6 Key Factors to Consider While Comparing Health Insurance Plans
Buying health insurance for yourself and your family is one of your most important decisions. Hence, it is essential to understand your health insurance coverage needs, the policy you will be buying, and its features and benefits. To ensure you choose the best policy for your family from the available options, you must consider some key factors while comparing health insurance plans. In this article, we will discuss some of these key factors.
The first step in buying health insurance is understanding your family's requirements. You need to evaluate the following:
Before you compare health insurance plans of various companies, you need to research the health insurance companies. You can evaluate the companies on the following parameters:
You are clear about your health insurance requirements and have evaluated insurance companies. Now it is time to compare the health insurance plans of various companies. You may consider the following key factors for comparing health insurance plans.
Before jumping into the detailed factors, it’s important to understand the balance every policyholder must strike. Many people either end up underinsured- exposed to high out-of-pocket costs- or overpay for features they don’t need. The idea is to select a plan that has coverage that is consistent with your real-life risks, family size, and budget.
Underinsurance usually happens when you pick a low sum insured just to save on premiums. Overpayment occurs when you purchase unnecessary add-ons or a very high coverage amount, even though your medical usage is unlikely to justify it.
A smart comparison will keep you out of either, and you will get the complete protection at the appropriate price.
Coverage and sum insured form the heart of any health insurance plan. The coverage defines what the policy protects you from- hospitalisation, daycare treatments, pre- and post-hospitalisation expenses, ambulance charges, domiciliary care, AYUSH treatments, and more. The sum insured determines the maximum claim you can make in a policy year.
A lower premium might look attractive, but a plan with insufficient coverage can leave you paying heavy bills during emergencies. Conversely, having a very large sum insured without adequate utilisation can be a waste of your budget.
Each family has individual healthcare requirements. The amount insured that would be sufficient for a young couple might not be sufficient for a family with elderly parents. The following are some of the guidelines to consider what is appropriate to you:
Individuals who have a sedentary occupation, inherited risk, or chronic conditions are advised to choose higher coverage. Such lifestyle disorders as diabetes, hypertension, and cardiac problems usually demand costly treatments.
There is a high difference in healthcare costs:
In India, medical inflation is between 12 and 14 per cent every year. A strategy that might seem sufficient today might be inadequate in a couple of years. A high sum insured option or selection of plans that have sum-insured restoration and annual increase options will help with long-term affordability.
Premium is usually the initial aspect that individuals compare, yet it cannot be used alone as the deciding factor. A low premium can be a sign of less coverage, increased deductibles, a limit on the amount of room rented, or an increase in co-payment provisions.
Co-payment implies that you have to pay a percentage of the cost of treatment with your own money. An example of this is a 20% co-payment on a 2 lakh bill, which will see you pay 40,000.
To strike the right balance:
The good plan is one in which the premium is reasonable when compared to:
Plans with high co-payment percentages might appear budget-friendly but result in higher expenses during claims. It’s ideal to choose plans with:
Look for:
A plan that rewards you for staying healthy adds more value in the long run.
A large network of hospitals ensures cashless treatment- meaning you don’t pay upfront during emergencies. The claim settlement ratio (CSR) reflects how efficiently an insurer settles claims.
Both factors heavily impact your experience during medical emergencies.
A wider network means faster and smoother cashless approvals.
Check:
Plans with strong CSR and transparent claim processes are always preferable.
Add-ons, also known as riders, allow you to customise your health plan. They strengthen your base policy by offering additional protection against specific risks.
Offers a lump-sum payout if diagnosed with a covered critical illness like cancer, stroke, or kidney failure.
Provides daily cash allowance to manage expenses not covered under base insurance, such as travel, meals, and special assistance.
Covers accidental death, permanent disability, and partial disability.
Useful for young couples planning to start a family.
Reimburses consultations, diagnostics, and minor treatment that do not involve hospitalisation.
Although riders increase protection, they raise the premium. You should therefore select only the ones that are suitable for your family's healthcare requirements.
All health insurance policies are associated with some restrictions, primarily waiting periods and exclusions. These dictate which claims can be made instantly and those that have to wait.
Most policies have:
A plan with shorter PED waiting periods offers faster coverage.
Exclusions are conditions or treatments not covered under the policy, such as:
Comparing exclusions helps you understand the real scope of protection.
We have discussed six key factors to consider while comparing health insurance plans. There are additional factors that can be compared.
ManipalCigna Health Insurance (MCHI) offers a wide range of health insurance plans under various categories. These categories include hospitalisation cover, personal accident cover, critical illness cover, daily hospital cash, and riders (that can be optionally attached). Within categories, MCHI has various plans and different variants within some plans. You can compare various plans on the product comparison page. On a specific product page, if the product offers variants, you can compare the features of the variants.
The comparison process may take some time, but it will help you identify the plan that best suits your needs. When you have bought a health insurance plan that fits your requirements, it will give you much-needed peace of mind.
One of the most significant financial decisions that you will make is the selection of a health insurance plan. Considering variables such as coverage, premium, network hospitals, riders, wait times, and exclusions, you will be able to choose a plan that actually fits the healthcare requirements of your family.
The correct policy ensures your financial stability in the long run, peace of mind, and safeguards against unexpected medical expenses. Rather than being purely about the premium, strive to have a plan that gives a maximum value, flexibility, and reliable coverage in times of healthcare crisis.
The important items to consider include coverage, sum insured, premiums, co-payment terms, network hospitals, claim settlement ratio, waiting periods, exclusions, and riders. These are the factors that guarantee you the appropriate protection without having any hidden surprises.
The coverage should be first. A moderate premium on all-inclusive cover is preferable to a low premium cover that under-insures you. Select a middle ground that will not only fit your budgetary limit, but will also provide you with protection against the high medical expenses.
The riders will provide additional protection by addressing certain requirements, such as critical illness, personal accidents, maternity benefits, or OPD cover. They enable the personalisation of your plan, so that it is more specific to your family lifestyle and medical risks.
