance
Maximum entry age of proposer 65 years 65 years; Renewal 80 years 80 years 55 years; Renewal 65 years No limit
Sum Insured Rs.2-5 lakhs Rs.2-10 lakhs Rs.1-10 lakhs Rs. 1-5 lakhs Rs. 2-10 lakhs
Medical check-up exemption upto 45 years 45 years 45 years 60 years 46 years
Annual Premium Rs.8,837 Rs.8,860 Rs.6,110 Rs.5,440 Rs.11,390 (without sub-limits)
PED waiting period 4 years 4 years 4 years 4 years 4 years
Sub-limits and Co-pay No sub-limits except for Ayurvedic/Homeopathic treatment; Ambulance charges: Rs. 1,000; Room, boarding charges - 1% of SI/day 10% compulsory co-pay; Sub-limits can be opted for a lower premium
Ambulance charges: Rs. 2,000 Sub-limits applicable for cataract ICU Expenses: 2% of SI/day Ambulance charges - Rs.1,000
    Specific sub-limits for certain diseases Room, boarding charges - 1% of SI/day
    10% deductible for claims for persons above 60 years ICU Expenses: 2% of SI/day
    Medical checkup: Upto 1% of average SI of preceding 3 years Specific sub-limits for certain diseases
Additional benefits 5% bonus on SI for every claim-free year. 5% bonus on SI for every claim-free year No 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 deductibles Personal accident cover can be added

 

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