How to Compare Health Insurance Plans: Key Features to Look Out For

A recent survey revealed that even though 96% of Indians know about health insurance, only 43% have one. This striking contrast highlights the risk the other 53% are taking because without health insurance, you are left on your own to pay for all medical expenses. In this blog, let’s explore the right strategy to choose a health insurance plan. 

Assess Your Healthcare Needs

Understanding your healthcare needs is essential to maintaining your well-being. Let’s delve into the factors you should consider:

Age

Your age plays a significant role in determining your healthcare needs. You won’t have significant health issues when you are young, but unexpected accidents can happen anytime. Due to reduced health risks, insurers will be more willing to offer lower premiums for young policyholders. So, buying insurance early will help you find lower premiums, extensive coverage, and a ride-out of the waiting period without any health crisis.

Pre-existing Conditions

If you have any existing health conditions, such as diabetes, hypertension, or asthma, it’s essential to prioritise health insurance that covers out patient expenses as well. With pre-existing conditions, your health risk increases, and so is the need for a comprehensive health insurance plan. 

Anticipated Medical Expenses

Assessing expected medical costs means checking if your health insurance covers necessary services like hospital visits and medications, which might increase your premiums if you need extra coverage. If you are getting married, look for maternity cover. For example, if your job involves traveling to international locations, look for international coverage. 

Family Size

Considering your family’s size in healthcare planning is like understanding the dynamics of a team. Adding more people to your family floater plan means that all of you must share the sum insured. If one of your family members have a health condition, it can affect the premium and coverage for everyone. Also, adding your elderly parents to your family insurance may not be a good idea if they have chronic conditions. Evaluate the needs of everyone in your family and decide whether you can buy a family floater plan or individual health insurance plans. 

Lifestyle

Understanding your eating, exercise, sleep, stress, and substance use habits helps you know your healthcare needs. A sedentary lifestyle and stressful jobs increase the likelihood of certain diseases. Similarly, if your job involves travelling in two-wheelers for longer hours, it can increase the risk of accidents. So, understand your lifestyle to evaluate coverage options. Along with these, you must know the treatment cost of some common diseases and lifestyle diseases to which you are prone. For ex, in India, you must think about these 10 diseases which are very common and safeguard your pocket against these diseases with the right health insurance: 

1. Malaria
2. Diarrhoea
3. Gastrointestinal disease
4. Chickenpox
5. Dengue
6. Jaundice
7. Cardiovascular Diseases
8. Diabetes
9. Tuberculosis
10. Hepatitis

Financial Stability

You must be sure about your financial status before planning health coverage. The minimum medical bill which can dent your savings or investments, should be the minimum cover amount you must have. Having health insurance worth this value will ensure that you do not need to break your ongoing financial planning just because of any medical emergency. Over and above this, you should consider the factors listed in previous sections to evaluate exact cover amount you would need. 

Key Features to Compare

When comparing health insurance plans, focus on these key factors:

Coverage Amount

When looking at how much coverage a health insurance plan offers, look at coverage limits, which show the most the insurance will pay for your medical expenses in a set time. Also, see if there are any limits on what’s covered and if the plan offers restoration benefits, which can top up your coverage if you’ve used it all up. 

Premium

When comparing health insurance plans, assess the cost of premiums, which you pay regularly to keep the coverage. Higher premiums might come with extra benefits, while lower ones could be for group plans or have fewer benefits. Topping up insurance with add-on covers will increase premium, but it will also increase protection. Always ensure that you get the adequate coverage to avoid out of pocket expenses as much as possible during medical emergencies. 

Deductibles

When you have health insurance, you often need to pay a certain amount from your pocket before the insurance starts covering your medical bills. This initial amount you pay is called a deductible. Plans with higher deductibles usually have lower monthly payments, but you’ll pay more if you need medical care. 

Policy Features

When comparing health insurance plans, check if they cover pre-existing conditions or critical illnesses. Pre-existing condition coverage helps with ongoing medical needs, while critical illness coverage provides financial help for serious diagnoses.  Plans with this coverage might cost more due to higher risk for insurers, but they offer valuable protection. 

Co-payment

It is crucial to see if you must pay a percentage of medical costs with each claim, known as coinsurance. This usually ranges from 10% to 30%. Also, check for copayments, fixed amounts you pay for certain services, like doctor visits or prescriptions. Whether copayments are good or bad depends on your situation. To optimise insurance costs for senior citizens, you can opt for a higher co-payment. However, ensure that your budget will allow you to meet those out-of-pocket expenses. 

Room Rent Cap

When checking health insurance plans, see if there’s a limit on hospital room charges, called a room rent cap. This sets the maximum amount the insurance will cover for room costs per day or hospital stay. Some plans offer add-ons for higher room rent caps, which can increase premiums. Some policies include room charges for free up to a limit or within a specific network of hospitals. 

Outpatient Department (OPD) Coverage

It is essential to see if the insurance plan covers expenses for doctor visits and tests outside of hospital stays, known as Outpatient Department (OPD) coverage. This coverage typically includes consultations, diagnostic tests, and treatments conducted outside the hospital. Some plans may offer unlimited OPD coverage, allowing for frequent visits and tests, while others may have limitations on the number of visits or a cap on the amount reimbursed per visit. 

Cumulative Bonus

Look for plans that offer cumulative bonuses or rewards for staying healthy and not making claims regularly. This cumulative bonus could either increase your sum insured or reduce your premium for every claim-free year. 

Claim Settlement Ratio

Claim Settlement Ratio (CSR) tells you what percentage of claims the insurer approves and pays out. Obviously, you must choose an insurer with a higher CSR, which means that you are more likely to get your claim approved. This CSR data is publicly available that you can find from the insurer’s website. 

Insurers History

Exploring insurer’s history will give you insight into their reputation and financial stability. Some new players in the market may lure you with attractive lower premiums. However, choosing stable insurers who have been in the insurance business, settling claims for a few years is better. A company with strong financials and good CSR is a safer option. 

Claim Repudiation Ratio

Claim Repudiation Ratio tells you the percentage of claims an insurer denies. This is the opposite of CSR. An insurer with lower repudiation ratio settles most of the claims. You can also find this information online and get it directly from the insurer’s website. 

Key Takeaways

Choosing health insurance is vital for financial security and proper medical care. Assess your needs, compare key features, and consider factors like age and budget. Prioritise comprehensive coverage and check the insurer’s reputation. By comparing plans and understanding policy, you can make informed decisions that support their long-term health and financial well-being. 

Additionally, you can consider platforms like PhonePe for a seamless and hassle-free insurance purchase experience.