WHILE choosing a health insurance plan various aspects need to be evaluated. The common queries range from which is the best plan for health insurance, should one go for a floater policy or a plan with individual sum insured, what should be the sum insured and will that sum be sufficient? There are also a few questions that you need to ask yourself such as what is your age, are you single, or do you have a family consisting spouse and children or do you want to cover your parents in the same policy? You need to assess requirements based on all these factors.
For a single person aged 25 years a sum insured of Rs 1,50,000 would be the minimum recommended cover. A person above 25 and up to age 35 years should be looking at any thing around Rs 2,00,000 to Rs 2,50,000. A person above age 45 years must have a policy with minimum Rs 3,00,000 as sum insured. This is considering the incidences of sickness as well average maximum expenses for hospitalisation due to any major illness or accident for respective age groups.
There are floater products in the market where the sum insured floats over the family. This means any one individual under the poli cy can claim up to the family floater sum insured, however, the maximum that can be claimed for all covered persons put together would be limited to the family sum insured in a policy period. Family floater sums insured of Rs 7,50,000 or Rs 10,00,000 could be considered reasonable protection for a family of self, spouse and two children. However, family floater policies with low sums insured say Rs 2,00,000 to Rs 3,00,000 may be inadequate, god forbid there is an accident involving two or more persons of the family and consequent hospitalisation expenses could go very high.
Similarly, if the age profile of persons in the family is on the higher side then considering the risk profiles and incidences of major illnesses, the family floater sum insured may be found to be inadequate.
It is recommended that a policy with individual sums insured would be a better and safe option.
With introduction of portability such policies will be easily portable with full benefits across insurers. The floater policies though cheaper than the individual ones, the benefits from an individual policy in terms of suffi cient protection are much higher compared to the discounts in premiums in a floater policy. Further most policies where sums insured are on individual basis a provision of a family discount of 5 per cent to 10 per cent is generally available when more than one person is covered.
While choosing a retail health insurance plan in addition to the sum insured one has to evaluate the extent of coverage as well as product specifications of the plans offered by different insurers. The waiting periods including those for pre-existing conditions, any sub-limits for room rents, sub-limits for certain specific conditions like appendicitis, hysterectomies, cataracts, detailed exclusion list, co-payments and age up to which the policy is renewal.
One of the biggest differentiator in health insurance are the service levels of the insurer and it has been observed that insurance companies which have an in-house claims servicing unit have proved to be much better in service levels than those who use TPAs.
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