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Health Insurance Plan: 6 Facts You Must Know

best health insurance plan

Are you looking for the best health insurance plan to protect you and your family?

You may be wondering why you need a health insurance plan. However, if you’re really serious about financial planning, then you must get it as soon as possible.


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Despite saving your hard earned money, health insurance plan also helps you to save taxes. It allows you to pay your skyrocketed unwanted hospital bills. So, that you can live the rest of your life happily.

I was tempted to write this post on the health insurance policy as I was also searching for the best health policy. And now that I found one for myself, I thought why not share it with you.

Depending on your requirement and needs, you can choose a health insurance policy. So, before calling your insurance agent, let’s look at the crucial factors that help you to decide which one you need.

Claim Settlement Ratio (CSR) – Health Insurance Policy

CSR is the ratio of the total number of claims settled by an insurer to the total number of claims received in a particular period. So, if CSR is high, then you can expect your insurer to settle your claim without any hassles.

Incurred Claim Ratio (ICR)

ICR is the ratio of the total claim amount received by an insurer to the total premium collected in a particular period. Like CSR, if ICR is also high then the insurer may likely to accept your application.

Moreover, it also indicates that the waiting period for pre-existing illnesses will be less. Apart from that, the insurer is more likely to issue new policies if you have pre-existing illnesses.

Hospital Network

You must look for an insurer which has a good number of hospital networks in each city. Moreover, the hospitals must have nursing homes, day care centre, and multi-speciality hospitals.

Pre-existing illnesses Waiting Period

If you’re already suffered from any disease, then check for pre-existing illnesses waiting period. It is one of the key factors and you need to look for a low waiting period.

You cannot claim your health insurance plan before completion of the waiting period. So, if an insurer offering you a low waiting period then you can opt for it.

Some insurers specify pre-existing illnesses waiting period to be more than 4 years. However, you can look for a waiting period of 2 years.

Premium Amount

Premium amount is another crucial factor that you must look for before applying for a health insurance policy. Your health insurance premium must cover room rent, medical and surgical expenses. It must also cover pre and post hospitalization cost.

Health Insurance Plan – Choose Type

You have the option to choose from different types of health insurance plan. Depending on your needs, you can opt for individual health policy or a family floater health plans.

Moreover, you can also choose a senior citizen plan for your parents, top-up health plans, or critical illness health policy.

Health Policy Types…

The individual health insurance policy offers you a higher coverage and benefits. However, you’ll be eligible to claim the benefit for yourself only and not any other member of your family. Even, you cannot transfer it to anybody else.

On the other hand, family floater health insurance policies protect your entire family. You need to pay a single premium for the whole family.

It lets you cover 4 children and 2 adults at a lesser cost. However, your family floater may be exhausted because of the hospitalization of any of your family member.

You can opt for senior citizen health insurance plan for your parents. However, its premium is high and the waiting period for pre-existing illnesses is also high.

If you’re already suffered from specific illnesses like cancer or heart disease, then you can choose critical illness policies. However, you need to pay a higher premium for such policies.

Apart from the above health policies, you can also opt for Top-up and Super top-up insurance plans. These policies come with a deductible clause. You will be entitled to get the benefits once the specified deductible amount is exhausted.

Suppose you have a health insurance policy of sum insured Rs. 5 lakhs. Assume you get hospitalized and your medical bill gone up by Rs 8 lakhs. In such cases, you can claim for Rs. 5 lakhs only and the remaining Rs. 3 lakhs will have to be borne by you.

However, with a Super top-up insurance plan, you will be eligible for claiming the additional medical bill of Rs. 3 lakhs as well.

Other Key Factors

Apart from the above key factors to keep in mind before you apply for an insurance plan, there are some other facts as well.

Health insurance policy becomes expensive as you grow old. So it is always better to take one when you are young. You must choose the sum insured carefully as per your family size.

Choose the right amount of sum insured as per your family size. Smokers, obese individuals and people with inactive lifestyles have higher health risks and need higher cover.

To increase your family health cover, you can buy Top-up or Super top-up policy along with a family floater policy. You can avoid buying insurance plans that have sub-limits on per day expense or room rent.

Many insurers reimburse only 70-80% of the costs if you get treated at a non-network hospital. So, check all the clauses for getting treated at network and non-network hospitals.

Furthermore, you also need to buy a health insurance policy before you get any critical illnesses. As you grow old, buy a separate individual health plan for yourself and your spouse.

It is really important as family floater policies are issued against the name of the oldest person in your family. In case the oldest person passes away, your policy will get ceases.

Key Takeaways

ICICI Lombard Insurance has a network of 4500+ hospitals to avail cashless facilities. As per IRDAI, it has CSR of above 98.32% and ICR of 80.38%. It indicates that people are renewing their policy and also making claims.

Star Health Insurance has a high claims settlement percentage of 98.72% and ICR of 60.51% with a whopping 8200+ hospitals are on its network.

Furthermore, the claim settlement ratio of Apollo Munich Health Insurance is 98.18% and an ICR of 54.99%. That means the company is highly likely to settle your claim and also likely to issue policies to new customers.

So, you must look for the above-mentioned facts before purchasing any health insurance plan.

If you have already purchased one then share your experience with us in the below comment section.

If you like this post on the health insurance policy, then do share it on your social networks like Facebook, Twitter, and LinkedIn.


Published on: Apr 24, 2019

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