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Health Insurance is complex

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AT THE time of a medical emergency in the family, money should not emerge as a prime concern for any household. Traditionally, people used to borrow money from friends and family during these difficult times, but with health insurance gaining popularity, it is now easier to cope up as and when the situation arises.

Till few years ago, insurance companies were offering only plain vanilla health insurance plans with standard features and caps on hospital bills. However, that has changed over a period of time and now the health insurance space is filled with variety of features and sum insured limits.

Choosing right sum insured is only the beginning.

Policyholders now have to be cautious about the specific features like room rent caps, coverage for pre-existing diseases and maximum age of renewability.

Sum insured: Choosing right sum insured is one of the most important decisions while buying a health insurance. If a policyholder chooses an inadequate cover, then the health insurance policy would be useless at the time of any major disease that requires huge expenses. While, if the sum insured is too high, then the policyholder would be paying high annual premium without actually using the policy.

Unlike life insurance, health insurance has no straight-jacketed ways to arrive at the quantum of cover one should take. A lot depends on how much one can afford towards premium and realise the value of this insurance.

In case of those who already have a group cover from their employers, high sum insured is not required.

Moreover, if they intend to continue with the same employer, then they might as well choose a top-up health insurance plan rather than choosing a separate health plan.

Room rent caps: Generally a health insurance policy with room rent caps or sub-limits is cheaper than the plan that does not have any such restriction. While policyholders should always check if his policy has such limits or not, it is not necessary that the policy with sum-limits is a bad choice.

Depending on the city of residence and choice of hospital, a person can choose an insurance plan. However, one should be aware of such limits before buying the policy so as to avoid unpleasant surprises later on.

Limit of room rent also puts restriction on operation theatre charges, consultant fees and medical equipment charges.


Pre-existing diseases: Although most insurance companies cover pre-existing ailments, like early stages of diabetes and high blood pressure, it is always better for policyholders to undergo medical tests so that the risk is analysed by the insurance company even before they accept the risk. By doing this, chances of insurance company rejecting the claim are reduced.

Lifelong renewability: Insurance companies were issuing policies that were renewable till the age of 60 or 65 till few years go, but that has changed now. Policyholders would feel more secure with a health insurance plan that they can be renewed till they live without the hassle of switching to a new company.

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