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Being referred to as the ‘Diabetes capital of the world’, the health of most Indians needs improvement. Combine this with growing medical inflation, and the cost of quality healthcare can be overwhelming, even for routine treatments. This makes having health insurance essential and no longer just a mere 'good option'.
Simply buying any health insurance plan is not enough. What matters is whether the coverage amount is truly adequate. You have to find an answer to—"Can it handle a real emergency without draining your savings?"
So, let’s learn how to find the appropriate health insurance coverage that fits your needs, including personal, financial profile, and health risks.
Key Takeaways
Start with your specific needs: Consider existing conditions, family needs, or maternity coverage when deciding on insurance coverage.
Coverage is often estimated as a multiple of annual income (commonly around 6 times) to handle major emergencies, though exact needs vary by individual circumstances..
Check for cashless hospital networks to avoid paying bills upfront and ease the hospitalisation process.
Mind the waiting period: Choose policies with shorter waiting periods, especially if you have pre-existing health issues.
Avoid co-payment clauses if you want minimal out-of-pocket expenses during treatment.
Look at the insurer’s Claim Settlement Ratio (CSR) - a high CSR indicates trustworthiness and smoother claim processing.
Prefer wide coverage including pre- and post-hospitalisation expenses for at least 60–90 days.
Understand plan exclusions and sub-limits to avoid unpleasant surprises during emergencies.
Ensure flexibility to add new family members or adapt the plan as your life stage changes.
Consider influencing factors like age, lifestyle, medical history, and rising healthcare costs while selecting the plan.
Identify the Requirements
It involves checking the reason for your decision to opt for health insurance cover. Is it pre-existing health conditions, family health, maternity and childbirth coverage or any other reason? Many financial advisors suggest choosing a cover amount that is several times your current annual salary (e.g., 5–6 times), but the actual requirement depends on your personal and family health needs. Subsequently, shortlist among the available plans that fit your criteria. Focus on the sum insured associated with the plan. Be mindful that a high amount will increase the premiums, while a low sum will not be enough to pay the bills.
Check for the Cashless Hospitalisation Benefit
Cashless hospitalisation benefits refer to obtaining the most effective and quality medical treatment without paying the bill yourself. The insurance company must cover the bill. It is possible to choose an insurance service provider with a wide network of hospitals. Reading through the fine print and checking the list of covered cashless hospitals helps make the optimal choice.
Did You Know?
Autoimmune disorders are currently the fifth-leading cause of death in women under 65 years old.
Source: Scientific American
Consider the Waiting period.
It refers to the time you need to wait before raising a claim on the chosen policy. It is different for the variety of plans and insurance providers, and ranges from zero to several years. Depending on your and your family's health conditions, the appropriateness of this period will vary. Examine to find the low pre-existing disease-based waiting period while comparing the policies.
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Avoid Co-payments
This feature requires the policyholder to pay a predetermined amount of the insured or covered sum themselves. It reduces the health insurance premiums. Again, the suitability of the feature will depend on your income and the stage of life you are in. Check for the presence of such a feature if you need, or the flexibility to opt out of it if you don’t need. Generally speaking, the co-payment adds to your out-of-pocket expenses, thus poorly influencing your finances.
Check Claim Settlement Ratio
The claim settlement ratio refers to the percentage of claims settled by the insurance provider compared to the claims raised in a year. The high ratio indicates the settlement of most claims, indicating a better quality of service.
Conclusion
Health insurance is a necessity nowadays, considering the poor lifestyle, diet and lack of exercise among individuals. With numerous options to choose from, the choices can be difficult to make. However, assessment of your needs helps you make clear choices. You must also consider other essential aspects that influence the cost incurred by you on medical treatments, such as coverage of the plan, exclusions, inclusions, waiting period, claim settlement ratio and others. Accordingly, make a decision that is specific and suitable for your needs.
Glossary
Autoimmune Condition: A condition in which the immune system attacks the body’s own tissues, causing long-term health issues.
Rider: An add-on to your life insurance policy that offers extra benefits like critical illness or hospital cash.
Underwriting: The evaluation process insurers use to determine the risk of offering coverage to an individual.
Medical Emergency: Any health crisis requiring urgent medical attention, such as hospitalisation or surgery.
Critical Illness: A serious condition, like cancer or heart disease, usually covered under specialised insurance riders.
FAQs
For parents above 80, higher coverage (often in the range of ₹10–20 lakhs) may be considered, depending on existing health conditions and expected medical costs.
No, there lies a difference between the two in terms of covered pre and post-hospitalization expenses, medical conditions, costs, benefits and number of claims.
The variety of health insurance plans includes individual, family, senior citizen, critical illness, maternity health insurance and others.
Disclaimer - This article is issued in the general public interest and meant for general information purposes only. The views expressed in this blog are solely those of the writer and do not necessarily reflect the official policy or position of Canara HSBC Life Insurance Company Limited or any affiliated entity. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability with respect to the blog or the information, products, services, or related graphics contained in the blog for any purpose. Any reliance you place on such information is therefore strictly at your own risk. You should consult with a qualified professional regarding your specific circumstances before taking any action based on the content provided herein.
