World Health Day: Health insurance in a nutshell – All you need to know!

Health insurance is an agreement between the insured and the insurer, wherein the insurer promises to pay some or all of a policyholder’s medical expenses (for illness, accidents or any sort of injuries) in exchange for a specific premium. More particularly, health insurance typically pays for the insured’s medical, surgical, prescriptions, dental expenses etc. depending on the type of plan an insurer opts for.

Why it is important to have a health insurance policy?

Talking about the statistics in India, the current health status of the population is not that positive. Although India’s health care sector is one of the rapidly growing sectors in the world, there still prevails certain medical issues which are most common among the major population in the country and can be one of the primary reasons for individuals getting themselves covered. The stats say that around 73 million Indians suffer from Type 2 diabetes so far and are more likely to be prone to a variety of other medical complications owing to it. This figure is expected to double to around 134 million by the year 2025.

It was also observed that oral diseases accounted for approximately 61 per cent of all deaths and around 224 million people suffered from hypertension as of 2017. The other survey conducted in the year 2016 depicted that the life expectancy of males was 68.7 years and that for females was 70.2 years, which is still below the global average.

Not only diabetes is the problem, but other terminal illness such as cancer has also been a concern for the people in India. As per a recent report, the estimated number of people living with the disease was around 2.25 million every year, approximately 12 lacs cases have been reported and around 7.8 lacs deaths occurred. These worrying number is not just the end, other issues such as heart diseases, infertility, congenital abnormalities, cataract issues, hearing loss, infectious diseases, hair loss, obesity etc are other health issues that have been for a while. The treatment of all such diseases needs professional help which could be quite expensive at times depending on the patient’s situation, hence, having an optimum plan can help one and their family to deal with the situation financially without any hassle.

Moreover, the inflation of the health insurance plans is never-ending and with the awful pandemic experience in the past years, medical care has become critical. A health insurance plan is essential for managing healthcare-related expenses besides being financially equipped during medical emergencies.

What has changed in the past two years?

Several things have changed owing to the pandemic - taking every possible precaution to stay safe, wearing masks, hand sanitisers, social isolation and more. Another vital thing that has changed is the right awareness of having a health insurance plan. The pandemic has forced people to abandon their aversion to purchasing health insurance policies and made them more aware of the advantages of having one.

How to choose the best health insurance plan for yourself?

With many health insurances plans to choose from, it's easy to get confused as to which policy is best for you. Here are some things to consider when choosing the plan -

Before purchasing a health insurance policy, review the insurer's claim process; the relatively simple the claim process, the faster the claim settlement. Looking for after-sales service as well as having good customer support is highly essential while you are clueless.

Choose the sum assured amount wisely for the medical expense coverage. Age, income, number of family members, pre-existing diseases, and other factors play a major role in determining the suitable sum insured and hence must be correctly revealed to the insurer. Moreover, pregnancy-related medical costs can be exorbitant, hence choosing a medical plan that includes maternity benefits can be suitable for couples planning for kids. Checking the waiting period for claims as well as the policy's sub-limit is equally vital.

Select an insurer that provides a cashless payment option at network hospitals. It is better to pick an insurer with a large network of cashless hospitals. The cashless treatment option eliminates the hassle of settling hefty hospital bills as the insurer pays the medical expenses directly to the hospital. However, it should be noted that the policyholder is responsible for co-payments (if any) during claim settlement.

The cost of health insurance also varies based on the extent of coverage, type of plan, and deductibles. Hence, these factors must also be taken into consideration while looking for a plan.

While one is looking for an optimum health plan, ensure to check the different policy options available online and opt for the one which best fits your and your family’s medical needs. Don’t just buy for the sake of tax benefits; it’s recommended to do thorough research, read the documents well in advance, understand the exclusions and other terminologies, and then opt for the plan that suits your requirement.

Rakesh Goyal is the Director of Probus Insurance, an InsurTech broking company selling both life and non-life insurance policies.