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How to get the right health insurance for your family

With rising healthcare costs, it is obvious that you have to buy a health insurance policy. Here are some tips to buy the right mediclaim policy for you and your family.

November 30, 2015 / 03:22 PM IST
Anil Rego

One of the most crucial insurance plans that one should get is the health cover. Given the rising health costs, and worsening health conditions for most people, if one wants to avoid burning a hole in one’s pocket, a good health cover is very important. In India, medical/ health insurance is taken mainly for treatment of various ailments and overnight stay at hospitals, although a few insurance companies provide cover for critical illnesses as well. Even a 2-3 days hospitalization can burn a hole in ones pocket at time when one cannot afford it. Let us look at health cover in a little more detail.

Typically, most insurance policies are basic policies, in such that they cover only the regular medical expenses such as pre & post hospitalization expenses, waiting periods for pre-existing illnesses, expenses & loads, and no claim bonuses. Apart from this basic plan, one can also look at opting in for a critical illness plan, which can be purchased as a separate plan altogether or as an add on to one’s basic health plan. However, it is important to note that there are no customized insurance packages, and one should select the insurance that is closest to their requirements.

There are several important factors to consider before selecting the right insurance for you, such as the pre & post hospitalization expenses, waiting periods for pre-existing illnesses, expenses & loads, and no claim bonuses. Insurance companies are also prone to stating a certain limit to the overall policies, with sub-limits being given to sub-categories. For example, the insurance maybe for Rs. 5 Lakhs, but there could a limit of Rs. 50,000 on medicine, and Rs. 3 Lakhs of a certain type of surgery. This break-up needs to be taken into account while choosing the right insurance.

One of the key areas that one should analyze is the hospital network, as more the number of member hospitals the better it is. Also, always check on the conditions - some covers include medicine, doctor’s fees, and a stipend during recovery period; other cover only the hospital costs; while still others might cover non-traditional treatments such as ayurveda or homeopathy.

Most insurance companies have the concept of deductibles & co-pay, which essentially means that you have to bear a portion of the cost. For example, if the deductible is 10%, and your medical expense is Rs. 1 Lakh, then you will need to pay Rs. 10,000 before the insurance company will pay the remaining Rs. 90,000. Ideally, one should look for insurance plans that cover 100% of the expenses, even if the premiums are higher it will be worth it in the long run.

There is also the ‘pre-existing conditions’ clause, wherein, based on any illnesses/ ailment (for example diabetes, a heart condition, etc.) that one already has, may or may not be covered. The renewal age is another factor that should be considered, since when one is in their twenties the premium is very low, but as one ages not only does the premium increase, but in many cases the cover ceases. It is important to choose an insurance policy which has the longest renewal age, so that you can benefit from the medical insurance for as long as possible.

One should also ideally opt for family floater plans, which as the name suggests covers one’s entire family in the medical insurance, thereby saving a lot of money and hassle in the event of any unforeseen illness. Even if the family consists of a husband and wife, it is advisable to take a family floater plan as these offer higher covers and benefits such as this cover can be entirely used by one person (if required).

Health insurance is very important and one should get the maximum benefit possible - in terms of cover and age up to which it covers you
Cover your entire family
You can get a tax benefit as well by investing in medical insurance
Insurers with more hospitals in their network are better

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