5 things to consider while purchasing health insurance during a pandemic

The pandemic has propelled health insurance sales and awareness levels in the past year. Consumers have multiple health insurance schemes to choose from and combine for optimal health cover and benefits. Product features play a pivotal role in ensuring ample long-term and comprehensive coverage.

There has been a remarkable shift in the way Indian consumers regard Health Insurance since last year. Rampant spread of the pandemic led to buyers seeking urgent medical cover to absorb extensive financial strain from Covid-19-related hospital treatment. While the pandemic was a sporadic catalyst to reinforcing its importance, long-term implications of rising medical inflation, early onset of lifestyle diseases and increase in critical illnesses have reconfirmed the significance of having sufficient and exhaustive health cover.

Health Insurance is a long-term investment that requires careful consideration of certain crucial factors. A thorough assessment of personal profile and family demographics related to medical history, household income and permissible budget towards health insurance premium would be a good starting point. This would help identify the right category or categories of health insurance plans, which extend to individual plans, family floater options, senior citizen plans, critical illness benefit policies and top-ups or super top-ups, as well as the coverage amount or Sum Assured required.
When looking to invest in health insurance that is meant to serve you over a lifetime, one must take into account the following critical components that would determine the optimum plan combination and coverage amount.

Top 5 Factors to Consider when Purchasing Health Insurance, especially during a Pandemic:

Comprehensive and Timely Coverage: The primary objective of health insurance is to safeguard against significant hospitalization expenses. This should be mitigated by having adequate Base Cover up to Sum Assured (via Pre-, In-patient and Post-hospitalization costs coverage, for example) and Add-on Covers or Riders (such as Maternity Benefits, Major Organ Transplant, Critical Illness Cover etc.). The latter would be a good option to customize the plan to suit personal medical requirements. Timely coverage would mean lower Waiting Periods (be they for Pre-Existing Diseases, Specified Illnesses or any other conditions) for quicker eligibility to claim for related medical expenditure. In addition, a good health insurance plan should cover all Day Care procedures that do not necessitate hospitalization, instead can be performed in less than 24 hours owing to technological advancements.

Claim-oriented Features: The real advantage of having health insurance is gained when a considerable medical expense arises as a result of hospital treatment for a health emergency, and your medical insurance covers you for those costs. However, hospitalizations and subsequent claims submissions may not be a regular affair, and that too ought to translate into tangible benefit for the policy holder. Therefore, seeking features such as Restoration Benefit (reinstatement of Sum Assured upon multiple claim submissions in a year) and No-Claim Bonus (increase in Sum Assured for claim-free years) will help maintain or augment the total coverage amount offered by the health insurance plan.

Exhaustive Cover for Incidental Medical Expenses: Expense heads such as Room Rent charges, Doctor’s Fees and ICU charges preferably should not have a cap or an upper limit on them. These should be accepted on actual expenses or with no limits, to enable the insured member undergoing hospitalization to avail comfortable treatment without having to compromise on superior quality medical facilities. Moreover, the plan should support ancillary expenses such as Ambulance charges at a higher amount, free Health Check-ups, second Medical opinion etc. for holistic cover.

Insurer-oriented Features: The Insurance Company offering the chosen plan should have a high Claim Settlement Ratio or CSR, which determines the propensity of the insurer to settle more claims out of the total received in a fiscal year. Furthermore, the Claims Settlement Efficiency Ratio published by the Insurance Brokers Association of India (IBAI) suggests the efficacy of the insurer to pay claims within a 3-month window. These would be good indicators of the overall claims’ management process; whether or not it is prompt, efficient and hassle-free. A wide list of Network Hospitals in close proximity to your location would be beneficial for Cashless Admission and Claims Settlement.

Pandemic-specific Coverage: The second wave of the pandemic placed a huge strain on the country’s health infrastructure as a result of exponential spread and extreme cases of infection; particularly among patients with comorbidities. In such situations, having a health insurance plan with Domiciliary Hospitalization Cover (i.e. at-home hospital-like treatment upon doctor’s advice) up to Sum Insured for maximum number of days and Alternate Therapy Cover such as AYUSH (also up to Sum Insured) would be helpful.

There are over 300 health insurance plans across numerous categories available in the market today. Such variety, while welcome, might make it difficult to zero in on the right mix of plans for the individual, family or enterprise. A prudent means to decision making would be to compare the benefits, features and premium payable across a few health insurance policies to arrive at the best option. Detailed terms and conditions governing the selected plan is mentioned in the Policy Wordings document or Customer Information Sheet that is provided by the insurance company individually for each product. Needless to say, this document is sacrosanct and should be thoroughly read and understood before signing on the dotted line.



Views expressed above are the author’s own.



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