Health emergencies can come unannounced and often disrupt the best-laid schemes. An unplanned health-related expenditure can also cause a dent in your budget and can be demanding on you and your family. Therefore, it is important to have an adequate health insurance policy to safeguard your medical and financial interests. In addition to its tax-saving benefits, health insurance also acts as a financial tool that protects you from the rising demands of medical inflation.

While investing in health insurance is important, choosing a plan that best suits your requirements is paramount. Several factors must be considered while selecting a health insurance plan that fits your needs. Here are the things you need to watch out for when buying a plan from the best health insurance company in India.

Things to look for in the best health insurance plan in India

A balance between premium and coverage

It can be tempting to judge a health insurance policy solely by the premium amount you must pay. However, this is a mistake. A lower premium must not come at the expense of essential coverage. However, it is also important not to overcommit and then default on paying premiums.

The idea is to find a plan you can afford without compromising benefits. If you are investing in a policy with a lower premium, take note of the benefits not being extended to you, so you are not in for a surprise later.

Policy design

Most health insurance plans are designed to cover your expenses upon hospitalisation. Therefore, they may not cover pre and post-hospitalisation expenses such as diagnostic tests, medicines, outpatient counselling or psychotherapy, and ambulance services. Moreover, health insurance plans only apply to some medical-related procedures. Cosmetic surgery, for instance, is not covered by most medical plans. So you may have to customise plans from even the best health insurance company in India with top-up coverage to cater to your requirement.

If you have dependent family members such as children and retired parents, choosing a health insurance plan that covers the entire family is time-saving and economical.

Terms and conditions

Any health insurance policy is subject to terms and conditions, and your claim settlement is based on how you, as a policyholder, meet these terms and conditions. For instance, you have been hospitalised for a health issue traced back to a pre-existing health condition you did not declare while applying for the policy. In this scenario, you may be denied settlement based on the terms of your policy on account of non-declaration.

Similarly, terms and conditions also apply to the waiting period. The time frame after which you can file a health insurance claim is referred to as the waiting period. Ideally, the shorter the waiting period, the better it is for the policyholder. So ensure that you read the policy carefully before investing in it.

Co-payment clause

Co-payment refers to the breakdown of the percentage of the expense you will pay versus the amount the insurer will pay. Some policies may also have a sub-limit clause that restricts the monetary extent of co-payment on specific medical procedures. Before selecting a plan, you must clearly understand any co-payment or sub-limit clause so that there are no surprises in the event of hospitalisation.

Cashless Health Insurance Options

The idea behind a well-rounded health insurance plan is to protect policyholders against risks and reduce the financial load. With the rise of digitisation, several health insurance plans make allowance for the cashless health insurance feature.

Under this payment mode, you will not have to pay the hospital bill and then claim the reimbursement. Instead, the bill is routed to the insurance company directly, which settles the payments with the hospital. It is also essential to remember that cashless health insurance is only available in some hospitals. So make sure to check before you opt for treatment in any hospital.

Claim Settlement Ratio

The claim settlement ratio is a percentage value that refers to the probability of an insurance claim being approved by the insurer successfully. It is calculated as the number of settled claims of an insurer to the total number of claims raised. A higher claims settlement ratio for an insurer indicates a higher chance of a claim settlement. In most cases, claims are not settled due to fraudulent practices, improper declaration, and flouting of terms and conditions.

Customisation flexibility

Sometimes, your healthcare demands may undergo significant changes in a few weeks. Therefore, choosing a plan that gives you the space for customisation is important. A popular way to customise your policy is by adding a top-up cover or an add-on cover by paying an additional premium. This will increase your overall health insurance coverage.

No Claim Bonus

No Claim Bonus is a benefit provided to insurance holders who have not made any claims during the timeframe of the concerned policy. As an incentive for not making any claims, the premium costs are usually decreased for policyholders. Alternatively, some insurance providers may also increase coverage during policy renewals as a reward.

In Conclusion

Health insurance is an essential financial tool that helps strengthen your financial security and protects the best interest of you and your family. It works best when it is tailored to fit your needs as a policyholder. Knowing what to include and omit in your policy can help streamline your search for a plan from the best health insurance company in India to suit your needs.