8 Reasons to be Extra Careful while Choosing Health Insurance Plan

The income of an individual and their standard of living is increasing day by day. Simultaneously, the cost of hospitalization is also increasing at a faster pace. Over a decade ago, health insurance cover of Rs.2 lakh was sufficient for an entire family but today this cover might not be sufficient for an individual himself. Diseases like heart problems, strokes, diabetes, and cancer are common these days and their treatments eat up your savings. Thus health insurance policy also called as mediclaim policy has become a necessity for each one of us. This policy helps to cover the actual hospitalization expenses incurred if you are hospitalized due to some disease, surgery or accident.

With so many health insurance policies of different insurance companies, it has become difficult to choose the best policy suiting your needs. More or less the basic features of each policy are similar in nature. But there are certain other features which need to be taken care of, while choosing a mediclaim policy for yourself or your family members.

Maximum Coverage possible

It is important to select the maximum possible coverage for your mediclaim policy depending upon your premium paying capacity. Higher the coverage, more the premium amount and vice a versa. Certain cost like consultation fees, dentist cost, regular medicine cost are manageable but it is difficult to manage huge hospitalization cost and hence it is important to cover all your family members for the same.


Few policies might have certain limits prescribed for particular kind of expenses or for particular treatment. For example;one of the limit clause is per day room rent cannot exceed 1% of the covered amount. It means that if you have a policy worth Rs.3 lacs than room rent expenses upto Rs.3000 per day can be claimed. Any expense over and above that is needed to be borne by the claimant himself. Hence one needs to be careful while selecting a room category at the time of hospitalization. Also the treatment cost and the doctor’s fees also vary as per the room category. All these expenses at time of claim will be paid proportionately. Thus this sub-limit criteria need to be compared and checked thoroughly while selecting your policy.

Maximum Renewal Age

Maximum Renewal age is the age at which your policy will discontinue and no renewals are allowed henceforth. Few policies may have the maximum renewal age up to 65 years or may be 75 years or lifetime. Hence it is important to check this limit as we need the health insurance cover the most at the later stage of our life than the early stage. Thus products with lifetime renewal age should be opted for.

Pre-Existing Diseases

Almost all health insurance companies do not cover certain pre-existing diseases for first few years from the inception of the policy. This feature plays an important role for those already suffering from any pre-existing disease. The list of diseases whose treatment can be covered after specific years is provided in the policy document. Hence you should read the policy document carefully and compare with other policies accordingly.

Co-payment (Co-pay)

Certain insurance companies have the co-payment condition attached with their policy. Co-payment indicates that certain percentage of the covered amount needs to be paid by the insured himself. For example 20% co-pay for the pre existing disease or may be 10% co-pay for all the claims or 10% co-pay after 65 years of age. A policy with no co-payment will always be better than a policy with co-payment option.

Empanelled hospitals and Cash-less facility

Every insurance company has a list of hospitals with whom they have the tie ups. You can check the specialty, reputation and the distance from your home of these hospitals. At the time of emergency it becomes easy and convenient for you. These hospitals are generally instructed by the insurance companies on the procedure and the documents required for settling the claim. Thus the claim settlement procedure works faster. Also few of the hospitals in the companies listed, provide cashless facility wherein the insured only needs to pay the deposit amount during the period of hospitalization.

Credibility of the company

One should check the credibility and the history of the company before choosing its product. It is important to check the credit history, claim settlement ratio, customer friendliness, etc. to know that they stand by you when you need them the most.

Family Floater Policy

Besides individual mediclaim policy you also have the option of family floater health insurance policy. A family floater health insurance is one of the best options when it comes to safeguarding the health of your loved ones. This policy usually covers you along with your spouse and children. However, some insurance providers also have the provision to cover dependent parents, siblings and parents-in-law. Thus family floater policy relieves you from maintaining several insurance policies for each individual member of the family.

The main benefit of this policy is that it is cheaper than buying individual covers for each member of the family. In case of a medical emergency of one family member, the entire family cover is available for the unwell member of the family. In this way, you can get all your dependent members eligible for quality treatment without any compromise.

But you need to be extremely careful while deciding on family floater insurance plan. It will be a plan on which all your dear ones will be dependant. So, you need to be sure that the chosen plan will be able to serve the covered members with quality coverage. Age, number of people to be insured, their present health status and pre existing disease are some of the essential parameters to be checked before taking any decision. For example, if a family member is suffering from cancer, than the likelihood of claims made by him every year are high and hence other members will be left with less cover for that part of the year. Thus it is important to ascertain the risk profile of each member and a separate policy should be taken for the member whose risk profile is high.

Life is full of uncertainties and one needs to be prepared for such circumstances. In order to live a happy and financially sound life, it is extremely important to have your health insurance policy intact. A comprehensive mediclaim policy will help you to stay financially tension free from falling ill or any sort of hospitalization. Thus comparing policy only based on the premium will not be a correct decision. Features apart from those mentioned above like pre and post hospitalization expense, waiting period, no claim bonus and discount, option to increase sum insured, loading of premium, etc also needs to be considered. One needs to be extra careful before selecting an appropriate mediclaim policy. You can consult a financial advisor or planner who can help you to select the right policy suitable for you. Also they are the ones who give unbiased advice and who can provide assistance during your pickups, renewals or even during the time of claims.

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