Team AckoFeb 8, 2023
A health insurance policy has many jargons that could confuse you while buying coverage. One such commonly misunderstood term is deductibles. There are high or low deductible health insurance plans where you can determine the deductible limit. But are there plans useful to you? If you are confused, then let’s deconstruct both types of health insurance plans to understand which is better.
First, let’s get a clear picture of the role of deductibles in health insurance.
At the time of claim settlement, you need to bear a part of the claim amount. This amount is called a deductible. There are two types of deductibles in health insurance plans — Compulsory and voluntary.
The former type is mandatory and is usually set at 10% of the claim amount. Say you make a claim for Rs. 1 lakh, then you need to pay Rs. 10,000 for the treatment and the insurer will bear the remaining amount. Whereas the latter i.e. a voluntary deductible can be set by the policyholder while buying health insurance. Note that the amount of voluntary deductible can be changed. This is how you can get a health insurance plan with either a high deductible or a low deductible. Let us understand these concepts in detail in the following sections.
The limit of deductible is set at a higher amount in this plan. Your insurance company will settle the claim only when the amount exceeds the limit of deductibles. And you must bear the cost of a medical event up to the pre-decided limit of deductible. The insurer will pay the excess amount.
When buying a high deductible health insurance plan, you choose the deductible amount and the sum insured. After that, if you raise a claim and its value is more than the selected deductible, the insurance provider will cover the excess.
Consider that you buy a health insurance policy with a sum insured of Rs. 5 lakhs and set the deductible at Rs. 1.5 lakhs. Say you raise a claim for Rs. 3 lakhs. In this case, you will bear the claim amount up to the deductible (Rs. 1.5 lakhs), and the insurance company will bear an excess amount (Rs. 1.5 lakhs) as per the terms of the plan.
Note that the claim settlement amount is Rs. 1.5 lakhs.
Now that you have understood what a high deductible health plan is and how it works, it is time to look at its pros and cons. So, here is a gist.
|Your insurer’s risk reduces, hence, the premium is relatively low. Therefore, you can choose a higher sum insured to meet the expensive treatment costs.||If the deductible is high, you might incur high out-of-pocket expenses during claim settlement.|
|If you select a high sum insured, the coverage features become pretty inclusive. You can, thus, enjoy wider coverage benefits under the policy.||You will be unable to trigger the claim under the policy unless you cross the deductible. As such, the policy would prove ineffective for small claims.|
Low deductible health insurance plans have a low deductible, and once your claim crosses this limit, you will receive the excess. These plans work on a similar concept as high deductible, the only difference here is the low deductible threshold.
Under a low deductible policy, you choose the sum insured and the deductible amount. So, if the claim amount is more than the deductible, the policy pays the excess.
To simplify things, consider the following example.
Consider that you buy a health insurance policy with a sum insured of Rs. 5 lakhs and set the deductible at Rs. 25,000. Say, you raise a claim for Rs. 3 lakhs. In this case, you will bear the claim amount up to the deductible (Rs. 25,000), and the insurance company will bear an excess amount (Rs. 2.75 lakhs) as per the terms of the plan.
Note that the claim settlement amount is Rs. 2.75 lakhs.
Like high deductible health plans, low deductible ones also have their respective merits and demerits. These are as follows.
|Since the deductible is low, your out-of-pocket expenses on medical costs will reduce.||The premium payable is higher, as your insurer’s risk increases.|
|The probability of claim settlement increases since low deductible plans come in handy for small claims too.||If you don’t make frequent claims, the higher premium proves to be an added expense.|
Now let us discuss the main topic in question — should I choose high or low deductible health insurance? Since both high and low deductible plans have their respective pros and cons, you must be wondering which policy to choose. Well, the choice boils down to two things.
1. Your coverage requirements
You can pick high deductible health plans if -
You are young and healthy and have a lower probability of seeking medical attention due to illnesses.
You have an existing health insurance plan, either bought by yourself or an group health insurance. In such cases, the existing health cover can meet claims up to the deductible amount, and the high deductible policy would pay the higher claims.
You are looking for a high coverage level without paying a very high premium for severe medical emergencies or critical illnesses.
You can afford the out-of-pocket expenses or pay for the claim up to the high deductible.
On the contrary, a low deductible health plan proves suitable if -
You expect frequent claims due to existing illnesses.
There are planned treatments for which you would need coverage in the short term.
You don’t want to incur high out-of-pocket expenses during claim settlement.
You don’t mind paying higher premiums to ensure that you get covered with a lower deductible.
You don’t have an existing health cover, or even if you have one, the sum insured level is limited.
The choice of a high or low deductible plan depends entirely on your and your family’s health, medical needs, and affordability. So, assess your coverage needs, premium affordability, and the existing health insurance coverage you have and then make an informed choice.
Both high and low deductible plans have their respective benefits and drawbacks. You should assess your coverage needs, affordability for premiums, and bear the out-of-pocket expenses. Then, select the right plan.
Yes, a high deductible policy can help you save on the premium costs and give comprehensive health insurance coverage. However, remember that the policy would mean high out-of-pocket expenses on claims up to the deductible amount.
You can choose a high deductible policy if you don’t incur frequent claims or have another health insurance policy. A high deductible policy would enhance your coverage at a lower premium.
Yes, since the deductible is higher, the premium payable for the policy is low. As such, the policy is cost-effective. However, you should also consider the out-of-pocket expenses that you would incur on claims up to the deductible when assessing the cost-effectiveness of the policy.
A deductible is a part of the health insurance claim amount that you need to pay during claim settlement. The insurance company will bear the remaining claim amount.
No, all health plans do not have deductibles. Regular health plans might have deductibles on specific coverage benefits. Top-up and super top-up plans do have deductibles, though.
|Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.|
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