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How to Choose the Right Health Insurance Policy?

TeamAckoJan 18, 2024

When it comes to safeguarding our health and well-being, having the right health insurance policy is crucial.

Medical expenses can be overwhelming, and a good insurance plan ensures that we are protected from financial burdens in times of need.

However, with numerous options available in the market, choosing the right health insurance policy can be a daunting task.

In this comprehensive guide, we will walk you through the essential factors to consider when selecting a health insurance policy, providing you with the knowledge and confidence to make an informed decision.




What is Health Insurance?

Health insurance is like having a friendly agreement between you and an insurance provider. They promise to help you with some or all of your medical expenses so that you don't have to stress about paying a fortune for healthcare. It's like having a safety net for your finances, giving you peace of mind while ensuring you can access the best healthcare possible. Health insurance policies come in all shapes and sizes, offering different benefits and prices to suit your unique needs and the needs of your loved ones.

Why is Health Insurance Important?

Here are some important reasons why having the right health insurance policy is essential:

  • Financial Protection: Medical treatments can be costly, and lacking insurance coverage can lead to significant financial strain. Health insurance acts as a safety net by covering medical expenses, reducing the financial burden on policyholders.

  • Access to Quality Healthcare: Having a health insurance policy grants individuals the opportunity to avail themselves of a broad network of hospitals, clinics, and healthcare providers. This guarantees that they receive prompt and suitable medical care, thereby enhancing their likelihood of achieving a full recovery.

  • Preventive Care: A variety of health insurance plans provide coverage for preventive services such as vaccinations, screenings, and wellness check-ups. By using these services, individuals have the opportunity to identify and address potential health concerns at an early stage, leading to better health outcomes.

  • Protection for Loved Ones: Health insurance policies often provide options to extend coverage to family members. This ensures that the entire family is protected and can access necessary medical treatments when required.

How to assess your healthcare needs

Here are some factors to consider:

  • Current Health Condition: Evaluate your overall health and any existing medical conditions. This will help determine the level of coverage you require.

  • Family Considerations: If you have dependents, consider their healthcare needs as well. Assess if you need coverage for your spouse, children, or parents.

  • Medical History: Take into account your medical history and any recurring or chronic conditions that may require specialised care.

  • Preferred Healthcare Providers: Assess whether you have any preferred healthcare providers or hospitals and verify if they are part of the network covered by the insurance plans under your consideration.

  • Budget: Assess your financial capability to pay premiums and out-of-pocket expenses. Consider your monthly budget and ensure that the chosen insurance policy aligns with your financial goals.

Factors to Consider When Choosing a Health Insurance Policy

When evaluating different health insurance policies, it's important to consider the following factors:

  • Coverage: Assess the coverage provided by each policy, including hospitalisation, doctor visits, prescription drugs, preventive care, maternity care, mental health services, and more. Ensure that the policy aligns with your specific healthcare needs.

  • Premiums: Consider the monthly or annual premium you will have to pay. Remember to balance affordability with the level of coverage and benefits provided.

  • Deductibles and Copays: Evaluate the deductibles and copays associated with the policy. A deductible is the amount you must pay before the insurance coverage kicks in, while co-pays are the fixed amounts you pay for specific services.

  • Network of Providers: Check if your preferred doctors, hospitals, and specialists are included in the insurance plan's network. Accessing out-of-network providers may result in higher costs.

  • Out-of-Pocket Expenses: Determine the maximum amount you will have to pay out-of-pocket during a policy year. Once this limit is reached, the insurance company covers all further eligible expenses.

  • Customer Service and Reputation: Research the insurance company's reputation for customer service, claims processing, and promptness in resolving issues. Read reviews and seek recommendations from trusted sources.

Types of health insurance plans in India

  • Individual Health Insurance Policies

Individual health insurance policies are tailored to cover individuals against medical expenses. These policies provide coverage for hospitalisation expenses, including pre and post-hospitalization charges, ambulance fees, and specific day-care procedures. The coverage amount varies based on the policy terms and the premium paid. With individual health insurance, you can secure comprehensive protection for yourself.

  • Family Floater Health Insurance Policies

Family health insurance plans offer coverage for the entire family under a single plan. This cost-effective option provides a higher coverage amount compared to individual health insurance policies. The sum insured can be utilised by any family member covered under the policy, allowing for flexibility and convenience. With a family floater policy, you can ensure the well-being of your loved ones.

  • Senior Citizen Health Insurance Policies

Senior citizen health insurance policies are specifically designed to address the healthcare needs of elderly individuals. As age increases, the risk of developing health issues rises. These policies provide coverage for age-related ailments, hospitalisation expenses, pre-existing conditions, and often include benefits like day-care procedures, domiciliary hospitalisation, and annual health check-ups. With a senior citizen policy, you can prioritise comprehensive care for yourself or your elderly family members.

  • Critical Illness Health Insurance Policies

Critical illness health insurance policies offer coverage for life-threatening illnesses such as cancer, heart disease, kidney failure, stroke, and organ transplant, among others. In the unfortunate event of a critical illness diagnosis, these policies provide a lump-sum payout. This financial assistance can be used to cover medical expenses, treatment costs, or any other financial obligations that may arise during the recovery period. With critical illness coverage, you can ensure financial stability during challenging times.

  • Group Health Insurance Policies

Group health insurance policies are provided by employers to offer health coverage to their employees and their families. These policies are cost-effective as the premium is usually shared between the employer and the employees. Group health insurance policies often have certain limitations and may not cover pre-existing conditions. However, they provide essential coverage to a larger group of individuals, fostering a sense of security within the workforce.

  • Maternity Health Insurance Policies

Maternity health insurance policies are specifically designed to cover medical expenses related to pregnancy and childbirth. These policies usually have a waiting period before maternity benefits can be availed. Maternity coverage includes pre and postnatal expenses, delivery charges, hospitalisation expenses, and sometimes even newborn baby coverage. With a maternity policy, you can ensure comprehensive care for both the mother and the newborn.

  • Mediclaim Policies

Mediclaim policies are the most commonly opted health insurance policies in India. They provide coverage for hospitalisation expenses due to illness or accidents. Mediclaim policies reimburse the actual medical expenses incurred during hospitalisation, up to the sum insured. These policies also provide coverage for pre and post-hospitalization expenses, subject to policy terms and conditions. With a mediclaim policy, you can have peace of mind knowing that your medical expenses are taken care of.

  • Top-up and Super Top-up Health Insurance Policies

Top-up and super top-up health insurance policies act as add-ons to enhance your existing health insurance coverage. These policies come into effect once the basic sum insured is exhausted. Top-up policies have a single claim limit, whereas super top-up policies consider the cumulative value of claims made in a policy year. These policies provide additional coverage at a relatively lower premium, providing an extra layer of financial protection.

How to compare health insurance plans

Comparing health insurance plans allows you to make an informed decision. Here's how to effectively compare different policies:

  • Make a Spreadsheet: Create a spreadsheet to list the insurance plans you are considering. Include columns for coverage, premiums, deductibles, co-pays, network of providers, and other relevant factors.

  • Evaluate Coverage and Benefits: Fill in the spreadsheet with the details of coverage and benefits provided by each plan. Highlight the variations and assess which plan best meets your healthcare needs.

  • Consider Total Costs: Calculate the total cost of each plan by adding up the premiums, deductibles, and expected co-pays for your anticipated healthcare utilisation. Compare these costs to determine the most cost-effective option.

  • Review Policy Exclusions: Review exclusions or limitations mentioned in the policies. Ensure that the essential services you require are not excluded or subject to significant restrictions.

  • Seek Expert Advice: If needed, consult an insurance broker or a healthcare professional to get expert advice on choosing the right health insurance policy. They can provide valuable insights and help you navigate the complexities of insurance terminology.

  • Read Policy Documents: Before finalising your decision, carefully read the policy documents of the shortlisted plans. Understand the terms and conditions, including any waiting periods, pre-existing condition coverage, and claim procedures.

Remember that choosing a health insurance policy is a personal decision based on your unique circumstances. Take your time, thoroughly research your options, and seek clarification whenever needed.

Common health insurance terminologies explained

Understanding health insurance terminologies can help you navigate the policy selection process. Here are some common terms explained:

  • Premium: The amount you pay to the insurance company for coverage.

  • Deductible: The amount you must pay out-of-pocket before the insurance coverage starts.

  • Co-pay: The fixed amount you pay for specific services at the time of receiving care.

  • Co-insurance: The percentage of medical costs you share with the insurance company after reaching your deductible.

  • Out-of-Pocket Expenses: This is the amount you will have to pay out-of-pocket during a policy year.

  • Pre-existing Condition: A health condition that existed before the insurance coverage began.

  • Network: The group of doctors, hospitals, and other healthcare providers that have contracted with the insurance company to provide services at negotiated rates.

  • In-network: Providers who have a contract with the insurance company and offer services at negotiated rates.

  • Out-of-network: Providers who do not have a contract with the insurance company and may result in higher costs for policyholders.

  • Claim: A formal request submitted to the insurance company for payment of medical expenses.

  • Underwriting: The process of evaluating an individual's health condition and risk factors to determine eligibility and premiums for health insurance.

Frequently Asked Questions

Here are the answers to the most asked common questions related to how to choose right health insurance policy.


Can I change my health insurance policy after purchasing it?

Yes, you can change your health insurance policy after purchasing it. However, the ability to switch policies depends on the terms and conditions set by the insurance company. It is advisable to review the policy documents and contact your insurance provider to understand the process of changing policies.

What is the waiting period in health insurance?

The waiting period refers to a specific length of time that comes after buying a health insurance plan, during which certain benefits might not be accessible. Waiting periods commonly apply to pre-existing conditions, maternity coverage, particular treatments, or surgeries. It's important to carefully read the policy documents to comprehend the waiting periods linked to the insurance policy you have selected.

Are pre-existing conditions covered by health insurance?

Many health insurance policies provide coverage for pre-existing conditions. However, the coverage and waiting periods can vary between insurance providers and policies. It is important to carefully review the policy documents and seek clarification from the insurance company regarding the coverage of pre-existing conditions.

Can I add family members to my health insurance policy?

Yes, most health insurance policies allow you to add family members to your policy. This includes spouses, children, and sometimes parents or other dependents. Adding family members may have an additional cost, so it's important to review the policy details and consult with the insurance provider to understand the process and associated charges.

What is a network hospital, and why is it important?

A network hospital is a medical facility that has a contract with the insurance company to provide medical services at agreed-upon rates. Visiting a network hospital ensures that you can avail cashless treatment, where the hospital directly settles the bills with the insurance company. It is important to check the list of network hospitals associated with your health insurance policy to ensure convenience and cost savings.

How do I make a claim under my health insurance policy?

To make a claim under your health insurance policy, you generally need to follow these steps:

  • Notify the insurance company: Inform the insurance company about the claim by submitting a claim form or contacting their customer service.

  • Submit relevant documents: Provide all necessary documents, such as medical bills, prescriptions, diagnostic reports, and discharge summaries, to support your claim.

  • Follow claim procedures: Adhere to the claim procedures outlined by the insurance company, such as completing claim forms, providing additional information if requested, and meeting any specific requirements.

  • Await claim approval: The insurance company will evaluate your claim based on the policy terms and conditions. Once approved, they will reimburse you for the eligible expenses or directly settle the bills with the healthcare provider, depending on the policy.

It is advisable to carefully read the policy documents and understand the claim procedures specific to your health insurance policy.


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