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What you should know before you sign on for a health insurance policy

Health insurance plays a pivotal role in combating the battle of finances, in case of unforeseen events.

September 25, 2012 12:37 IST | India Infoline News Service
In today’s fast paced life where all of us are trying hard to achieve targets or meet deadlines, we often tend to overlook nature’s precious gift to us - our health. Changing lifestyles and erratic work hours have given rise to many health issues and make us vulnerable to many ailments and lifestyle diseases.

With an increase in the number of ailments, the cost of medical treatment and advancement in medical technology is also increasing. Health insurance plays a pivotal role in combating the battle of finances, in case of unforeseen events. According to a survey on consumer behaviour, people want to invest their money in something which fetches them instant return, which is reflected in the fact that the decision of buying a health insurance cover is often postponed. However, people have begun to understand the need for buying health insurance as with health insurance, a person can remain hassle-free while considering the various treatment options available for every disease, ailment or niggling health condition.

There certainly are many more health insurance policies on offer in the market today than ever before. Cashless mediclaim, room rentals, sub-limits, family floater versus individual plans, exclusions, waiting periods – these are all terms that a person should not only be familiar with, but must understand its implications before signing on for a health insurance cover for oneself and his or her family.

One needs to be mindful while choosing a cover, as it is a long term decision. Here are ten easy-to-follow tips to help you while buying the perfect health insurance plan as per your needs.


Get insured at an early age: Health risks increase with growing age and to be applicable for the pre-existing disease coverage, you would need to spend at least three years as a waiting period. Hence, it is advisable to opt for an adequate health cover at an early age. An early start to a health insurance cover would ensure the completion of waiting periods when you may need it the most, following which you can enjoy the full benefits of your health insurance plan. At this stage you would be able to hedge a larger financial risk for efficient treatment at the best healthcare provider.

Coverage: Ensure that you are adequately covered keeping in mind your age, your family members’ ages, higher health care costs, etc. A person in the middle to young age group should have an indemnity cover of at least Rs. 3-5 lakhs. In case of a married individual, it would be wise to choose a family floater plan of Rs. 5-7.5 lakhs sum insured, covering an individual and the spouse.

Gradual increase in sum insured. It is advisable to increase one’s sum insured level at regular intervals to hedge against medical inflation. You should consider various policies available on the websites of different companies, or speak to your insurance advisor about a policy that is right for you and your family.

Fill up the proposal form yourself: You should always fill up your own proposal form and not depend on agents or any third party. The information shared through the form should always be correct and authentic. You should refrain from hiding any information or overwriting on the proposal form. Inadequate information or exclusion of medical conditions during the proposal time can lead to issues of delayed or non-payment of claims during times of need.

Know the limits and exclusions: You should carefully note the exclusions and waiting periods applicable by various insurance providers. All insurance policies would have broad exclusions and waiting periods for effective coverage. You should always ask for sample policy wordings and go through its benefits, definitions, terms, conditions and exclusions in detail, while comparing policies of different insurance companies.

Claims related limits. Look for treatment-respective limits in the products which basically cap the amount you can claim for a particular surgery under the policy. Such limits would cap your claim, even if you have a large sum insured under the policy. You need to weigh this in, before you sign up.

Read and understand the policy wordings: Always read the policy wordings and documents carefully. Once you take an informed decision and obtain coverage from an insurer, we suggest you read through the policy schedule and policy wordings document. Understand the claim process, document requirement, payment options, special conditions, coverage and exclusions.

Individual insurance policy Vs family floater policy: In comparison to an individual health insurance policy, the family floater option extends cover for the entire family for the sum insured level at a marginally incremental premium. A family floater policy enables and facilitates optimal utilization of the insurance policy.

Hospital network of the insurance company: You should spend time in obtaining the details of the hospital network of the insurance company. You should consider an insurer that has an extensive list of hospitals in its network across cities.

Choose a policy with no sub-limits: It is always advisable to choose a health insurance plan that has no disease specific or expenditure specific sub-limits to avoid situations at the time of claims.  This may be marginally expensive in some cases, but you will hedge larger financial risk and have freedom for efficient treatment at the best healthcare provider.

Opt for additional coverage: You should consider opting for additional covers such as Maternity and Critical Illness that are now  offered along with standard health insurance plans. A critical illness rider offers additional coverage for heart attacks, cancer, diabetes, kidney failure, organ transplant or paralysis. In case any of these ailments run in your family, you can benefit from these riders over and above your existing health insurance policy.

Clear all your doubts before taking the final decision: Before making the final decision, take time to read all the documents once again. Ask your advisor or the insurance company as many questions as you can to clarify all your concerns. It will clear any confusion or doubts that may exist.

Once you have ensured that you have carefully pondered over the above points, you will be in a positive position to choose your insurance provider. Congratulations! You are on your way to a healthier and secure future for the years to come.

The author is Chief Executive Officer, Apollo Munich Health Insurance


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