This comprehensive guide covers crucial aspects spanning health insurance policy features, claims processing track record, hospital network coverage and technology adoption that customers should evaluate before selection.
Evaluate the Overall Scope of Coverage
Don’t just compare premiums while choosing a health insurer. Take a holistic view of the overall coverage being offered:
- Check sub-limits on crucial aspects like room rents, ICU charges, etc. Many basic plans cap these at 1% or 2% of the sum insured. Go for policies with higher coverage limits of 5% or more.
- Review add-ons or optional covers like outpatient treatment, dental care, critical illness, restoration benefits, etc. These provide enhanced overall protection.
- Examine the list of permanent exclusions. Ensure it is not too exhaustive, leaving out coverage for routine or common treatments.
- Verify if pre-existing illnesses are covered after 2-3 years of continuous policy renewal. This ensures coverage continuity.
Analyse Insurer’s Claim Settlement Record
While comparing premiums and policy features is necessary, their utility holds relevance only if the insurer actually honours and pays out claims when required.
- Evaluate the claim settlement ratio of insurance providers before buying the policy. Higher is better – select ones settling over 90% of claims.
- Check if the insurance company has a track record of efficient claim processing and settlement. Go through online reviews to gauge the experience of settling hospitalisation or cashless claims.
- Examine if the insurer has an expansive network with quality hospitals to ensure smooth admission and discharge when you raise a claim.
Evaluate the Network of Cashless Hospitals
Keep in mind the following:
- Verify that the insurer has tie-ups with top hospitals in your locality or city. If the network presence is small, you may encounter issues and delays later during claims.
- Cashless hospitals should span public and private establishments, multi-speciality and super specialities to ensure optimum utility of policy when the situation arises.
Check Digital Services Offered
With customers now seeking contactless processes, evaluate specific digital services extended by the insurer:
- Presence of a well-designed customer app or portal for policy management, claims tracking, locating network hospitals, etc.
- Cashless approvals at networked hospitals via app or portal to avoid delays or documentation gaps.
- seamless integration with other systems like insurers, hospitals, payment gateways, etc., to enable faster services and claims settlement through reduced paperwork.
Key Pointers for Senior Citizen Plans
If you are purchasing health covers specifically for parents or senior citizens in your family, a few additional aspects to assess would be:
- Entry age (Usually 60-65 based on the terms of the insurance company).
- Coverage provisions for managing pre-existing illnesses after 2 or 3 continuous policy years.
- Inclusion of add-on covers for outpatient doctor consultations, home care post-hospitalization, critical illness rider, etc., considering rising healthcare needs.
While these are broad guidelines, detailed product understanding is also essential before making the purchase. Carefully read through policy documents, brochures and assessments shared by the insurer.
Questions to Ask Before Choosing an Insurer
Instead of simply looking at brand names, ask some key questions directly to insurance providers to assess their suitability:
- How long have you been in the health insurance business in India? Look for established players with over a decade of operational experience.
- What is your claim settlement process, and what support do you provide through the process? Understand the ease of making claims.
- How do you determine premiums charged to customers? Evaluate if pricing is reasonable relative to coverage.
- What policy alterations can be made – enhancing cover, adding family members? Assess the flexibility available.
- What are the digital capabilities and services offered to customers? Check the engagement channels present.
The answers to these questions will give you a better perspective of the insurer’s proposition. Combining this understanding with parameters around claim settlement rates, network hospitals and product features as discussed earlier will enable you to make an informed health insurance provider choice.
Conclusion
Whichever insurer you select, thoroughly examine inclusions/exclusions, sub-limits, etc., to ensure there are no gaps in understanding about what is precisely covered. As costs inflate over time, also consider enhancing protection levels by increasing the sum insured every 2-3 years for continued, adequate coverage. Click here to learn more about Medicare Nationwide.
