What benefits should a comprehensive health insurance policy offer?


The world we live in today has become somewhat unstable due to the seemingly endless battle with Covid. Previously with Alpha and Delta and now with the arrival of the Omicron variant, everyone is cautious and increasingly aware of the need for access to quality healthcare.

The pandemic period was marked by a shortage and an increase in the cost of health facilities across the country. Today, consumers are increasingly aware of the benefits of health insurance plans. There has been an increase in the adoption of health insurance policies over the past couple of years, and experts further believe that this robust growth will continue and the health and medical insurance market will continue to grow at a compound annual growth rate (CAGR) of 19 percent. cent for the period 2019-24.

Digital means of purchase and payment have become the industry standard, which has accelerated the digitization of insurance purchasing and service. Today, most insurers allow customers to make intimate claims online and submit documents digitally, reducing their claim processing time.

Despite this, several consumers have opted for an interim arrangement when purchasing a health insurance policy in the recent past. Like choosing a Covid-related policy, which is far from sufficient to cover the holistic health needs of an individual/family. It does not even remotely protect them from the financial burden resulting from other life-threatening illnesses. However, it can be seen as a first step by the hitherto underserved segment of the market and makes it easier for them to upgrade their policies to full coverage as we move forward.

The need for a comprehensive healthcare plan is more relevant than ever due to various lifestyle changes.

What should your health insurance have?

Although there is no age barrier for taking out health insurance, it is always advisable to buy one early in life, as it can prove to be a great help as you grow older. ‘we’re aging. Making sure of certain crucial elements is necessary before subscribing to health insurance.

  • Coverage Option Assessment: Contracts governing insurance plans have several clauses and sub-clauses that provide a list of prerequisites and conditions. Consumers should try to check offers and understand what is included or excluded in coverage to be free from ambiguity. While the focus on cover for Covid is expected today, it is best to ensure that there is sufficient sum insured in the event of any unforeseen serious illnesses that may be diagnosed or major surgery required. Buyers should also understand if it is an individual or family floating plan.
  • Plan Comparison: Comparing plans from different service providers is the primary way to determine the best-fit plan. Moreover, with several insurance aggregators in the market, the task is easier for consumers.
  • Claims payout ratio: Most insurers often disclose their claims payout ratio, which is a crucial detail that consumers should pay attention to. Buyers should also understand the average time taken by the company to settle a claim, as this would help them understand the service potential of the insurer.
  • Prerequisites and other restrictions: Before taking the final call, buyers must read and understand all prerequisites associated with the program. They should be aware of the limitations and sub-limitations of the procedures such as room rent ceiling, OPD expense coverage, etc.
  • Hospital network: Last but not least, consumers should remember to check the list of registered hospitals/network of the respective insurer. It is in their interest to be aware of nearby hospitals that would offer cashless hospitalization.

Choosing the right comprehensive health insurance policy

After understanding the essentials of health insurance policy, the next step is to choose the policy that best suits your needs.

  • Individual Health Coverage: Individual health insurance plans meet the needs of an individual. These plans may vary by age, sum insured, etc. Separate premiums must be paid for each beneficiary as they do not cover more than one person in a plan.
  • Family floating plan: More than one family member is covered by a family floating plan without any additional premium. Parents, spouses and children can be covered by these plans.
  • Critical illness insurance plans: Conditions requiring extended treatment periods and high treatment costs are covered by critical illness insurance plans. These policies help consumers meet their long-term financial needs for the medical treatment of these conditions.
  • Covid insurance plans: with the pandemic outbreak, health insurers have started providing standard indemnity policies that cover Covid-related costs; known as “corona kavach”, these schemes do not cover other illnesses.
  • Multi-risk plans: Health insurance policies that provide full coverage of hospitalization expenses in case of acute or chronic illnesses, accidents, viral infections like Covid, etc., fall under the category of multi-risk plans. ‘Health Insurance. These services are available after completion of the stipulated waiting periods.
  • Supplemental plans: Plans that provide additional coverage to an existing health insurance plan are called supplemental plans. So, if you have Rs 5 lakh coverage, you can take an add-on plan of, say, Rs 20 lakh which kicks in if the cost of treatment exceeds Rs 5 lakh, which is offered at very affordable premiums.

Consumers should exercise discretion and make an informed decision when purchasing health insurance policies. While opting for condition-specific coverage may seem like a cost-effective approach, choose carefully over the long term and invest in comprehensive health insurance policies. The minor difference in premiums can make a big difference in securing them against financial stress resulting from medical emergencies.

The author is Director and Head of Retail, Care Health Insurance.

(Disclaimer: The opinions expressed are those of the author and Outlook Money does not necessarily endorse them. Outlook Money will not be liable for damages caused to any person/organization directly or indirectly.)


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