Five things to look for before buying a health insurance

Buying a health insurance contract can be a tricky ordeal, with all the clauses and the jargon. This article will look to simplify the ordeal of selecting the best healthcare for yourself and your family members.

image credits: Getty Images

Health is wealth. This is a saying we have grown up hearing, and it is important to protect our health as, without a healthy body and a healthy mind, a human being will be incapable of anything.

With this said, potential medical emergencies that require massive expenses can take a toll on one’s finances. With rising healthcare costs, especially regarding top private hospitals in India, one must look for alternate ways to see to it that their healthcare expenditures will be taken care of – and the most efficient way to see that is done is through a health insurance contract.

However, buying a health insurance contract can be a tricky ordeal, with all the clauses and the jargon. This article will look to simplify the ordeal of selecting the best healthcare for yourself and your family members.

Before selecting a health insurance contract, these are the five things you will have to look for:

1) Choose a health plan that fits your top requirement

There are different types of health plans that are available for college students, young parents, senior citizens, heart disease patients, diabetics, already diagnosed cancer patients, etc. Note that you can choose multiple contracts with multiple insurance companies if you’d like, but you will have to identify your main priority i.e. your no.1 requirement from the contract. It could be the coverage of a pre-existing illness, coverage of maternity and childbirth, coverage of treatment abroad, etc. There are different contracts for many of these and you can choose as per your requirement.

2) Find a cashless hospitalization network that covers the top hospitals of your city or town

It is simply unreliable to opt for a health insurance plan that does not offer a cashless service. This part is arguably the most important part of this procedure.

What a cashless hospitalization network means is that the hospital bills are directly settled by the insurance company instead of you, the patient, having to pay them. While almost all insurance companies do these cashless services, not all hospitals do. For instance, only around 10% of all private hospitals in a city may be equipped for this cashless service. So you must look for the best hospitals in your city that deal in cashless transactions; the best hospitals only since you need to ensure your health is in the safest possible hands.

3) Figure out the exact coverages offered

There are five core components to policy coverage that every insurance customer should look for

a) in-patient hospitalization coverage – this is the main reason you will be looking to buy a health insurance plan, i.e. this is the maximum amount you are liable to claim against hospital expenses.

b) daycare treatment – these are procedures that take less than 24 hours in a hospital. While seeing this coverage, look for a plan that covers all daycare treatments without restrictions or at least a higher number of treatments.

c) room rent – depending on the plan you choose, the room rent coverage may give

  • no capping on room rent
  • offer a single private room
  • allow a limit of up to 1% or 2% insured

On a cover of say 5 lakh rupees, a room rent of 1% is most probably not going to cover your room rental needs. So ensure that you pick the plan suited to these room rent requirements.

d) pre-hospitalization and post-hospitalization – this refers to reimbursement of any hospitalization expenses before and after your discharge from the hospital.

You may see 30 days and 60 days eligibility period respectively but some plans may put a coverage amount on this too. As with everything else, consider the plans that offer you the most coverage

e) possible sub-limits on your plans – sub-limits are a cap on how much a policyholder can claim – eg, 1% on room rent, 10000 rs per eye cataracts, maternity expenses, etc.

4) Examine the plan’s waiting period and copayments

The waiting period of the plan is like a hibernation period where any claims made won’t be admissible for insurance purposes. Depending on the contract, the waiting period can be four years, three years, or even just two years; as a customer, you need a note that the lower the waiting period, the better the choice of an insurance contract it will be.

Also, you’ll need to look out for co-payments, i.e. the share of the insurance claim that needs to be paid from your pocket. This clause gets generally triggered for senior citizens or specific need plans.

In short, look out for these small clauses in the contract and ensure to run it through by your lawyers.

5) Identify benefits that enhance sum insured

As mentioned earlier, the cost of medical coverage is on the rise and we need to look for a plan that enhances medical coverage over time. There can be primarily two ways this can be done –

  1. No Claim Bonus (NCB) – No Claim Bonus is a way by which insurers reward policyholders for having a claim-free year with an increase in sum insured ranging from 5% to 50% at the same premium level. If you can maintain your health and can somehow avoid accidents, this bonus can go up to as much as even 100%.
  2. Restoration benefit – On the converse of the No Claim Bonus, if you were to consume your entire sum insured, then the insurer would add more coverage without taking an additional premium. This additional premium applies to any claims with an untreated illness.

Other variables in your insurance contract you can go through include OPD expenses, wellness services, health checkups, in-house claim settlement, etc but these are not as crucial as the above factors.


To summarize the entire article, ensure that while selecting an insurance contract –

  1. You choose a health plan that fits your top requirements
  2. Ensure you have the chance of the best private hospital in your city that provides cashless service with your insurance
  3. Educate yourself on the exact coverages offered, the waiting periods, and the co-payments.
  4. Go for policies that have the best NCBs and restoration bonuses.