Paying heed to the advice of her close friend, Mrs. Reema Desai decided to invest in a health cover for herself and her family members. She understood that a health insurance policy offers financial security for high medical expenses in an event of hospitalization. However, she was confused about which insurance provider to choose given the various options available in the market.

Mrs. Desai is not alone in this dilemma. Given the availability of multiple options, numerous individuals find the process of buying a health insurance plan cumbersome. The best solution is to compare various plan features and benefits and select the provider that offers coverage according to your needs.

You may consider the following five aspects when you compare health insurance plans.

1. Age limit

The risk of falling ill at an older age is higher. Not being covered under a health insurance policy at an older age will result in huge out-of-pocket expenses, thanks to rising medical inflation. Therefore, it is recommended to opt for a policy that offers coverage up to an older age. It is also recommended to opt for lifetime renewability policies in case you wish to include your aging parents in a family health cover.

2. Network hospitals

Many hospitals offer the benefit of the cashless facility to their customers. According to this arrangement, the insurance provider settles all hospitalization-related expenses directly with the hospital. You, therefore, do not have to pay any amount from your personal funds. This provides a great sense of financial relief, as there is no need to make a necessary arrangement of money.

An important aspect to keep in mind is that you may benefit from the cashless facility only if you are admitted at any of the insurer’s network hospitals. It is, therefore, necessary to look for the list of network hospitals before purchasing a health insurance policy. You may check the proximity of these network hospitals from your place of residence, so that in times of medical emergency, you may enjoy the benefit of the cashless facility without any hassles.

3. Waiting period

The waiting period is another factor to take into consideration when you compare health insurance plans. It refers to the period during which no insurance coverage will be available and hence no claims can be made towards hospitalization expenses. Once the waiting period has passed, you may enjoy coverage facility. The main purpose of the waiting period is to prevent individuals from making claims for pre-existing diseases. This means pre-existing health conditions do not get immediate coverage. Insurers also have the waiting period clause to deter policyholders from taking unnecessary advantage of the policy. You may also note that insurers cover maternity expenses after a certain waiting period, say nine months to three or four years.

4. Rider options

Given the rising medical inflation, it only makes sense to think beyond the basic mediclaim policy. Insurers provide the benefit of riders, also known as add-ons, to increase the scope of your coverage. Through the payment of a nominal premium, you may expand your medical coverage.

Following are some of the most common add-ons associated with health insurance plans.

• Critical illness rider – Provides sum assured benefit upon diagnosis of any of the critical illnesses mentioned in your policy document. Some common critical illnesses covered under this rider include paralysis, cardiac arrest, kidney failure, and cancer, among others.

• Accidental death rider – It offers financial security to your loved ones in case of an unfortunate event of death due to an accident.

• Temporary/permanent impairment add-on – Provides sum assured amount in case of an impairment that may be either temporary or permanent.

• Hospital cash rider – The Insurer offers a fixed amount for each day that you are hospitalized. This amount is generally fixed and may be used to cover ancillary expenses such as inadmissible hospital expenses or travel expenses for family members.

• Waiver of premium rider – As the name suggests, premium payment will be waived off in case you are unable to pay insurance premiums, due to loss of earnings or impairment.

The list of available rider options varies from insurer to insurer. Therefore, you may choose the insurance provider that offers rider options according to your coverage needs.

5. Exclusions

Though you may be aware of what your family health cover or individual insurance policy covers, it is equally important to be informed of what is not covered. Common expenses that are excluded from most insurance plans include dental surgeries, alternative treatment like Ayurveda or homeopathy, permanent exclusions such as HIV or congenial diseases, and certain hospital costs like ambulance cost or doctor’s fees. Therefore, you must carefully analyze different health insurance policies to ensure that your treatment or condition is not under the list of exclusions. For this, you may read the terms and conditions of the policy carefully before signing on the dotted line.

Individuals generally commit a grave error of opting for a certain mediclaim policy merely due to lower premium rates. However, this should not be the case. It is necessary to consider various factors to enjoy maximum benefits during medical emergencies. You may keep in mind the aforementioned factors while comparing health insurance policies. You may also consider other factors such as the insurer’s claim settlement ratio, sub-limits, renewal option, and preventive care cover, among others. By doing so, you may choose the best plan according to your budget and coverage needs.

By Chakraborty

Dr Chakrabarty is the Chief Innovation Officer of IntuiComp TeraScience. Earlier she was Assistant Professor of Delhi University, a QS ranked university in India. Before that she has held research positions in IIT Mumbai, IIT Chennai and IISc Bangalore. She holds 2 patents and over 20 research publications in her name which are highly cited. Her area of research is in smart technologies, integrated devices and communications. She also has a penchant for blogging and is an editor of Business Fundas.