Introduction
With the rise inawareness among the people and growing medical inflation, almost all households
have started purchasing a health insurance policy, and many have availed of a
family floater for their family members. A family floater is a health insurance
policy that covers different family members under a single coverage, and the
insured sum is shared among the insured family members. Below are some of the
tips to buy the best family insurance policy.
1.Claim settlement ratio: The number tells us about the percentage ofclaims settled successfully by the insurer against the total number of claims
that they have received. It is mandatory to check the claim settlement ratio of
an insurance company because it gives an insight into their consistency level in
settling claims, commitment to pay claims and the insurer's financial ability.
One can purchase the best health insurancefor family if the ratio falls between 75% and 90%.
2.Adequate insured sum: Before purchasing health insurance for thefamily, it is necessary to ensure that the sum insured in the plan is adequate
to meet the family's medical requirements. Ideally, one should consider the
number of family members, their ages, and pre-existing health conditions before
purchasing a policy. Because under the family floater plan, the insured sum
will be divided among the family members. In case of inclusion of aged parents
in the plan, it is always advisable to insure a higher sum.
3.Premium amount: It is the amount one needs to pay to keep the healthinsurance policy active. The premium amount goes up along with the insured sum.
It depends upon the age of the eldest family member in the plan, and one can go
for add-ons for added benefits. It is always advised to purchase a plan with an
affordable premium.
4.Coverage: One of the crucial things to check before purchasing a policyis its coverage and benefits. Experts recommend that people buy policies
covering pre-existing diseases, critical illness, pre- and post-hospitalization
expenses and daycare and transportation expenses, among others.
5.Extensive hospital network: Since finding a hospital that agrees to covertreatment costs under insurance policies during a medical emergency is
challenging, it is better if the insured purchases a health insurance policy
with an extensive list of network hospitals. One cannot search for a hospital
that offers quality treatment or travel miles to avail quality treatment during
an emergency. So, it will be more convenient for the insured to find a hospital
nearby if the list of network hospitals included in the policy is longer.
6.Cashless hospitalization: Most of the insurance companies offer cashlessMediclaim for the treatment availed at their network hospitals. It means the
insurer will settle the hospitalization and other medical expense bills
directly upon submitting the bills. This will conveniently remove the hassle of
bearing the medical expenses, submitting bills and invoices and waiting longer
to get a refund amount. One needs to inform the company at least a few days in
advance in case of planned hospitalization and within a day or two in case of
accidental hospitalization.
7.Pre-existing disease coverage: It refers to the medical conditions that aninsured was diagnosed with before signing up for a policy. IRDAI guidelines
make it clear that an insured is said to have a pre-existing disease if they
were diagnosed with a medical condition up to 48 months before purchasing the
policy, and it includes any long-term condition right from high blood pressure
and diabetes to thyroid and asthma. It is also important to declare the
pre-existing disease at the time of purchase because non-disclosure will lead
to the rejection of claims or, in rare cases, cancellation of the policy.
8.AYUSH treatment coverage: Due to the general belief that AYUSH(Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) treatment
focuses on the complete well-being of a patient and not the illness alone, many
have started considering it as an alternative to the standard medical
treatments. Since only specific health insurance policies cover the treatment
expense, it is advisable to check this particular clause before purchasing a
policy. Only recently has the Insurance Regulatory and Development Authority of
India (IRDAI) modified its guidelines to let insurance companies cover the
treatment expense.
9.Waiting period clause: Almost all insurance companies have a 'waitingperiod' clause in their policies, and it prevents the insured from availing of
all the policy benefits right after purchasing it. It means that policyholders
must wait for a period before enjoying the policy's benefits. The waiting
period starts from the policy commencement date and usually ranges between two
and four years. So, purchasing a plan with a minimal waiting period is
advisable.
10.Co-payment: Co-payment denotes a fixed sum in the claim amount that thepolicyholder agrees to pay, irrespective of the claim amount. While the insured
pays the agreed co-payment amount, the insurer will pay the remaining amount.
In most cases, it varies from 10% to 30%. It is always advisable to purchase a
policy with no co-payment or less co-payment because a higher co-payment kills the
purpose of buying the insurance policy.
11.Lifetime renewal: Since most health insurance policies have set an age limitfor renewal, choosing a policy with lifetime renewability is always
recommended. It means a policyholder can renew their coverage anytime without
re-qualifying for a new policy. With this policy, a policyholder need not worry
about bearing medical expenses from their pocket after retirement and can
continue receiving the benefits till the end.
12.No-claim bonus: One of the essential things to check before purchasing apolicy is the no-claim bonus because it provides a monetary benefit for every
no-claim year. It is a type of remunerative benefit that the insurance
companies will provide to policyholders for every claim-fear year. The insurer
will either offer a cumulative bonus – under which policy holders' insured
amount will increase by a certain percentage – or a discount on premiums –
under which the premium rate of policies will come down by a certain percentage.
Conclusion
These are the essentialelements to consider when purchasing a health insurance policy. By picking the
right policy, one can tackle financial crises during medical emergencies
without much hassle.