Top 12 points to be considered when taking health insurance

In today’s tough competition, choosing health insurance is very challenging because each insurance company communicates its product better than the other, the only answer is that you should make a checklist that includes the health insurance plans of the insurance company.

You will regret it later if you do not check this before taking your insurance, If you do not check this before taking your insurance, you will have to regret it later, that I did not get the claim for health insurance, did not get even the full amount, many deductions were lost, cashless is not provided, even in reimbursement claim there’s lots of formalities like third-party investigation and many more.

Please keep in mind that the insurance company is a profit-making corporation, they will try to reject your claim, even a single mistake or mistake by their third-party investigator.

Here are some important checklists to make it easier for you to choose your health insurance:-

• Claim Settlement Ratio;
• Services feedback from existing policyholders;
• How Quick Insurance Company, give pre-authorisation approval;
• How hassle-free of discharge formalities;
• Compare the premium, but don’t go only with low premium;
• Information sharing, about awareness topics to their insured person by the Insurer;
• How the Application and IT are working;
• Limits and Sub-Limits in total admissible claim;
• Non-Medical Waiver Expenses;
• Policyholders’ Claim experience in early claim policy;
• Network Hospital;
• Caping on Advance and Modern Treatment.

Claim Settlement Ratio– Means the total number of claims approved against the total no of claims (CSR) in a financial year. You must check this information, if the insurance company’s last year’s loss is more than 95% then you can consider it.

Services feedback from existing policyholders– Whenever you are thinking about buying a health insurance policy, always check the feedback from the existing customers regarding the insurance company’s services or check it through an online medium. I am not saying at all that all the online reviews are authentic. But check the details once and consider them while buying the policy.

How Quick Insurance Company, give pre-authorisation approval– Insurance companies always ensure that cashless pre-approval is given in just 30 minutes, which also checks the reality.

How hassle-free of discharge formalities– The insurance company gave the pre-approval quickly but took care of the discharge, there are some issues in society, and sometimes it takes multiple hours to discharge.

Compare the premium, but don’t go only with a low premium– Always compare the premium while buying the policy but it is not necessary which premium is higher will be a better policy or will be charging services or will be less premium to leap product, again get feedback from an existing customer to check the reality.

Information sharing, about awareness topics to their insured person by the Insurer– It is a very common perception that the insurance agent or insurance manager can sell the policy just to meet their target, but this is not completely true, in health insurance, the policy cannot be sold for even a small amount, there are many clauses, waiting periods, permanent exclusions, PED waiting periods are hote hain, claim rejection reasons are hote hain, if in all these your insurance agent/manager is telling you that he is professional, then there will be no issue regarding your services in future also.

How the Application and IT are working– IT plays a very important role in health insurance, please check that the insurance company’s application and customer portal are working properly.

Limits and Sub-Limits in total admissible claim– You must have heard that everything is covered in health insurance, that is, all types of IPD treatment expenses are covered, but it is not so, suppose the limit of ambulance per event is Rs.5000, then you will have to pay this amount from your pocket, and then The eligibility of your room is single private ac room if you have taken any deluxe room or suite room upto the co-payment/deductible of the excess amount to be paid in your complete course of treatment

Non-Medical Waiver Expenses – In health insurance plans, there are some expenses that are not usually covered like Paper gloves, Syrinc, and Cotton etc, but in some health insurance plans, their waiver has to be deducted from your additional premium whereas in some plans, these are in-built. hain. But it is not true that if your plan is in the form of a rider or in-built form, then 100% of the treatment expenses will be borne by your insurance company, there are some exceptions like Hospital Registration charges etc.

Policyholders’ Claim experience in early claim policy– Early claim in health insurance is the biggest priority for both the insurer and the insured person. Let us understand this from a real example, Mr. Gopal had taken the policy from a standalone health insurance company, in August 2023, and he had a heart-related attack in January 2024, the insurance company denied cashless and assured the insured person to file a claim through reimbursement, proper investigation. If after a third-party investigation, the claim is found to be genuine then it will be approved. now here Mr. Gopal is an athlete, yet he suffered a heart attack and underwent surgery to place a stent in the heart, the hospital made a bill of almost Rs 2 lakh and he had to pay from his pocket, even though the insured person had taken the policy. They did not go cashless and there is no guarantee that the claim will be approved in reimbursement, because the third-party investigator will always investigate in the interest of the insurance company, because their commission is tied, to getting the claim rejected. These are the most important points to consider when considering an insurance plan.

Network Hospital– When it comes to metro cities, almost all the hospitals are on the network of the insurance company, where a cashless facility is provided, but when it comes to rural and some other cities, the feedback of the insurance company is not correct. Suppose an insured person went to his home town and fell ill there and then if he was cashless he had to spend out of pocket and set aside a separate head for reimbursement.

Caping on Advanced and Modern Treatment– Whatever health insurance plans there are in the industry, almost all of them have 12 types of modern/advanced treatment coverage, but the conditions of coverage can be different in all like 10%, 20% of the sum insured or up to Rs. 1 lakh, or There is no co-payment for robotic surgery.

Now, it’s time to conclude that all the above-mentioned points need to be considered and you can validate this tool to choose the right of your insurance coverage.

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