7 Important Health Insurance Parameters to Select the Right Plan for Yourself

Health issues don’t just take a physical toll. They also affect you mentally and financially. The current pandemic drives home the importance of being financially secured. Consider this a reality check on how critical it is to safeguard your health and choose the right health insurance policy. When you select the right insurance plan, you can sail through expected or unexpected medical expenses without stress. However, this can be done only when you identify the health insurance parameter that actually affects you. Do not take a one size fits all approach! Instead, choose the right health insurance plans based on important features like cashless transactions or ambulance cover. 

7 Critical Health Insurance Parameters to Consider

See the total sum assured

The total sum assured is the maximum amount that a health insurance provider will have to pay you in case a claim has been made. It is very important to check this amount as that will decide if this option is feasible or not. When your medical expenses exceed the total sum assured, you might have to bear additional costs. Consider your current medical needs and choose the right health insurance policy that suits it. Usually, a higher sum assured is better as it caters to increasing medical costs. However, this may come at a higher premium. 

Ask for the coverage type

Select the right insurance by checking what is covered in the plan. There are plans that cover major issues and those that cover routine healthcare. Keep in mind that there are different plans to suit different requirements. You could opt for plans that cover critical illness or choose plans tailor-made for senior citizens or women. A family plan can secure all members in your home while a top-up can supplement the deductible limit of an existing policy.

Evaluate easy renewing options

Getting health insurance is usually not a one-time investment. Most insurance companies provide lifelong renewal options. However, these may come with age caps or limitations based on health conditions. Choose right health insurance by studying these. Secondly, check if renewing it is easy to do online. This helps you remain protected without going out of your way.

Get the details on the claim settlement figures

This is one of the key parameters to consider before shortlisting the right health insurance plans. Weigh the ratio of claims settled with the total number of claims filed during a financial year. A claim settlement ratio of 85% and higher is usually considered ideal. A higher ratio implies that your health insurance provider accepts all genuine claims. Another health Insurance parameter to check in this category is the turnaround time of cashless or reimbursement settlement. [3]

Here is a comparison of the claim settlement efficiency ratio among different providers for the year ending March 31, 2020. 

Source: General Insurance Claims Insights, A Policyholders Handbook – 5th edition by Insurance Brokers Association of India

Check sub-limits carefully

Sub-limit refers to the amount you can claim for a specific procedure or medical expense. Check if there are caps under any such cost-heads. This means you may have to pay out of pocket in case you exceed the limit. Some providers include a cap on room rent while others may include them on medical procedures like cataract surgery or maternity services.

Ask if there is co-payment facility

Co-pay clause is an option where you pay a part of your medical costs while the insurer pays the rest. The co-pay amount is normally fixed, so check it prior to selecting your policy. This clause is usually applicable to senior citizen plans<span data-contrast="none">. It reduces the premium you pay but weigh its benefit against the cost before you decide. 

Confirm if there is a cashless hospitalization benefit

A cashless claim helps you to manage your hospital treatments affordably. Here, you need not worry about paying for your medical treatment as bills are settled by your insurer. Make sure you check the provider’s network of affiliated hospitals. This helps you get seamless medical care when you need it. It also ensures that you can visit preferred hospitals.

These health Insurance parameters define how useful a policy will be for you and your loved ones. They also influence how easily you can address medical emergencies. Check out the Aarogya Care plans on Bajaj Finserv Health to see a wide range of cost-effective options.  

With up to Rs.10 lakh sum assured, cashless claims, and a claims ratio that exceeds that of competitors, they offer ideal coverage. These comprehensive plans also offer benefits like free doctor consultations, health check-ups, and loyalty discounts from top healthcare partners. All this helps you take a proactive approach to your and your family’s health.