What Benefits Should A Comprehensive Health Insurance Policy Offer?

The world we live in today has become somewhat unsettled owing to the seemingly never-ending battle with Covid. Earlier with Alpha and Delta and now with the Omicron variant coming in, everyone is cautious and increasingly aware of the need for access to quality healthcare.  

The pandemic period has witnessed a shortage and increase in the cost of healthcare facilities across the country. Consumers today are becoming increasingly aware of the benefits of health insurance schemes. There has been a higher uptake of health insurance policies over the last two years, and experts further believe that this robust growth would continue, and the health and medical insurance market would continue to grow at a compounded annual growth rate (CAGR) of 19 per cent for the period of 2019-24.  

Digital means of purchase and payment have become the norm in the industry, which has fast-tracked the digitisation of insurance purchase and servicing. Now most insurers allow customers to intimate claims online and submit documents digitally, thus reducing their time to get their claim serviced. 

Despite this, several consumers have opted for a stop-gap arrangement while purchasing a health insurance policy in the recent past. Like choosing a Covid-related policy, which is far from being adequate to cover holistic healthcare requirements of an individual/ family. This does not safeguard them even remotely against the financial burden arising from other life-threatening diseases. However, this can be seen as a first step by the hitherto underserviced segment of the market and makes it easier for them to upgrade their policies to a comprehensive cover as we move further. 

The need for a comprehensive healthcare plan is more pertinent now than ever before due to various lifestyle changes. 

What Should Your Health Insurance Have?

While there is no age barrier for purchasing a health insurance plan, it is always advisable to buy one early in life, for it can prove to be of great help as one grows older. Ascertaining some crucial elements is necessary before signing up for a health insurance scheme. 

• Assessing coverage option: The contracts governing insurance schemes have several clauses and sub-clauses that provide for a list of prerequisites and conditions. Consumers must try to ascertain the offerings and understand what is included or excluded in the cover to be free from ambiguity. While the focus on coverage for Covid is expected today, it is best to ensure whether the sum insured is sufficient in case of unforeseen critical illnesses that may get diagnosed or a major surgery required. Buyers must also understand whether it is an individual or a family floater plan. 
• Plan comparison: Comparing plans from different service providers is the primary way to ascertain the best-suited plan. Moreover, with several insurance aggregators in the market, the job is easier for consumers.  
• Claim settlement ratio: Most insurers often communicate their claim settlement ratio, which is a crucial detail that consumers must pay attention to. Buyers must also understand the average time taken by the company to settle a claim, as it would help them understand the insurer’s servicing potential.  
• Peremptory conditions and other restrictions: Before taking the final call, buyers must read and understand all the preconditions associated with the scheme. They should be aware of the limitations and sub-limitations on procedures like a cap on room rent, coverage OPD expenses and so on. 
• Hospital network: Last but not least, consumers should not forget to check the enlisted/network hospitals list of the respective insurer. It is in their best interest to be aware of the nearby hospitals that would provide cashless hospitalisation.  

Choosing The Right Comprehensive Health Insurance Policy 

After understanding the health insurance policy essentials, the next stage is to choose a policy that best suits your requirement. 

• Individual health coverage: Individual health insurance plans meet the requirements of an individual. These plans can vary according to age, sum insured etc. Separate premiums have to be paid for each beneficiary as they do not cover more than one person in a plan.  
• Family floater plan: More than one family member gets covered under a family floater plan without any additional premium. Parents, spouses and children can be covered under these plans.  
• Critical illness plans: Ailments with prolonged treatment periods and expensive treatment costs are covered under critical illness health insurance plans. Such policies help consumers meet their long-term financial requirements for medical treatment of such diseases. 
• Covid insurance plans: With the pandemic outbreak, health insurers started providing standard indemnity policies that cover Covid-related costs; known as "corona kavach", these plans do not cover other illnesses.  
• Comprehensive plans: Health Insurance policies that provide comprehensive coverage for hospitalisation expenses in acute or chronic illnesses, accidents, viral infections like Covid etc., come under the category of comprehensive health insurance plans. These services are available after the completion of stipulated waiting periods.  
• Top-up plans: Plans providing additional coverage on an existing health insurance plan are known as top-up plans. So, if you have a coverage of Rs 5 lakh, you can take a top-up plan of, say, Rs 20 lakh that kicks in if the treatment cost exceeds Rs 5 lakh, which comes at very affordable premiums.   

Consumers must exercise discretion and make an informed decision when buying health insurance policies. While opting for an ailment-specific cover may appear to be a cost-effective approach, one must choose prudently for the long term and invest in comprehensive health insurance policies. The minor difference in premiums can make a big difference by securing them against financial stress arising due to medical emergencies.  

The author is the Director and Head of Retail Business, Care Health Insurance.

(Disclaimer: Views expressed are the author's own, and Outlook Money does not necessarily subscribe to them. Outlook Money shall not be responsible for any damage caused to any person/organisation directly or indirectly.)