I am totally confused as to which health insurance plan to buy for my family. What are the most important pointers I must know before buying a mediclaim? I want total cashless insurance. My friends tell me that many insurance companies don’t cover all the claims. How will I know about that?

Ans: Hi, the coverage amount should be an estimate of the treatment you may be expecting in the near future in case you have any pre existing diseases. Else, due to the age being on higher end, you may have to pay higher premiums. Do not delay and purchase as soon as possible.

Ans: key things to consider before choosing a family health insurance plan with cashless coverage:

Family Coverage:

Member inclusions: Ensure the plan covers all your immediate family members (spouse, dependent children, and potentially parents depending on the plan).
Sum Insured: Choose a sufficient sum insured per person considering potential medical inflation and future healthcare costs. Opt for a joint sum insured or individual sum insured per family member based on your needs.
Cashless Network Hospitals:

Network breadth: Research the insurance company's network hospitals in your area. Accessibility and quality of hospitals within the network are crucial factors.
Cashless claim settlement ratio: Check the company's cashless claim settlement ratio, indicating the percentage of cashless claims approved. A higher ratio indicates smoother claim processing.
Policy Coverage:

Hospitalization expenses: Ensure the plan covers hospitalization bills, including room rent, surgeon fees, medications, and other related costs.
Pre-existing conditions: Look for a plan that covers pre-existing conditions if any family member has one. However, there might be waiting periods for coverage.
Daycare expenses: Some plans offer coverage for daycare expenses incurred during hospitalization.
Co-pay/Deductible: Some plans involve co-pays (fixed amount paid for specific services) or deductibles (amount you pay before insurance kicks in). Understand these clauses and choose a plan with terms that suit you.
Claim Settlement Process:

Claim settlement turnaround time: Research the average time the insurance company takes to settle claims.
Claim intimation process: Understand the claim intimation procedure and required documentation to ensure a smooth process.
Company Reputation:

Financial stability: Choose a health insurance company with a strong financial track record for claim settlements.
Customer service: Look for a company known for good customer service, especially regarding claim processing assistance.
Ways to Research Plans & Claim Coverage:

Company Websites: Most insurance companies have detailed information about their health insurance plans on their websites.
Insurance Comparison Websites: Websites like Policybazaar (https://www.policybazaar.com/), CompareRaja (https://health-plan-compare.com/), or Fincare (https://www.insurancedekho.com/health-insurance/news/religare-health-insurance-partners-with-fincare-small-finance-bank-7) allow plan comparisons and provide valuable insights.
Insurance Agents: A licensed insurance agent can help you compare plans, understand exclusions, and choose the one that best suits your family's needs.
Understanding Exclusions:

Most health insurance plans have exclusions, which are medical expenses the plan doesn't cover. Here's how to learn about them:

Policy Wording: Read the policy wording carefully, focusing on the exclusions section. This will clearly outline what isn't covered by the plan.
Speak to the Insurance Provider: Contact the insurance company directly and ask about any exclusions related to specific procedures or pre-existing conditions.
Choosing the Right Plan:

Don't just focus on premiums: While cost is important, prioritize comprehensive coverage over just the lowest premium.
Get quotes from multiple companies: Compare quotes from different providers to find a plan that offers the best value for your needs.
Ask questions: Don't hesitate to ask questions and clarify any doubts you have about the plan details or claim settlement process.
By considering these factors and thoroughly researching your options, you can choose a family health insurance plan with cashless coverage that provides peace of mind and financial protection for your loved ones.

Ans: Hello;

You may shortlist health insurers based on following factors:

1. Incurred claims settlement ratio for 3 years atleast, preferable if available for 5 years.

2. List of network hospitals across the country and around the places that you generally operate. The more the better.

3. List of black listed hospitals so as to avoid them.

4. Low waiting period for pre-existing illnesses.

5. Claim settlement through TPA or directly the insurer(better). Also cashless claim settlement feature is desirable.

6. Reputation in the market.(Capital adequacy)

7. List of permanent exclusions

8. No sub limit on daily room rent.

9. Alternative therapies covered(Ayurveda, homeopathy etc).

10. Psychiatric treatments coverage.

Key is to disclose all existing conditions and conduct medical tests as requested by the insurer.

This way the chances of claim rejection are reduced.

You may also consult an insurance advisor if required, for further clarity.

Best wishes

Ans: You have taken a wise and responsible step by thinking about family health insurance now. At 48, it is very important to secure medical protection beyond company cover. Your awareness about misleading sales practices is also right. Many people buy policies without understanding coverage limits, waiting periods, and exclusions. Let us carefully analyse your situation and guide you with a 360-degree approach to select the right health insurance plan for your family of three.

» Importance of Having Independent Health Insurance

Company health insurance is helpful, but it is temporary.

It stops once you leave or retire from your job.

A personal health insurance policy continues lifelong.

Medical costs in India are rising faster than inflation.

A single hospitalisation can easily cost Rs 3 to 10 lakh.

Hence, a family policy ensures full protection even after job loss, change, or retirement.

» Understanding Your Current Cover

You are covered by a company group health plan for Rs 2 lakh.

That is too low for a family of three today.

A small surgery or private hospital stay can consume this limit fast.

Once the company cover is used, you may need to pay from your pocket.

So, personal family floater health insurance is essential.

» Ideal Coverage Amount

At your age, a base cover of Rs 10 lakh for family floater is ideal.

A top-up or super top-up plan can be added for Rs 15–20 lakh more.

Together, you get Rs 25–30 lakh total protection at low cost.

A base plan covers day-to-day hospitalisation.

A top-up covers large or multiple claims in a year.

This combination keeps your premium reasonable and coverage strong.

» Choosing Family Floater or Individual Plan

A family floater plan covers all members under one sum insured.

It is cheaper and convenient for a young family.

Since your wife is 41 and son is 5, a floater plan fits well.

The premium depends on the eldest member’s age, so it will be based on your age.

Individual plans are better only when there is a wide age gap or health issue in one person.

You can start with a floater now and add individual plans later if needed.

» Key Features to Check in a Good Policy

When comparing policies, focus on these core features instead of marketing offers:

Lifelong renewability: Ensure policy renews lifelong without age limit.

No claim-based loading: Premium should not rise just because you claimed.

Room rent limit: Prefer plans without sub-limits on room rent.

Pre and post-hospitalisation cover: Should cover at least 60 days before and 90 days after hospitalisation.

Daycare procedures: Should cover all daycare treatments, not a limited list.

No capping on diseases: Avoid policies that restrict specific illness costs.

Restoration benefit: Should automatically restore sum insured if used in a year.

Cashless network: Must have a large network of hospitals near your area.

Ambulance and domiciliary care: Should include both.

These points matter more than just low premium or cashback offers shown on comparison portals.

» Understanding Waiting Periods and Pre-existing Disease Cover

Every insurer keeps a waiting period for pre-existing diseases, usually 2–4 years.

It means such conditions are covered only after that period.

Some insurers offer shorter waiting periods or buyback options.

Choose one with minimum waiting period.

Also, check the initial waiting period of 30 days for general illness.

Accidental hospitalisation is usually covered from day one.

» Evaluating Claim Process and Customer Service

Many people face problems during claim time, not while buying policy.

Choose an insurer with proven cashless claim approval process.

Ask about their claim settlement ratio.

A good insurer should have 90% or more cashless claim success.

Also, check their grievance handling speed.

Reading genuine customer reviews (not ads) can help understand real service quality.

» Comparison of Plan Types

Base Health Insurance Plan: Gives full protection for normal hospitalisation.

Super Top-up Plan: Extends coverage at low cost after base amount is used.

Critical Illness Plan: Provides lump sum on diagnosis of major diseases.

For you, base plus super top-up plan is enough now.

Later, after age 55, you can consider adding a small critical illness cover.

» How to Avoid Getting Misled by Insurance Sellers

Never buy a policy just because of a low premium or gift offer.

Read the policy brochure carefully.

Focus on inclusions and exclusions.

Avoid agents who hide waiting period or sub-limit details.

Always buy from a Certified Financial Planner or registered insurance intermediary.

They explain in simple language and help you select need-based coverage.

Online comparison sites only show prices but not suitability.

So, you need professional guidance, not automated ranking.

» Suitable Coverage Strategy for Your Family

You can buy a Rs 10 lakh family floater base plan now.

Add a Rs 20 lakh super top-up policy from same insurer for seamless claim.

Include coverage for maternity and newborn care if planning second child.

Ensure coverage includes your wife’s and son’s hospitalisation, dental surgeries, daycare, and paediatric care.

Select a policy with annual health check-up benefit.

This will help you maintain regular health tracking.

» Premium Payment and Tax Benefits

Premium paid for health insurance qualifies for tax deduction under Section 80D.

You can claim up to Rs 25,000 per year for self, spouse, and children.

Paying by online transfer or card helps maintain valid proof for claim.

Avoid monthly premium options as they may cost more than annual payment.

» Evaluating Co-pay and Deductibles

Co-pay means you share part of hospital bill, usually 10–20%.

Some plans apply it above certain age or for specific treatments.

Prefer policies with zero or minimum co-pay.

Deductible applies mainly in top-up plans.

If your base plan covers Rs 10 lakh, keep deductible same for super top-up.

This ensures full coverage continuity without confusion.

» Importance of Health Declaration Honesty

Always declare your medical history truthfully when applying.

Even small ailments like high BP or sugar must be declared.

Non-disclosure can lead to rejection later.

Once declared honestly, the company cannot deny claim after waiting period.

» Family Health Planning Beyond Insurance

Maintain healthy lifestyle habits to reduce medical risks.

Eat balanced food and exercise at least 30 minutes daily.

Avoid smoking, alcohol, and stress.

Take regular health check-ups even if not covered.

Build a small health emergency fund for non-insured expenses like medicines or diagnostics.

» Understanding Why Early Purchase Matters

Premiums rise sharply with age after 45.

Buying now locks your health history and age slab.

If you wait till 50 or 55, premiums may be double.

Some diseases may start by then, making coverage harder.

So, early purchase ensures lifelong protection without exclusions.

» Policy Renewal Discipline

Never skip annual renewal.

Even one day delay can cause loss of continuity benefits.

Keep renewal date reminder in phone calendar.

Always pay directly through official insurer portal or trusted intermediary.

» Managing Health Insurance with Future Goals

Health insurance is not an investment. It is risk protection.

Do not mix with ULIPs or endowment policies.

Keep it separate from savings and mutual funds.

As income grows, you can enhance cover every few years using top-ups.

Also, review coverage every three years for family needs and inflation.

» Common Mistakes to Avoid

Selecting cheapest plan without checking hospital network.

Ignoring disease sub-limits and waiting periods.

Forgetting to check cashless tie-up in your city.

Not reading exclusion list carefully.

Mixing critical illness plan with hospitalisation plan wrongly.

Assuming corporate policy is enough for lifetime.

» How to Evaluate Insurer Reliability

Choose insurer with long experience in health segment.

Check claim settlement ratio, ideally above 95%.

Review their in-house claim team instead of third-party administrator.

Insurers with in-house claim management usually offer faster approvals.

Also, ensure they have digital claim intimation and mobile support.

» Role of Certified Financial Planner in Policy Selection

A Certified Financial Planner evaluates policies based on your health, age, and family.

They assess premium affordability, coverage adequacy, and claim process.

They also help renew and track changes every year.

This avoids confusion from online aggregators who just compare prices.

Hence, working with a CFP ensures clarity and long-term protection.

» Reviewing Cover Every Few Years

Inflation in medical cost is about 10–12% yearly.

Rs 10 lakh today may not be enough after 8–10 years.

Increase your base cover every 5 years or after salary rise.

You can add another super top-up plan instead of replacing old one.

This layered approach keeps protection current with changing healthcare prices.

» Planning for Post-Retirement Medical Security

After retirement, income may fall but health cost rises.

A lifelong renewable plan ensures you stay covered.

Premiums will be higher at 60, so start building a health fund.

Keep 2–3 years of premium in a liquid or debt fund.

This fund will help you maintain policy even without active income.

» Understanding Hospital Network Importance

Always choose insurer with hospitals near your home and office.

Check both private and multi-speciality hospitals in list.

Cashless approval makes claim easier and stress-free.

Reimbursement claims are lengthy and may delay refund.

So, wide hospital network is a strong selection factor.

» Building Complete Family Protection Plan

You should have:

A family floater health insurance plan.

A super top-up plan for high-value protection.

A separate term insurance plan for life risk.

An emergency medical fund for small expenses.

Together, these give full 360-degree family protection.

It secures your health, income, and financial peace.

» Steps to Finalise Your Policy

Shortlist 3–4 insurers with strong reputation.

Compare features, not just prices.

Call each insurer to clarify doubts before buying.

Buy directly from company or through CFP-managed service.

Keep all communication on email for record.

Verify policy document immediately after issue.

Inform your spouse about policy details and claim helpline.

» Finally

You have shown maturity and foresight by planning family health insurance at 48. This single decision will protect your family from major financial shocks. Focus on coverage features, not on advertisements or cashback offers. A Rs 10 lakh base plus Rs 20 lakh super top-up family floater policy is an ideal start. Buy from a reputed insurer with proven claim record and large hospital network. Ensure lifelong renewability, no sub-limits, and smooth cashless process.

Your family’s health safety deserves careful planning. With honest disclosure, timely renewal, and regular review, your policy will serve you reliably for decades. This will ensure you can focus on life goals with confidence and peace.

Best Regards,
K. Ramalingam, MBA, CFP,
Chief Financial Planner,
www.holisticinvestment.in

https://www.youtube.com/@HolisticInvestment