Things to keep in mind before deciding “Best Health Insurance Company” in India
Health insurance is the most desired product in India due to the Corona virus pandemic which has created havoc among the Indian public. The rising health care costs have pushed many people to opt for an individual health insurance or family health insurance policy which suits their budget as well as other requirements. During the time of lockdown when the general and life insurance companies reported negative growth, health insurance companies have reported a huge increase in their sales. As per a report more than 30% growth in health insurance sales has been observed during and after the lockdown period. The main reason for this increase is due to the fear which was instilled among the public and the cost of treatment involved for Corona. There were few hospitals which were looting public in the name of Corona treatment and this has come to the view of Government which then capped the treatment costs for Corona and instructed the hospitals to accept insurance policy as well.
After the removal of lockdown the sales of health insurance policies have come down due to the reduction of fear among the people. It is important to consider many factors while selecting the health insurance because it is not possible to shift from one insurance to company to the other easily unlike the motor or property insurance. The insurance company which you wish to port your health insurance policy may or may not accept your proposal, if accepted the new health insurance policy may not satisfy all your existing requirements and the premium may or may not be at par with what you are paying now. So taking all the factors into consideration it is important to decide on the Best health insurance policy by taking the below factors into consideration:-
Product Features & Coverage:
Almost all the health insurance policies from different insurance companies would contain same features such as in patient hospitalization, Day care treatment, domiciliary hospitalization, Ayush benefits etc. Apart from the basic features few health insurance products contain extra coverage such as Ambulance Cost, Restoration Benefit, No Claim Bonus, Preventive Health checkups etc. These extra benefits are provided in the health insurance policy without payment of any additional premium to the insurance company.
Health insurance product can be designed to include or delete any coverage, so an insurance company may have more than one health insurance product to offer to its customers. Most of the insurance companies design health insurance products by keeping different factors in mind such as:
- Senior citizen health insurance in which the health insurance product is specifically designed to cover the needs of elderly people. In general most of the health insurance plans in market have the maximum entry age of 60 years above which the customer cannot take that particular health insurance policy. For instance a person aged 59 years can take these policies and renew them throughout lifetime but a person aged 61 would not be eligible to take that policy. To prevent these issues, insurance companies have designed senior citizen health insurance policies which would cover the health insurance requirements of elderly people, these policies are usually designed with the inclusion of Co-pay option where the customer has to pay a pre agreed percentage of claim amount.
- Disease specific health insurance policies which cover certain diseases with/without having waiting period. For instance, there are Diabetes health insurance policies in Indian market which are intended to cover the healthcare costs of diabetes patients with minimal waiting period. Such policies do not cover the other medical costs associated which can arise due to any other illness or diseases. The premium for these kinds of policies would be less compared to the other health insurance policies which cover all types of illness and diseases.
Co-pay or Co-payment is term used to refer the part of claim which has to be borne by the insured customer for every claim made. In general the co-pay under the health insurance policies would range from 5% to 20% depending on the type of health insurance product. The concept of co-pay is to make the customer responsible in the claim payment process where a part of claim amount has to be borne by the insured customer. When comparing the health insurance policies it is important to check if the health insurance policy has any co-pay clause included. Opting for co-pay can reduce the premium to be paid by the insured customer.
For instance if your health insurance policy has a co-pay of 10% and the claim amount has accounted to Rs.1 Lac then 10% of the total claim amount i.e. Rs.10k has to be borne by the insured and the remaining amount would be settled by the insurance company. Senior citizen health insurance policies and other cheap health insurance policies would generally have co-pay clause imbibed in it. The main intention of installing this clause is to discourage people from making petty claims which not only affects the claim ratio of the insurance company but also increases the health insurance premium at the time of renewal. One more reason is to prevent people from undergoing unnecessary treatments in expensive hospitals, also having an insurance policy increases the confidence of an individual to take treatment in an expensive hospital as the bill will be paid by the insurance company.
It is important to check if your health insurance policy has co-pay clause, there would be many health insurance policies in the market which charge less premium. People need to make apple to apple comparison and check for co-pay clause in the proposed policy. Best Health Insurance Company does not include a co-pay clause in their health insurance policy.
Exclusions are the list of diseases or illnesses which are not covered under your health insurance policy and the list is mentioned in the brochure of the health insurance policy and the policy copy. Many agents or intermediaries refrain themselves from explaining the exclusions in the health insurance policy to the customer as it may hamper their sale process. Most of the customers unknowingly take health insurance policies without reading the exclusions mentioned under the health insurance policy. This leads to rejection of claims in most of the cases where the customer was not aware of what is covered and what is excluded in a health insurance policy.
The first and foremost thing a customer should do is to get the list of exclusions under the proposed health insurance policy copy from the agent of the insurance company and go through them thoroughly before paying the premium. Few health insurance policies have certain exclusions such as Robotic treatments, Treatment under Ayush etc. which might have been covered under a different health insurance policy. There are two types of exclusions which can be in any health insurance policy, they are:-
- Permanent exclusions in health insurance such as HIV/AIDS, WAR, NUCLEAR etc. which would not be covered under any circumstances. Any diseases or illnesses arising out of these permanent exclusions would not be payable. Other exclusions such as Cosmetic Surgeries and accidents due to participation in Hazardous activities are outside the scope of a health insurance policy. These permanent exclusions are common for all the health insurance policies available in India as per the directive of the IRDA.
- Specific Exclusions in health insurance such as the Hypertension, Diabetes, Chemo therapy, treatment for mental illness etc. are excluded in certain health insurance policies for a definite period of time by the insurance companies.
It is in the interest of customers to check for the diseases or illnesses that are specifically excluded by the insurance company apart from the permanent or compulsory exclusions. It is advisable to select the health insurance policy if it doesn’t have any specific exclusion.
Claim Settlement Time – Cashless & Reimbursement, In house or TPA:
Insurance is a service industry where the time taken to settle claim creates an impression on the customer rather than the appearance of the product. Insurance as a product has only policy document which is a promise for the future in case of any claim, if the insurance company can satisfy the customer with the service then it is rated high based on the service provided. Claim settlement time is the time taken by the insurance company to settle the health insurance claim of the customer. As per the IRDA the claim settlement time would be within 30 days after submission of all the relevant documents by the insured customer.
Claim settlement can be done in two ways: Cashless Claim settlement and Reimbursement Claim settlement depending on the option chosen by the customer.
- Cashless claim settlement involves the customer getting admitted in the hospital and taking approval from the insurance company for claim settlement directly to the hospital. This process is more popular among the customers due to the reason being that the customers need not pay the amount from their pocket. Cashless claims are authorized by the insurance company within few hours of getting admitted in the hospital. Few companies take 4 hours to authorize while few companies take 2 hours to authorize. The cashless option is available only in the network hospitals where the insurance companies have a tie-up; insurance companies have an agreement with the hospitals and decide on the rate to be charged for each type of operation as a package. The time to authorize a claim is considered important in the cashless claim settlement process. It is advisable to talk to your agent and know the cashless approval time before purchasing the health insurance policy.
- Reimbursement Claims are those which are reimbursed to the insured customer after submitting all the claim related documents. Reimbursement process involves the customer to pay the claim amount and then get it reimbursed from the insurance company. If the insured decides to get treated in a hospital other than the network or tie-up hospital then the customer needs to pay the claim amount first and get it reimbursed from the insurance company later. For reimbursement of claim amount all the relevant and required documents are to be submitted to the insurance company within the stipulated time and the reimbursement would be done within 7-15 days after the receipt of all the required documents.
- Most of the insurance companies have Third Party Administrators (TPAs) to settle the claims of their customers. These TPAs act as the intermediaries in providing the service to the customers of the insurance companies. The insurance companies provide a percentage of the premium to the TPAs to serve their customers. There are advantages and disadvantages with the TPAs, as the time taken to approve a claim may be longer with the involvement of a third party.
- Few insurance companies have In house Claim Settlement Team which settles all the health insurance claims of their customers. This team provides approvals for cashless and settles the claim on reimbursement basis as well. The time taken for claim settlement with the In House team depends on the number of staff the insurance company has for claim settlement.
It is advisable to check the list of network or tie-up hospitals in your area or locality before deciding on the health insurance policy. The more the number of network hospitals in your area the better it would be to go for cashless treatment. The difference between TPA and “In house “would be different for different insurance companies and it cannot be compared, this depends on the commission paid to the TPAs by the insurance companies. Best Health Insurance Company settles the claims of its customers within the least possible time.
Waiting period is the time the insured customer has to wait before making any claim under his health insurance policy. Any claim during the waiting period would not be covered by the insurance company and all the insurance companies have waiting periods. Insured needs to satisfy the waiting period requirements before making any claim. There are three types of waiting period in every health insurance policy, they are:-
- Initial Waiting Period/ 30-day Waiting period: An initial waiting period or 30 days waiting period in health insurance refers to the amount of time one has to wait before making any claim. The only exemption to the initial waiting period is any accident related injury claims under your health insurance policy. The 30 day waiting period is applicable to prevent people from buying a health insurance policy only at the eleventh hour. As an industry standard all the health insurance companies have an initial waiting period of 30 days under their health insurance policies.
- Specific Waiting Period: Specific diseases such as Cataract, Gastric ulcers, Hernia etc. have a waiting period of at least 2 years before the claim is settled under the health insurance policy. The reason to include this clause is that these specific diseases can be treated later and are not considered as an emergency. Any claim related to these diseases will not be settled by the insurance companies before the waiting period is satisfied. On an average the specific waiting period is 2-4 years depending on the insurance company.
- Pre Existing Waiting Period: Pre existing diseases or PED refers to any condition, ailment, injury or disease which has been diagnosed up to 48 months prior to the purchase of the health insurance policy. This means any disease which exists before purchasing the health insurance policy would be treated as a pre existing disease and a waiting period of 48 months needs to be satisfied before claiming for any PED. Few companies have a pre existing waiting period of 24 months while few companies have pre existing period of 48 months. Any disease or illness contracted after purchasing a health insurance policy would not be treated as the pre existing disease by the insurance companies.
- Maternity Waiting Period: Maternity is the state or quality of being a mother. Maternity claims are usually settled by insurance companies after a certain waiting period, for instance insurance companies have 9 months to 4 years waiting period for maternity related claims. The waiting period also includes the pregnancy period which is an added advantage to the insured customer.
It is advisable to select the insurance company and the health insurance plan which has the least waiting period requirements. In the best interests of the customer, one should take a health insurance policy in their young age to satisfy all the waiting period requirements. Best Health Insurance Company has the least waiting period which helps people with pre existing diseases or illnesses.
Premium is the amount of money paid by the insured customer to the insurance company in return for the health insurance coverage offered by the insurance company. The premium to be paid in a health insurance policy depends on the below factors:-
- Age of the insured: The age of the insured decides the premium to be paid. Higher the age, higher would be the premium to be paid. This is due to the chance of diseases of illness happening increases with the age. Now-a-days due to life style changes many people are suffering from one or the other diseases such as Diabetes, Blood pressure, Thyroid etc. Insurance companies classify customers as per the age bands and charge premium depending on the age of the customer.
- Sum Insured: The sum insured selected by you decides your health insurance premium. Higher the sum insured, higher would be the premium. Sum insured is the maximum liability of the health insurance company in case of a claim. It is important to carefully select the sum insured which suits your requirements, too high sum insured results in paying high premium and too less sum insured results in paying a part of claim amount.
Customers are advised to check the premium offered by the insurance company for their health insurance policy and compare it with the other health insurance products in the market before deciding on the best health insurance policy and the best health insurance company. The premium of different health insurance policies can be checked online using the link https://www.policybachat.com/health-insurance.
Extra benefits- Health check up, Second Opinion etc :
Health insurance policies also contain few extra benefits apart from the basic coverage; these extra benefits are offered without paying any extra premium to the insurance company. Extra benefits which can be offered by the insurance companies include:
- Yearly Health Check-up: In case of a claim free year health insurance companies provide free health check up option to their customers for free of cost at any of the tie-up hospitals or diagnostic centres. The health check up is offered to all the Adults mentioned in the policy copy. The types of checkups to be done depends on the type of policy opted. Basic tests include Blood test, Urine test etc.
- Second Opinion: If you are diagnosed with any of the illness mentioned in the policy copy, you can opt for a second opinion from different doctor and the charge for the same would be borne by the insurance companies. There could be some cases where the insured is diagnosed with cancer and the family doctor advises a particular treatment, if you are not satisfied with the advice you can take a “second opinion” from any other doctor and the charges for the same would be settled by the insurance company. It can happen in case of Organ transplant and any other major Critical illnesses mentioned in your health insurance policy.
The best health insurance company is the one which provides the best health insurance product which has the extra benefits apart from the basic coverage such as Second opinion, free health check-up etc. Usually these extra benefits cost some amount to the customer if taken separately.
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