Hi I want a health insurance for my family but unable to decide which one to choose. What are things need to know before taking Health insurance. I want total cashless insurance. I have heard some insurance company do not cover all in claim. How to know about that. Thankyou in advance

Ans: Choosing the right health insurance plan for your family is crucial, and it's understandable to feel overwhelmed by the options. Here are some important pointers to consider before buying a mediclaim policy:

1. Coverage and Benefits:

• Inpatient Hospitalisation: Ensure the plan covers hospitalisation expenses, including room charges, doctor's fees, surgery, and nursing.
• Pre and Post-Hospitalisation: Look for coverage of medical expenses incurred before and after hospitalisation.
• Daycare Procedures: Check if the policy covers treatments that don't require 24-hour hospitalisation.
• Domiciliary Treatment: Verify if home treatment is covered if hospitalisation is not possible.
• Maternity and Newborn Benefits: If relevant, look for plans that cover maternity expenses and newborn care.

2. Network Hospitals:

• Cashless Facility: Ensure the insurer has a wide network of hospitals offering cashless treatment. This means the insurer pays the hospital directly, reducing your out-of-pocket expenses.
• Hospital Network Size: The larger the network, the better your chances of finding a network hospital near you.

3. Claim Settlement Ratio:

• Research: Check the insurer's claim settlement ratio, which indicates the percentage of claims settled against the total claims received. A higher ratio is preferable.
• Customer Reviews: Look for reviews and testimonials regarding the insurer's claim settlement process.

4. Exclusions and Waiting Periods:

• Pre-existing Diseases: Understand the waiting period for pre-existing conditions.
• Specific Treatments: Check for exclusions related to specific treatments or conditions.
• Waiting Periods: Be aware of initial waiting periods, disease-specific waiting periods, and maternity waiting periods.

5. Sum Insured and Sub-limits:

• Adequate Coverage: Choose a sum insured that adequately covers potential medical expenses.
• Sub-limits: Be cautious of sub-limits on room rent, specific treatments, or diseases, which can limit your claim amount.

6. Premiums and Deductibles:

• Affordable Premiums: Ensure the premiums fit your budget without compromising on coverage.
• Deductibles and Co-payment: Understand any deductibles or co-payment clauses which require you to pay a portion of the expenses.

7. Additional Benefits:

• No Claim Bonus: Some policies offer a bonus for each claim-free year, which can increase your sum insured.
• Free Health Check-ups: Look for plans offering periodic health check-ups.
• Restoration Benefits: Check if the policy offers sum insured restoration in case it gets exhausted during a policy year.

8. Portability and Renewability:

• Policy Portability: Ensure the policy is portable, allowing you to switch insurers without losing benefits.
• Lifetime Renewability: Opt for plans offering lifetime renewability to ensure coverage in older age.

9. Customer Service:

• 24/7 Support: Check if the insurer provides round-the-clock customer support.
• Ease of Process: Evaluate the ease of buying, renewing, and claiming processes.

10. Regulatory Compliance:

• IRDAI Approval: Ensure the insurer and the plan is approved by the Insurance Regulatory and Development Authority of India (IRDAI).

11. Steps to Verify Coverage and Claims:

• Policy Document: Read the policy document thoroughly for detailed coverage, exclusions, and terms.
• Brochures and Websites: Check the insurer’s official website and brochures for detailed information.
• Customer Service: Contact the insurer’s customer service for any specific queries.
• Independent Reviews: Look for independent reviews and ratings on insurance comparison websites.
• Friends and Family: Gather feedback from friends and family who have experience with the insurer.

By carefully evaluating these factors, you can make an informed decision about the best health insurance plan for your family that meets your needs and offers comprehensive coverage.

Ans: You have done a good research job. If the features are same, then I suggest Star health policy of 1 Cr should be good for your family.

Here are few healthcare policies tailor-made for senior citizens:

1.Star senior citizen red carpet
2.Niva Bupa Senior First
3.Manipal Cigna Prime Senior
4.Care Senior Plan

You can select any one among these for your parents. Feel free to consult an insurance advisor if needed.

Ans: Hello;

Before signing up for a healthcare insurance cover you need to understand the permanent and time bound exclusions mentioned in the policy

Also check the black listed hospitals on insurers website and avoid them as far as possible.

Better is to select network hospital and go for cashless facility.

Also before signing up, you need to honestly disclose pre-existing diseases, hereditary history of you near blood relatives in good faith.

This will reduce chances of claim rejection.

For your reference I am sharing names of some health insurers whose incurred claims ratio(ICR) was above 80% in FY-24:

HDFC Ergo
ICICI Lombard
SBI General
Bajaj Allianz
National Insurance

Request you to do your due diligence and seek help from an investment advisor or insurance advisor for further help.

Best wishes;