If the Covid-19 pandemic reinforced something concrete, it was the need of a health insurance plan. Health insurance had always been there, but post-pandemic, the need has become more apparent. Suddenly, most people have realised its importance and the demand for health insurance has surged. Even if we eliminate the impact the pandemic has had on our minds, a health insurance policy is a must for your financial planning.
Why Choose a Health Insurance Plan
The reason is primarily because of the rising lifestyle diseases and its expensive treatments. Besides illnesses, there are chances of accidental injuries or any other medical contingency as well. When you suffer a medical emergency, the financial outflow is considerable, especially because it cannot be postponed or ignored.
Here is an approximate cost structure for a medical emergency in any Tier 1 city in India:
|Per day hospital stay cost in a government hospital||INR 4,452|
|Per day hospital stay cost in a private hospital||INR 31,845|
|Intensive care unit stay in a private hospital||INR 30,000|
|Open heart surgery in a private hospital||INR 2.8 lakh|
|Hospitalisation for a disease such as cancer||INR 93,305/day|
Medical expenses do create a financial strain. It dips into one’s financial goals. This is because medical inflation has been on the rise and treatments are becoming ever expensive. It is often quoted to be about 15% per annum.
To cover such expenses, a health insurance plan becomes imperative. Health insurance plans cover the medical expenses incurred on hospitalisation. They, therefore, provide you with the much-needed financial assistance in a medical emergency and protect your savings.
Health Insurance Plans For Your Family
Medical emergencies might strike any member of your family. As such, you need a health insurance plan which covers all your family members so that if anyone falls ill, the policy comes to your financial rescue.
There are various types of health insurance plans in India with a variety of benefits attached to it. However, while buying a health insurance plan for your family, it should be chosen with utmost care. You need to consider various aspects before finalising the plan. This would ensure that the policy is comprehensive and it provides adequate coverage to your family.
If you need help with choosing the right health insurance plan for your family, given below is a guide to help you with the same.
Health insurance plans are offered as family floater health insurance plans. These plans cover multiple family members under a single policy. You can avail coverage for –
- Your spouse
- Dependent children
- Dependent parents
Moreover, there are some plans which extend coverage to include parents-in-law, siblings and other extended members of the family. So, if you are looking for coverage of your whole family, you can opt for family floater health insurance plans.
How To Choose A Health Insurance Plan For Your Family?
Here is a definite guide for choosing the right health plan for your family –
Step 1: Choose The Right Policy
Health insurance plans come in different variants and each variant provides a specific type of coverage. So, the next step would be to zero in on the right policy for your family.
Here are the commonly available health plans –
- Individual health plans
Health Insurance Plans that cover a single individual under a single sum insured. This is an indemnity health insurance plan wherein the claim would be paid only for the expenses borne for the hospitalization.
Tip: So, if you are looking for a plan for yourself only, or a single member of the family, you can opt for this type.
- Family floater plans
Health Insurance Plans that cover all the family members under a single sum insured. Family floater plans provide umbrella coverage so that each person can claim up to the entire sum insured.
Tip: Family Floater Plans are usually cheaper than opting for individual members of the family. This is especially true for a young family.
- Senior citizen plans
Health Insurance Plans that cover individuals aged 60 years and above. Since this plan specially caters to senior citizens, it usually covers all necessary benefits that mainly senior citizens would need like outpatient department treatment (OPD) coverage, pre-existing disease coverage, etc.
Tip: This type of plan can be taken for your parents.
- Disease specific plans
Health insurance plans that are meant to cover specific illnesses and their complications like dengue, heart ailments, Covid-specific, etc.
Tip: This type of plan caters to any specific risk and is usually cheaper. Hence it can be taken along with an indemnity health insurance plan.
- Critical illness plans
Health insurance plans that cover specific critical illnesses and pay the sum insured in lump sum if the insured suffers from any covered illness like heart attack, stroke, cancer, etc. These plans are usually fixed benefit plans, i.e. if you are diagnosed with any critical illness, the entire amount would be payable irrespective of the amount spent on treatment.
Tip: This plan can be taken along with an indemnity health insurance plan for enhanced coverage.
- Top-up and super top-up plans
There are supplemental health plans which come with a deductible limit. Claims exceeding the deductible limit are paid by these plans.
Tip: Opting for a top up or a super top-up health insurance plan is the cheapest way to enhance your already existing health insurance coverage.
So, ideally, you can opt for one family floater policy covering yourself, spouse and dependent children. If you have dependent parents, you may opt for a separate senior citizen policy for them.
Even in case of dependent children, remember that the family floater policy would cover them till 23 or 25 years of age. Once your children cross this age, an independent health insurance plan would be needed for them in most plans.
Also, along with an indemnity health insurance plan for your family, a critical illness plan is also recommended. The policy would cover dreaded illnesses, which have become common in recent times, and give you a lump sum benefit to meet the expensive treatment costs. So, you can opt for a critical illness policy for complete coverage for the family.
Step 2: Opt for an Adequate Sum Insured
In order to find the adequate sum insured for your health insurance plan, you need to find out the total members that need to be covered. So, you need to choose a sum insured that is sufficient to cover the expected medical costs of all the members of the family.
Given the increasing medical costs and medical inflation, a high sum insured is desirable. However, a high sum insured also results in a high premium. As such, if affordability becomes an issue, you can opt for top-up or super top-up health insurance plans to enhance the coverage limit without a considerable premium outgo.
A top-up or super top-up policy acts like a supplemental health plan. The policy has a deductible limit. Claims up to the deductible limit are not paid. However, if claims exceed the deductible limit, the top-up or super top-up plan pays the excess claim.
However, a top up health insurance plan considers the deductible for each and every individual claim whereas a super top up plan takes an aggregate for the deductible.
How do Top Up Health Plans work?
Let’s understand how top-up and super top-up plans work –
|Sum insured of a top-up plan||INR 10 lakh|
|Deductible under the plan||INR 5 lakh|
|1st claim||INR 4 lakh|
|Will the top-up plan pay the claim?||No, since the claim is below the deductible limit|
|2nd claim||INR 7 lakh|
|Will the top-up plan pay the claim?||Yes, since the claim exceeds the deductible.A claim of INR 2 lakh (which is in excess of the deductible) would be paid|
For adequate coverage, you can initially opt for an indemnity health insurance plan and then supplement the coverage with a super top-up policy.
Tip:The deductible of the super top-up plan should be equal to the sum insured of the base policy so that claims up to the deductible are met by the normal health plan. The excess claims would be taken care of by the super top-up policy.
Step 3: Look for Comprehensive Coverage Benefits
The next step in buying the best health plan for the family is to ensure that the plan has all the necessary coverage benefits. Ensuring a comprehensive coverage is important so that all possible medical expenses get covered. Moreover, when considering the coverage benefits, you need to ensure that the benefits are suitable to your requirement.
For example, a newly married couple must opt for a health plan with maternity benefit. This coverage would ensure that when you have a child, the related costs of child birth would be covered by the plan and you would not face any financial burden.
Similarly, if you incur OPD expenses quite frequently, plans which cover such expenses would be beneficial.
Step 4: Check the Limits and Sub-Limits
Some health insurance plans have sub-limits on the room rent, especially for lower sum insured. If there is a sub-limit, it restricts the overall coverage. If you opt for a room whose rent is higher than the allowed sub-limit, your inpatient claim would be proportionately reduced. However, plans without sub limits are usually more expensive.
Similarly, some coverage benefits might have limits on them. Some common coverage benefits where sub-limits might be applicable include the following –
- AYUSH treatments (these include alternative medicine treatments such as ayurvedic, naturopathy-related, Unani, Siddha, and homeopathy)
- OPD expenses
- Domiciliary treatments
- Maternity coverage
- Organ donor expenses
Tip:When you are buying a health insurance plan for your family, check the sub-limits and limits applicable. Try to opt for plans which do not have sub-limits on room rent and other expenses.
Step 5: Opt for Coverage Riders
Health insurance plans allow optional coverage benefits. These benefits are called riders and they are available at an additional premium. Riders are optional in nature and can be chosen when you buy or renew your policy.
Riders provide additional coverage at a very low amount of premium. They enhance the scope of coverage of the health insurance policy and are recommended. Some common riders include the following –
- Personal accident cover
- Critical illness rider
- Hospital daily cash benefit rider
- OPD cover
- Maternity and newborn baby cover
Tip:Riders are usually a cheap way to increase the coverage. When buying a health plan for your family, check the available riders. Opt for riders which are relevant to your coverage needs and which would allow you to avail an all-inclusive coverage from your health insurance plan.
Step 6: Check the Hospital Network of the Insurance Company
Health insurance plans allow cashless hospitalisation wherein you don’t have to shoulder the hospital bills. The insurance company shoulders such bills on your behalf. Cashless hospitalisation is, thus, convenient and financially liberating. However, the benefit is allowed only if you get admitted in a hospital which is tied-up with the insurance company.
Insurance companies mention the number of networked hospitals that they are tied up with. You can also find the list of hospitals in your city on the insurance company’s website.
Tip: When buying a family health plan, check the list of networked hospitals. Check if the local hospital which you prefer is tied-up with the insurer or not. Also check the pan-India network strength. The stronger the better because it means that you would be able to locate a networked hospital easily, wherever you are.
Step 7: Check the Pre-Existing Waiting Period
Pre-existing illnesses are those which you or any family member suffers from when buying a new health insurance policy. Since the illnesses are already present, there is a waiting period before the cover is allowed for them. This waiting period is called the pre-existing waiting period and it ranges from 12 months to 48 months.
Tip:If you or any family member suffers from a pre-existing condition, look for plans which have a low waiting period. When the waiting period is low you would be able to avail coverage for your illnesses at the earliest.
However, if no one suffers from any illness and you are buying the plan at a younger age, you can opt for plans with a longer waiting period.
Step 8: Compare the Premiums
Health insurance plans are offered by multiple insurance companies. Every company has its own pricing policies and so, the premiums of health plans differ.
When buying health insurance plans, always compare the different policies on two bases –
- The coverage that they offer
- The premium that they charge
Tip:Don’t compare the premiums independently because the coverage benefits impact the premium rates. A plan might offer low premiums but it might not be comprehensive in terms of coverage. So, always compare the premiums against the coverage benefits and then choose a plan which offers a comprehensive scope of coverage at affordable premiums.
Step 9: Check the Exclusion List
Despite the comprehensiveness of a health plan, there are some instances wherein coverage is not allowed. Such instances are called policy exclusions and every health plan has a list of exclusions. When you are buying a health insurance plan for your family, check the exclusion list of the policy.
When you know the exclusions, you would know what is covered by the plan and what is not.
Step 10: Find Out the Premium Discounts
Health insurance plans offer attractive discounts on premium so as to reduce your premium outgo. Discounts are commonly offered for the following –
- No claim discount for not making a claim in the previous policy year
- Discount for adding two or more members to the coverage
- Discount for buying a long-term policy
- Discount for buying the policy online
- Discount for maintaining a healthy lifestyle and practicing healthy habits
Tip: Look for the discounts offered under the plan that you are considering to buy. Choose a plan which offers the maximum possible discounts so that you can save on the premium cost.
Step 11: Look for Value-Added Benefits
When comparing health insurance plans, look for value-added benefits which different plans offer. Value-added benefits are additional benefits which are offered along with the coverage features. Common benefits include the following –
- Sum insured restoration
- Free health check-ups
- Medical second opinion
- Telemedicine facilities
- Free doctor’s consultations
- Loyalty programs at partnered wellness outlets
- Assessment of your health
These benefits give something extra with the coverage and enhance your health insurance experience. Wellness is a very important aspect, especially in the post-pandemic situation and can be seriously considered at the time of opting for the same.
Choose a health insurance policy after you have considered all the above-mentioned aspects. This would help you find the most relevant and the best health insurance plan for your family. To buy the best policy, go online.
What To Do When You Have A Group Health Cover?
If you are an employee at a reputed organisation, chances are that you are covered under your employer’s group health insurance policy. Such coverage can also extend to your family members. If you and your family are already covered under a group health plan, does it mean you don’t need an independent policy?
No it doesn’t.
Even when you have group health insurance coverage, buying an independent health plan for the family is a must. Why? Here are some reasons –
- For adequate sum insured
The group cover would have limited sum insured and cannot be enhanced at your wish. For this you need an individual health plan.
You can also opt for a super top up plan over your group coverage.
- For having a plan with relevant coverage benefits
Group plans offer standard coverage benefits. If you need a comprehensive and inclusive scope of cover, an independent plan is needed.
- For lifelong coverage
Group plans allow coverage only till you are the member of the group. Once you retire, you would lose the coverage which becomes all the more important in older ages.
On the other hand, individual plans have lifelong renewability options.
- For tax benefits
You can enjoy tax benefits under Section 80D on the premiums that you pay for an independent health insurance plan upto INR 25,000 every policy year for premium paid for yourself, spouse and children and an additional amount of INR 25,000 to INR 50,000 for parents.
So, use the group health cover as a supplemental cover but it cannot replace the need for an individual insurance plan.
Reviewing Your Health Insurance Coverage
Just buying the best health insurance plan for your family is not enough. You should review your coverage every year to ensure that the plan is relevant to your needs. For example, if you get married or have a child, you have a new member who should be added to the coverage. Add the member either during the policy tenure or on renewal.
Similarly, if you want to opt for riders or increase the sum insured with changing needs, do so at the time of renewing your policy.
Regular review of your coverage would ensure that your coverage stays relevant at all stages of your life. Moreover, health insurance plans allow lifelong coverage. So, renew your policy within the due date, without fail, to enjoy uninterrupted coverage against medical emergencies.
A health insurance plan is non-negotiable. When you need to buy the same for family, be careful of choosing the right plan. Consider the afore-mentioned points and compare different plans to find the best and then buy accordingly.
Also, since health insurance plans can be ported, i.e. changed to any insurance company at any renewal, you need not wait for your perfect match. You can always change later. But remember the most important thing is to buy it now, without a delay.