How to choose the right health plan

Very often, affordability is the sole factor taken into consideration when one is deciding on a health insurance plan. But it would be more prudent to instead look out for the plans that are the most suitable for us. Here are ways to choose an appropriate health policy.

First and foremost, it is important to be able to determine a sufficient sum insured to cover your needs or that of your family in case of a family floater policy. Age is an important consideration in this regard. In particular, remember that the senior age group requires higher protection.

Also keep in mind that the healthcare costs differ across cities, so this should be factored into your calculation.

If your employer provides a health cover, it’s important to evaluate if this is sufficient and comprehensive or whether an additional plan is required over and above this. It is also imperative take into account some other key aspects like exposure to high levels of stress and lifestyle-related diseases when deciding on the right amount of sum insured. Network hospitals are a group of hospitals that are enlisted with the insurance company or a TPA (Third Party Administrator). The main benefit offered by a network hospital under an insurance policy is the cashless facility that lets you get admitted and treated without incurring any cost, thereby reducing your financial burden in case of a medical emergency. The network hospitals generally have negotiated prices for specific surgical procedures; consequently, the overall cost of hospitalisation may also reduce. It is advisable to opt for a health plan that has a higher number of network hospitals in your city or town.

Different plans will have specific limits on the benefits that can be claimed. These can vary from a limit on your hospital room charges and sum insured limits for specific diseases or limits on amounts payable toward doctor charges. An insurance plan with a sub-limit will impact your out-of-pocket expenses, as you will have to bear expenses not covered by the plan. It is advisable to opt for a plan with no sub-limits.

Most health insurance companies have a ‘waiting period’ when it comes to pre-existing diseases, i.e. any disease which the policy holder may have prior to buying the policy. This waiting period varies between 1-4 years across different plans available in the market. In addition to pre-existing diseases, some other standard ailments also have a one or two-year waiting period before the cover comes into effect, such as cataract, a hernia, etc. The common categories of standard exclusions include cosmetic surgery, suicide, HIV/AIDS, alternative therapies like acupressure and reflexology, etc.

Effectively, the lower the waiting period and exclusions, the more comprehensive the coverage.

While health insurance is primarily looked at for protection, you can look for plans that offer regular preventive check-ups, run personalised programmes to help you manage and improve your health and reward you for staying healthy.

Also check for plans that have a restoration facility. This becomes advantageous to the policyholder in cases where multiple medical emergencies or hospital stays that are not related to each other occur in the same policy year. This is an important feature and helps in getting additional coverage.

Besides this, it is important to take into consideration some of the other benefits, such as a maternity cover or a worldwide cover in case you travel frequently, or an outpatient cover, depending on the need.

Finally, if you want to reduce costs, there are a number of plans in the market today that provide the option to bring down premiums by opting to share a part of the claim cost. One needs to look out for plans that provide a deductible or co-payment option in case the cost is a constraint or there is already an insufficient existing plan which one would like to top up.

The writer is Managing Director and CEO, Cigna TTK Health Insurance

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