Most people buy health insurance hoping they’ll never have to use it. The focus is usually on getting a policy quickly, paying the lowest possible premium, and moving on.
But when a medical emergency actually happens, many realise they didn’t fully understand what they bought. Room rent limits, waiting periods, exclusions, and co-payments suddenly matter, and they can significantly increase your out-of-pocket expenses.
Whether you are buying health insurance for the first time or reviewing an existing policy, this checklist will help you make a better decision.
1. Check Whether Your Sum Insured Is Enough
A low premium usually comes with low coverage. While a ₹3-5 lakh policy may seem sufficient, medical costs in India have risen sharply over the years. Hospitalization, ICU charges, and surgeries can easily cost more than this amount.
When choosing a sum insured, consider:
- Your age and health condition
- Your city’s medical costs
- Family size and dependent members
Most experts suggest keeping your health insurance cover at a minimum of half your annual income. That said, going overboard with a very high sum insured can push up premiums, so it’s important to strike the right balance.
2. Understand the Type of Health Insurance Policy
Health insurance policies are not one-size-fits-all. You should clearly know which type you are buying:
- Individual health insurance for single coverage
- Family floater plans where one sum insured is shared by all family members
- Senior citizen policies with age-specific features
- Top-up or super top-up plans for additional coverage
Choosing the right structure is as important as choosing the insurer.
3. Understand Waiting Period for Pre-Existing Diseases
If you have pre-existing conditions such as diabetes, blood pressure, or thyroid-related issues, your policy may require you to wait for a specific period before claims related to these conditions are covered. This waiting period is usually up to three years, so choosing a policy with a shorter waiting period is often a better option.
4. Room Rent Restrictions
Some health insurance policies place a cap on the room rent you can choose during hospitalization. If you select a room beyond this limit, the insurer may proportionately reduce the entire claim, not just the room charges. This can significantly increase your out-of-pocket expenses. It is therefore advisable to choose a policy with minimal or no room rent restrictions.
5. Understand the Co-Payment Clause
A co-payment clause means you have to pay a fixed portion of the hospital bill from your own pocket, while the insurance company pays the rest. Policies with co-payment usually come with lower premiums, which can seem attractive initially. However, during hospitalization, this clause can significantly increase your out-of-pocket expenses, especially for costly treatments. This is why co-payment is generally best to avoid, unless it is mandatory or there is no other option.
6. Don’t Ignore Pre- and Post-Hospitalization Costs
Medical expenses are not limited to the days you spend in the hospital. Doctor consultations, diagnostic tests, and medicines before admission, as well as follow-up treatment and medication after discharge, can add to your overall costs. Choosing a health insurance policy that covers pre- and post-hospitalization expenses ensures better coverage beyond just the hospital stay.
7. Check the Insurer’s Claims Handling Process
The claim settlement ratio (CSR) shows the percentage of claims an insurer has settled in a given year and is often used as an indicator of reliability. While a higher CSR is generally a positive sign, it should not be the only factor you rely on. It is equally important to understand how claims are handled. Whether they are managed in-house or through a third-party administrator, how easy it is to track claims online, and the average time taken for settlement. A smooth and transparent claims process can make a real difference during a medical emergency.
8. Read the Exclusion List Carefully
Health insurance policies do not cover every medical expense, which is why it is important to read the list of exclusions carefully. Exclusions refer to treatments, procedures, or expenses that the insurer will not pay for under any circumstances or during specific periods. These may include cosmetic procedures, non-medical items, self-inflicted injuries, or certain alternative treatments. Understanding what is excluded from your policy helps set the right expectations and prevents confusion or disappointment at the time of claim.
What If You Are Unhappy With Your Existing Policy?
If your current health insurance policy has high premiums, poor coverage, or restrictive terms, you don’t have to stay stuck with it. You can port health insurance to a new insurer.
To understand how to port an existing health insurance policy, it is important to note that portability is allowed only at renewal. When you port, the credit for waiting periods already served is carried forward, while the new insurer decides the premium and other policy terms. To start the portability process, you must apply at least 45 days before your policy renewal date, inform your current insurer of your intent, and specify the insurer you plan to switch to.
Conclusion
Choosing the right health insurance policy requires more than just comparing premiums. Understanding policy features, exclusions, the claim process, and portability can help you avoid issues later. If you are still confused about which health insurance policy is right for you, connecting with Ashvvy Investment can help you understand your options and choose a policy that fits your needs.
