If the Covid-19 virus has strengthened something tangible that was the necessity of a health insurance policy. Health insurance was always available, but since the outbreak, it is becoming more evident. Now, a majority of people are aware of its significance and the need for health insurance has increased. Even if you can’t eliminate the negative impact that the pandemic affected your thoughts it is a fact that a health insurance plan is an essential part of your financial plan.
Why Choose a Health Insurance Plan
The reason lies in the fact of the increasing prevalence of health issues and the cost of treatment. In addition to diseases, there is a chance of injuries from accidents or another medical issue. If you are afflicted by an illness and incur financial loss, the cost is significant, particularly since it is not a matter of postponing or neglecting.
Here is an estimate of the cost structure for medical emergencies in any city that is a Tier 1 one in India:
- Per day hospital stay cost in a government hospital INR 4,452
- Per day hospital stay cost in a private hospital INR 31,845
- Intensive care unit stay in a private hospital INR 30,000
- Open heart surgery in a private hospital INR 2.8 lakh
- Hospitalization for a disease such as cancer INR 93,305/day
Medical expenses do create a financial strain. They can affect the financial goals of the person. It is due to the fact that medical inflation is increasing and treatments are becoming more costly. It is commonly said to be around 15% annually.
To pay for these costs to cover these expenses, a health insurance plan is essential. Health insurance plans pay for hospitalization-related medical expenses. They also offer you the needed financial support in case of an emergency. They also help ensure your savings.
Health Insurance Plans For Your Family
Health emergencies can affect anyone in your family. Therefore, you should have an insurance policy that includes all members of your family in the event that anyone becomes unwell, the policy will come to your financial assistance.
There is a variety that offers health insurance available in India with various benefits. But, when you purchase an insurance policy for your family members, you should select it with the utmost caution. You must consider a number of aspects prior to deciding on the plan. This will make sure that the plan is complete and provides adequate protection for your family.
If you require assistance in selecting the best medical insurance policy for your household, below is a step-by-step guide to assist you in the same.
The health insurance policies are sold as family health insurance policies that are floaters. The plans cover several family members on the same policy. The coverage is available for family members –
- YourselfYour spouse
- Dependent children
- Dependent parents
Furthermore, there are plans that extend coverage to parents-in-law as well as siblings and other relatives. Therefore, if you’re seeking coverage for all your family members then you should consider family floating health insurance plans.
How To Choose A Health Insurance Plan For Your Family?
Here’s a definitive guide to choosing the best health insurance plan for your family
Step 1: Choose The Right Policy
Health insurance plans are available in a variety of variants, and each variation provides a particular type of insurance. Therefore, the next step is to determine the best policy for you and your family.
Here are the most commonly-available health insurance plans that are widely available
Individual health plans
Health Insurance Plans that cover only one person in the same amount of insurance. It will be an indemnity insurance policy in which the claim is only paid for the cost paid for hospitalization.
Tips: If you’re seeking an option for yourself just or just only one member of your family, you may select this type of plan.
Family floating plans
The Health Insurance Plans cover all the members of the family in a single amount insured. Family floater plans offer umbrella coverage that allows everyone can be covered up to the full amount of the covered.
Tips: A tip for families: Family Floater Plans generally cost less than choosing to purchase individual members from the same family. This is particularly applicable to families with young children.
Senior citizen plans
Health Insurance Plans that cover those aged 60 and over. Because this plan is specifically tailored to seniors generally, it provides the necessary benefits older people require such as OPD or outpatient department (OPD) coverage and pre-existing illness coverage, and more.
Tips: This plan could be used by your parents.
Plans for specific diseases
Health insurance plans are designed to protect against specific diseases and their complications such as heart diseases, dengue, and Covid-specific illnesses.
A tip: This plan is designed to meet the needs of any particular risk and is typically less costly. It can therefore be used together with the indemnity insurance policy.
Plans for Critical Illness
Health insurance plans that protect certain critical illnesses and pay the amount of the insured in lump sums in the event of any of the covered illnesses, such as stroke, heart attack cancer, etc. These are usually defined benefit programs, i.e. in the event of any serious disease, the whole amount will be paid regardless of the amount you spend on treatment.
TIP: This plan may be used in conjunction with an indemnity insurance policy to get a greater amount of coverage.
Super top-up and top-up plans
There are additional health plans that have a deductible cap. Any claims that exceed the deductible limit are refunded through these insurance plans.
Tips: Choosing a top-up or Super top-up health insurance policy is the most cost-effective method to increase your current healthcare insurance.
Therefore, it is recommended that you should consider a family floater insurance policy that covers you as well as your spouse, and dependent children. If you have parents who are dependent and children, you can opt for an additional senior citizen insurance policy for the parents.
If you have dependent children, you should remember that the family floater plan will cover them until at least 23 or 25 years of age. When your children reach this age, an individual health insurance plan will be required for them under the majority of plans.
Alongside an indemnity healthcare insurance policy for your family members, the purchase of a critical illness insurance policy is highly recommended. It will cover the most feared diseases, which have become more prevalent in recent years, and offer the benefit of a lump sum to pay for the costly medical expenses. You can also choose an insurance policy that covers critical illnesses for total coverage for your family.
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Step 2: Opt for an Adequate Sum Insured
To determine the appropriate amount of insurance for your health insurance policy, you have to determine the number of family members that must be covered. This means that you have to select a coverage amount enough to pay for the medical expenses for all members of the family.
With the rising medical expenses and the rise in medical costs, an insured with a large sum is highly recommended. But, a substantial amount insured can also result in the cost of premiums being high. In case affordability is a problem it is possible to opt for top-up or super-top-up health insurance plans to increase the coverage amount without having to pay the expense of a substantial premium.
A super or top-up plan functions like a supplemental health plan. The policy comes with a deductible limit. All claims up to the limit of the deductible are not paid. However, if the claims exceed the limit of deductible the top-up or super top-up plan pays for the excess amount.
However, a super top-up health insurance policy considers the deductible of each claim, whereas super top-up plans use an aggregate to calculate the deductible.
What is the process behind how Top Up Health Plans work?
Let’s look at the way top-up and super top-up plans work.
- The sum insured under an additional plan of INR 10 lakh
- The deductible under the plan is INR 5 lakh
- First claim INR 4 lakh
- Does the top-up plan cover the claim? It won’t, as the claim is less than the deductible limit
- 2nd claim, INR 7 lakh
- What happens if the top-up plans pay the claim? Yes, because the claim is more than the deductible.A claim for INR 2.25 lakh (which exceeds the amount of the deductible) will be covered by the top-up plan.
- If you want to have adequate coverage, could start with in the first instance an indemnity healthcare insurance policy before enhancing the insurance with a top-up plan.
Tips: The deductible of the super top-up plan must be the same as the total amount of the base insurance so that claims of up to the deductible will be met by the health insurance plan that is normal. The additional claims will be handled through the top-up plan.
Step 3: Look for Comprehensive Coverage Benefits
The next step to purchasing the right health plan for your family is to make sure that the plan provides all the benefits necessary for coverage. Comprehensive insurance coverage is essential to ensure that any medical expenses are paid for. In addition, when evaluating the benefits of coverage, you have to make sure that the benefits are appropriate to your needs.
For instance, newlyweds should choose an insurance plan that includes the maternity benefit. This insurance will guarantee that if you had children, the expenses of childbirth are covered by the insurance plan and there would be no cost.
In the same way, if you have to pay OPD expenses often, insurance plans that pay for these expenses are advantageous.
Step 4: Check the Limits and Sub-Limits
Certain health insurance plans come with limits on room rent in particular for those with lower amounts covered. If there’s a limit that is not met, it limits the overall coverage. If you select a room that exceeds the permissible sub-limit, your claim for medical treatment is reduced in proportion. But, plans with no sub-limits are typically more costly.
In the same way, certain coverage benefits could have limits attached to the benefits. The most common benefits for which sub-limits could be a possibility include:
- AYUSH treatments (these comprise alternative treatments like ayurvedic naturopathy-related, Unani, Siddha, and homeopathy)
- OPD expenses
- Treatments for Domiciliary needs
- Maternity coverage
- Organ donor expenses
TIP: If you are purchasing an insurance policy for health care for your family members, be sure to check the limits and sub-limits that apply. Make sure you select plans that don’t have a limit on room rent or other expenses.
Step 5: Opt for Coverage Riders
Health insurance plans offer the option of obtaining additional benefits for coverage. These benefits are known as riders and are offered for an additional cost. Riders are a choice and are available when you purchase or renew your insurance policy.
Riders offer additional protection at an extremely low cost. They expand the coverage provided by your health insurance plan and can be highly recommended. A few common riders include the following:
- Personal accident cover
- Critical illness rider
- Cash benefit daily rider for the hospital
- OPD cover
- Baby and Maternity cover
Tips: Riders are typically a cost-effective option to boost coverage. When you purchase a health insurance coverage plan to cover your entire family members, look over the riders available. Choose riders that fit your requirements for coverage and will allow you to get the full coverage of the health plan you have purchased.
Step 6: Check the Hospital Network of the Insurance Company
Health insurance plans offer cashless hospitalization, meaning that you do not have to pay hospital expenses. Insurance companies pay these costs in your name. Hospitalization that is cashless is, therefore practical and financially empowering. However, this benefit can only be availed when you’re admitted to an institution that is affiliated with the insurance company.
Insurance companies provide the number of hospitals that are networked which they are associated with. You can also locate the list of hospitals that are located in your area on the website of the insurance company.
Tips: When purchasing an insurance plan for your family Check the list of hospitals in the network. Verify if the local hospital you would like to visit is a member of the insurer or not. Also, check the pan-India network’s strength. The stronger, the better as it means you will be able to find hospitals that are networked easily regardless of where you may be.
Step 7: Check the Pre-Existing Waiting Period
Pre-existing diseases are the ones that you or your family member suffers from while purchasing a medical insurance plan. Since the ailments are already present and have been treated, there is an interval of time before the policy will be able to cover the illness. This waiting time is known as the waiting period that is pre-existing and it can range between 12 and 48 months.
Tips: If you or a family member has an existing medical condition, look for insurance plans with an extremely short waiting time. If the waiting time is short, you’ll be able to get the coverage you need for your illness as soon as possible.
But, if nobody is suffering from any illness and you’re purchasing the plan when you are younger you may choose plans that have longer waiting times.
Step 8: Compare the Premiums
The health insurance plan is provided by a variety of insurance companies. Each business has its own policies for pricing and consequently, the costs of health plans are different.
When purchasing health insurance plans Always compare the different policies based on two different bases –
- The coverage they provide
- The price they charge for their services
TIP: Don’t make comparisons of the premiums on your own since the benefits of coverage affect the cost of premiums. The plan may have a low cost, but it could not provide a comprehensive range of coverage. Always compare costs against the benefits of coverage and then select a policy with a wide range of coverage for a reasonable price.
Step 9: Check the Exclusion List
Despite the extensiveness of a health insurance plan, however, there are circumstances where coverage is not permissible. These are referred to as exclusions from the policy and each health insurance plan comes with an exclusions list. If you’re buying an insurance policy for your family members, make sure you check the list of exclusions in the policy.
If you are aware of the exclusions, you will know what is covered under the plan and what’s not.
Step 10: Find Out the Premium Discounts
Health insurance plans provide attractive premium discounts to help reduce the amount you pay for premiums. Discounts are typically available for the following:
- Discount for no claim if you’re not making a claim for the previous year’s policy year
- Discount when you add two or more people to the protection
- Discount when purchasing an insurance policy with a long-term term
- Discount when purchasing the policy on the internet
- Discount for sustaining an active lifestyle and implementing healthy habits
TIP: Search for discounts included in the plan you are contemplating buying. Select a plan that offers the most discounts possible so that you are able to reduce the price of the premium.
Step 11: Look for Value-Added Benefits
When you compare the health insurance options, be sure to look for benefits that are value-added which various plans provide. Value-added benefits can be described as additional benefits that are included with coverage features. Common benefits include: —
- Sum guaranteed restoration
- Health checks are free.
- Medical second opinion
- Telemedicine facilities
- Consultations with a doctor for free
- Rewards programs for wellness establishments
- Evaluation of your health
These benefits provide something additional in addition to the coverage. They also improve your experience with health insurance. The importance of wellness is a crucial factor, especially in post-pandemic conditions, and should be considered when you decide to opt for health insurance.
Select a health insurance plan after having taken into consideration all of the factors mentioned above. This will help you choose the most appropriate and most appropriate health insurance policy that is suitable for you and your loved ones. To find the most effective policy, search online.
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What To Do When You Have A Group Health Cover?
If you’re employed by a well-known organization, there is a good chance that you’re covered under the group health insurance policy. This coverage may also extend to family members. In the event that you or your entire family members are already covered by the group health insurance is that it means you don’t require an individual policy?
There’s no way to do that.
Even if you have health insurance through a group purchasing an individual health plan for your family is an absolute requirement. Why? Here are a few possible reasons.
For adequate sum insured
- The group insurance would have only a limited amount of insurance and can’t be expanded at your discretion. You will need an individual health insurance plan.
- You could also consider an extra top-up plan to supplement your group coverage.
- To have a plan that has appropriate coverage benefits
- Group plans provide basic coverage benefits. If you require a complete and comprehensive coverage an individual plan is necessary.
- Lifelong coverage
- Group plans provide coverage only until you have become a participant in the group. After retirement, you’ll lose coverage, which is increasingly important as you the advancing years.
- However, individuals have lifetime renewal choices.
To receive tax benefits
Tax benefits are available under Section 80D on premiums you pay for an independent health insurance policy that can be as high as INR 25,000 each year for premiums paid by yourself, your spouse and children and an additional sum between INR 25,000 and INR 50,000 to parents.
Thus, consider using the health plan offered by the group as a supplement to your insurance plan, however, it’s not able to substitute the requirement of an independent insurance plan.
Reviewing Your Health Insurance Coverage
Simply purchasing the most suitable coverage for you and your family members is not enough. You must review your plan every year to ensure your plan meets your requirements. For instance, if are married or have children, you will be a new participant who must be included in the plan. Include the new member during the term of the policy, or upon renewal.
Also, if you wish to add additional riders, or to increase the amount that you are insured to accommodate changing needs you can do this when renewing your insurance policy.
A regular review of your coverage can ensure that your insurance coverage remains current throughout your life. Furthermore, health insurance plans offer lifetime coverage. Also, ensure that you renew your plan on time, every time, to ensure unending coverage in case of a medical emergency.
The health insurance policy is not a matter of negotiation. If you are required to purchase the same insurance for your family ensure you choose the best plan. Take note of the above-mentioned factors and then compare plans to determine the most suitable and then make the purchase.
Furthermore, because health insurance plans are able to be transferred, i.e. transferred to any insurance company at any time so you do not have to wait around for the perfect match. It is possible to switch later. But the most important thing to remember is to purchase it immediately, and without delay.