If the covid-19 pandemic reinforced anything, it was the need for a health insurance plan. Health insurance has always been around, but after the pandemic, the need has become more apparent. Suddenly, most people have realized its importance and the demand for health insurance has increased. even if we remove the impact that the pandemic has had on our minds, a health insurance policy is a must for your financial planning.
why choose a health insurance plan?
The reason is mainly due to the increasing lifestyle-related diseases and their costly treatments. In addition to illnesses, there are chances of accidental injuries or any other medical contingencies as well. When you experience a medical emergency, the financial output is considerable, especially since it cannot be postponed or ignored. here is an approximate cost structure for a medical emergency in any tier 1 city in india:
Medical expenses create financial strain. dives into one’s financial goals. This is because medical inflation has been on the rise and treatments are becoming more expensive. it is often quoted at around 15% per annum.
To cover such expenses, a health insurance plan becomes imperative. Health insurance plans cover medical expenses incurred in hospitalization. they therefore provide you with much-needed financial assistance in a medical emergency and protect your savings.
health insurance plans for your family
Medical emergencies can affect any member of your family. As such, you need a health insurance plan that covers everyone in your family so that if someone gets sick, the policy will come to their financial rescue.
There are various types of health insurance plans in India with a variety of benefits attached. however, when shopping for a health insurance plan for your family, you should choose it carefully. You should consider several aspects before finalizing the plan. This would ensure that the policy is comprehensive and provides adequate coverage for your family.
If you need help choosing the right health insurance plan for your family, here’s a guide to help you with it.
Health insurance plans are offered as floating family health insurance plans. These plans cover multiple family members under a single policy. you can take advantage of the coverage to –
- your spouse
- dependent children
- dependent parents
- individual health planshealth insurance plans that cover a single individual under a single insured sum. this is an indemnity health insurance plan where the claim would be paid only for the expenses incurred for hospitalization.tip: so if you are looking for a plan for just yourself or a family, you can choose this type.
- family floating planshealth insurance plans that cover all family members under a single insured sum. floating family plans provide blanket coverage so that each person can claim up to the full sum insured.tip: floating family plans are often cheaper than opting for individual family members. this is especially true for a young family.
- senior planshealth insurance plans that cover people age 60 and older. Since this plan caters especially to seniors, it generally covers all the necessary benefits that most seniors would need, such as outpatient treatment (opd) coverage, pre-existing condition coverage, etc. advice: this type of plan can be taken for your parents.
- disease-specific planshealth insurance plans that are intended to cover specific diseases and their complications such as dengue, heart disease, covid-specific, etc.tip: This type of plan caters to any specific risk and is usually cheaper. therefore, it can be taken in conjunction with an indemnity health insurance plan.
- critical illness planshealth insurance plans that cover specific critical illnesses and pay the insured sum in a lump sum if the insured suffers from a covered illness such as heart attack, stroke, cancer, etc. . These plans are generally fixed benefit plans, meaning if you are diagnosed with a critical illness, the full amount would be paid regardless of the amount spent on treatment.tip: this plan can be take along with an indemnity health insurance plan for enhanced coverage.
- top-up and super top-up plansthere are complementary health plans that come with a deductible limit. These plans pay for claims that exceed the deductible limit.Tip: Opting for a higher or higher health insurance plan is the cheapest way to upgrade your existing health insurance coverage.
- ayush treatments (these include alternative medicine treatments such as ayurvedic, naturopathic related, unani, siddha and homeopathy)
- opd expenses
- home treatments
- maternity coverage
- organ donor expenses
- personal accident coverage
- critical illness rider
- hospital daily cash benefit rider
- opd cover
- maternity and newborn baby coverage
- the coverage they offer
- the premium they charge
- no claim discount for not making a claim in the previous policy year
- discount for adding two or more members to coverage
- discount for buying a long-term policy
- discount for buying the policy online
- discount for maintaining a healthy lifestyle and practicing healthy habits
- sum insured restoration
- free medical check-ups
- second medical opinion
- telemedicine facilities
- free medical consultations
- loyalty programs in partner wellness establishments
- evaluation of your health
- For an adequate sum insured, the group coverage would have a limited sum insured and cannot be extended at will. for this you need an individual health plan. You can also opt for a super recharge plan on top of your group coverage.
- for having a plan with relevant coverage benefits group plans offer standard coverage benefits. if you need a comprehensive and inclusive scope of coverage, a stand-alone plan is needed.
- for lifetime coveragegroup plans allow coverage only until you are a member of the group. once you retire, you would lose coverage, which becomes even more important at older ages. on the other hand, individual plans have lifetime renewal options.
- for tax benefitsYou may enjoy tax benefits under section 80d on the premiums you pay for a stand-alone health insurance plan up to INR25,000 each policy year for the premium paid for you, your spouse and children and an additional amount of INR 25,000 to INR 50,000 for parents.
In addition, there are some plans that extend coverage to include in-laws, siblings, and other family members. So if you’re looking for coverage for your entire family, you can opt for floating family health insurance plans.
how to choose a health insurance plan for your family?
Here’s a definitive guide to choosing the right health plan for your family –
step 1: choose the right policy
Health insurance plans come in different variants, and each variant provides a specific type of coverage. therefore, the next step would be to focus on the right policy for your family.
these are the commonly available health plans –
so, ideally, you might opt for a family float policy that covers you, your spouse, and your dependent children. If you have dependent parents, you can opt for a separate seniors policy for them.
Even in the case of dependent children, remember that the floating family policy would cover them until they are 23 or 25 years old. Once your children get past this age, a separate health insurance plan will be needed for them under most plans.
In addition, along with an indemnity health insurance plan for your family, a critical illness plan is also recommended. The policy would cover dreaded illnesses, which have become common in recent times, and provide you with a lump-sum benefit to cover the expensive costs of treatment. therefore, you can opt for a critical illness policy for complete coverage for the family.
step 2: choose a suitable sum insured
To find the right sum insured for your health insurance plan, you need to find out the total number of members that should be covered. therefore, you should choose a sum insured that is sufficient to cover the expected medical costs of all family members.
Given rising medical costs and medical inflation, a high sum insured is desirable. however, a high sum insured also results in a high premium. As such, if affordability becomes an issue, you can opt for supplemental or super supplemental health insurance plans to bump up the coverage limit without a hefty premium outlay.
A recharge or super recharge policy acts as a complementary health plan. the policy has a deductible limit. claims up to the deductible limit are not paid. however, if claims exceed the deductible limit, the top-up or super top-up plan pays the excess claim. for the deductible.
How do health plan top-ups work?
let’s see how the recharge and super recharge plans work –
To get adequate coverage, you can initially opt for an indemnity health insurance plan and then supplement coverage with a super add-on policy.tip: the super add-on plan deductible should be the same to the insured sum of the base policy so that claims up to the deductible are covered by the normal health plan. claims in excess would be covered by the super recharge policy.
Step 3 – Find Full Coverage Benefits
The next step in shopping for the best health plan for your family is to make sure the plan has all the necessary coverage benefits. Ensuring comprehensive coverage is important so that all possible medical expenses are covered. Also, when considering the benefits of coverage, you should make sure that the benefits are appropriate for your requirements.
For example, a newly married couple must opt for a health plan with a maternity benefit. This coverage would ensure that when you have a child, the costs related to the child’s birth are covered by the plan and you do not face any financial burden.
Similarly, if you incur OPD expenses quite frequently, plans that cover such expenses would be beneficial.
step 4: check limits and sublimits
Some health insurance plans have sublimits on room rent, especially for lower sums insured. if there is a sublimit, it restricts total coverage. if you choose a room whose rent is higher than the allowable sublimit, your hospitalization claim will be reduced proportionately. however, plans without sublimits tend to be more expensive.
Similarly, some coverage benefits may have limits. Some common coverage benefits on which sublimits may apply include the following:
Tip: When shopping for a health insurance plan for your family, check the applicable limits and sub-limits. try to opt for plans that do not have sublimits on room rent and other expenses.
step 5: opt for coverage clauses
Health insurance plans allow for optional coverage benefits. these benefits are called riders and are available for an additional premium. riders are optional in nature and can be chosen when you purchase or renew your policy.
Rider provides additional coverage at a very low premium amount. they enhance the scope of coverage of the health insurance policy and are recommended. some common clauses include the following:
Tip: Riders are often an inexpensive way to increase coverage. When shopping for a health plan for your family, check out the riders available. choose riders that are relevant to your coverage needs and that allow you to take advantage of all-inclusive coverage from your health insurance plan.
step 6: consult the hospital network of the insurance company
Health insurance plans allow for cashless hospitalization where you don’t have to bear hospital bills. the insurance company assumes these bills on your behalf. Cashless hospitalization is therefore convenient and financially liberating. however, the benefit is only allowed if you are admitted to a hospital that is linked with the insurance company.
Insurance companies mention the number of network hospitals with which they are linked. You can also find the list of hospitals in your city on the website of the insurance company.
Tip: When shopping for a family health plan, check the list of network hospitals. check whether the local hospital you prefer is linked with the insurer or not. also check pan-indian network strength. the stronger the better because it means you can easily locate a hospital connected to the network, wherever you are.
Step 7: Check the pre-existing waiting period
Pre-existing illnesses are those that you or any member of your family suffers from when you take out a new health insurance policy. since the diseases are already present, there is a waiting period before coverage is allowed. this waiting period is called the pre-existing waiting period and ranges from 12 months to 48 months.
Tip: If you or a family member has a pre-existing condition, look for plans that have a low waiting period. when the waiting period is low, you’ll be able to get coverage for your illnesses as soon as possible.
However, if no one has any medical conditions and you are purchasing the plan at a younger age, you can opt for plans with a longer waiting period.
step 8: compare premiums
Multiple insurance companies offer health insurance plans. Each company has its own pricing policies and therefore health plan premiums differ.
When shopping for health insurance plans, always compare different policies on two bases –
Tip: Don’t compare premiums independently because coverage benefits affect premium rates. a plan may offer low premiums but may not be comprehensive in terms of coverage. so always compare premiums to coverage benefits, and then choose a plan that offers a comprehensive scope of coverage at affordable premiums.
step 9: review the exclusion list
Despite the breadth of a health plan, there are some cases where coverage is not allowed. these cases are called policy exclusions and each health plan has a list of exclusions. When shopping for a health insurance plan for your family, check the policy’s exclusion list.
When you learn about exclusions, you’ll know what’s covered by the plan and what’s not.
step 10: discover premium discounts
Health insurance plans offer attractive premium discounts to reduce premium expense. discounts are commonly offered for the following –
Tip: Look for the discounts offered on the plan you’re considering purchasing. Choose a plan that offers the most discounts possible so you can save on your premium cost.
step 11: look for value-added benefits
When comparing health insurance plans, look for the value-added benefits that different plans offer. Value-Added Benefits are additional benefits offered along with coverage features. common benefits include the following –
These benefits give coverage a little extra and enhance your health insurance experience. Well-being is a very important aspect, especially in the post-pandemic situation, and can be seriously considered when choosing it.
Choose a health insurance policy after considering all the aspects mentioned above. this would help you find the best and most relevant health insurance plan for your family. To shop for the best policy, go online.
what to do when you have group health coverage?
If you’re an employee of a reputable organization, you’re likely covered under your employer’s group health insurance policy. such coverage may also be extended to members of your family. If you and your family are already covered by a group health plan, does that mean you don’t need a separate policy?
no, it doesn’t.
Even when you have group health insurance coverage, purchasing a separate health plan for the family is a must. why? here are some reasons –
so use group health coverage as supplemental coverage, but it cannot replace the need for an individual insurance plan.
review your health insurance coverage
It’s not enough to buy the best health insurance plan for your family. You should review your coverage every year to make sure the plan is relevant to your needs. For example, if you get married or have a child, you have a new member that needs to be added to coverage. add the member either during the policy tenure or at the time of renewal.
Similarly, if you wish to opt for addendums or increase the sum insured with changing needs, do so at the time of renewing your policy.
Regular review of your coverage would ensure that your coverage remains relevant at all stages of your life. In addition, health insurance plans allow for lifetime coverage. so renew your policy within the expiration date, without fail, to enjoy uninterrupted coverage against medical emergencies.
A health insurance plan is not negotiable. when you need to buy the same for the family, be careful to choose the right plan. Consider the points mentioned above and compare different plans to find the best one and then shop accordingly.
Plus, since health insurance plans are transferable, meaning you can switch to any insurance company at any renewal, you don’t have to wait until you find the perfect match. you can always change later. but remember that the most important thing is to buy it now, without delay.