How to Choose the Right Health Insurance Plan for Your Family

health insurance

We all want to buy a health insurance plan that offers maximum coverage to our loved ones at the time of need. However, with the availability of different health insurance plans, it can get confusing to pick the right one. Going through so many policy types, their features, inclusions, and limitations can seem to be a daunting task. And to avoid the hassle or time constraints, a lot of people end up buying a health plan without knowing if it would be adequate for them or not. Here are some useful tips to help you choose the best health insurance plan for your family

1) Seek the Correct Policy Coverage

Select a health plan that offers you coverage against a wide range of medical problems, pre and post-hospitalization cover, ambulance charges, critical illness cover, maternity benefits, cashless treatment, daily hospital cash benefit, in-patient hospitalization, etc. If you are buying medical insurance for your family, make sure that the policy meets caters to the needs of each member that has to be insured. 

Consider your requirements, compare different plans, check out the policy features, and limitations. There can be hidden factors like sub-limits, waiting period, etc. that we tend to miss. Therefore, make sure that you go through the policy wordings for all the terms and conditions. This would ensure that you and your family do not have to face any trouble at the time of the claim.

Single person plans

Health Insurance Plans that cover a single individual under a single sum insured. This is an indemnity health insurance plan wherein the claim would be paid only for the expenses borne for the hospitalization.

Tip: So, if you are looking for a plan for yourself only, or a single member of the family, you can opt for this type.

Full family plans

Health Insurance Plans that cover all the family members under a single sum insured. Family floater plans provide umbrella coverage so that each person can claim up to the entire sum insured.

Tip: Family Floater Plans are usually cheaper than opting for individual members of the family. This is especially true for a young family.

Old persons plans

Health Insurance Plans that cover individuals aged 60 years and above. Since this plan specially caters to senior citizens, it usually covers all necessary benefits that mainly senior citizens would need like outpatient department treatment (OPD) coverage, pre-existing disease coverage, etc.

Tip: This type of plan can be taken for your parents.

Specific Disease plans

Health insurance plans that are meant to cover specific illnesses and their complications like dengue, heart ailments, Covid-specific, etc.

Tip: This type of plan caters to any specific risk and is usually cheaper. Hence it can be taken along with an indemnity health insurance plan.

Serious or critical illness plans

Health insurance plans that cover specific critical illnesses and pay the sum insured in lump sum if the insured suffers from any covered illness like heart attack, stroke, cancer, etc. These plans are usually fixed benefit plans, i.e. if you are diagnosed with any critical illness, the entire amount would be payable irrespective of the amount spent on treatment.

Tip: This plan can be taken along with an indemnity health insurance plan for enhanced coverage.

Insurance plans that offer additional coverage beyond the basic policy limits

There are supplemental health plans which come with a deductible limit. Claims exceeding the deductible limit are paid by these plans.

Tip: Opting for a top up or a super top-up health insurance plan is the cheapest way to enhance your already existing health insurance coverage.

So, ideally, you can opt for one family floater policy covering yourself, spouse and dependent children. If you have dependent parents, you may opt for a separate senior citizen policy for them.

Even in case of dependent children, remember that the family floater policy would cover them till 23 or 25 years of age. Once your children cross this age, an independent health insurance plan would be needed for them in most plans.

Also, along with an indemnity health insurance plan for your family, a critical illness plan is also recommended. The policy would cover dreaded illnesses, which have become common in recent times, and give you a lump sum benefit to meet the expensive treatment costs. So, you can opt for a critical illness policy for complete coverage for the family.

2) Seek Flexibility in Adding New Family Members to the Policy

While purchasing a family health plan, make sure that you can add a new family member easily. In case the senior-most family member passes away or is no more eligible for the coverage, then the other family members can continue with the same plan without losing the benefits of the plan.

3) Examine Waiting Period Clause

Usually, health insurance plans cover pre-existing diseases, maternity expenses, and certain specific treatments like hernia, varicose veins, etc. after a specified waiting period, i.e., 2 to 4 years, which varies from one plan to another. For instance, maternity expenses are usually covered after a period of 2 to 4 years from the date of policy purchase. 

Make sure that you check the time duration after which the pre-existing diseases will be covered in your family health plan and choose a plan that comes with a minimal waiting period.

4) Review Co-Payment Clause

It is the percentage of the amount that you will have to pay from your pocket. The insurance company pays the remaining hospitalization expense. For instance, if you have a policy with a 10% Co-pay clause, this implies that for a claim of Rs. 1 lakh, you will need to pay Rs. 10,000 form your own pocket while the insurance company will pay Rs. 90,000 as part of the claim. You can also look for a policy without a co-payment clause as well.

5) Select a Plan with Lifetime renewal option

Lifetime renewability is also an essential factor to consider. A lot of us tend to forget it. Make sure that you check the number of years that your policy remains validated; check whether it offers limited lifetime renewability or not. 

Why? Because you will require a health plan the most during the later years of age. So, choose a family health plan that offers lifetime renewability. This will enable you to continue with the same plan in the years to come without the hassle of buying another policy after crossing the age limit. For example, your health insurance plan offers renewability till 45 years. Once you pass the age, then you would need to buy another one that will cost you much more. And if you buy a plan with lifetime renewability, you can continue it further in a hassle-free manner.

6) Check Limitations on Room Rent

Whether you will get a private hospital room, semi-private room, or a shared room, it depends on the type of plan you choose. It’s always better to go for a policy that provides a higher room-rent limit if you want to avoid paying extra from your own pocket. 

7) Select an Appropriate Insurance Coverage Amount

In order to find the adequate sum insured for your health insurance plan, you need to find out the total members that need to be covered. So, you need to choose a sum insured that is sufficient to cover the expected medical costs of all the members of the family.

Given the increasing medical costs and medical inflation, a high sum insured is desirable. However, a high sum insured also results in a high premium. As such, if affordability becomes an issue, you can opt for top-up or super top-up health insurance plans to enhance the coverage limit without a considerable premium outgo.

A top-up or super top-up policy acts like a supplemental health plan. The policy has a deductible limit. Claims up to the deductible limit are not paid. However, if claims exceed the deductible limit, the top-up or super top-up plan pays the excess claim.

However, a top up health insurance plan considers the deductible for each and every individual claim whereas a super top up plan takes an aggregate for the deductible.

8) Verify the Coverage Limits and Sub-Limits

Some health insurance plans have sub-limits on the room rent, especially for lower sum insured. If there is a sub-limit, it restricts the overall coverage. If you opt for a room whose rent is higher than the allowed sub-limit, your inpatient claim would be proportionately reduced. However, plans without sub limits are usually more expensive.

Similarly, some coverage benefits might have limits on them. Some common coverage benefits where sub-limits might be applicable include the following –

AYUSH treatments (these include alternative medicine treatments such as ayurvedic, naturopathy-related, Unani, Siddha, and homeopathy)

  • OPD expenses
  • Domiciliary treatments
  • Maternity coverage
  • Organ donor expenses

Tip:When you are buying a health insurance plan for your family, check the sub-limits and limits applicable. Try to opt for plans which do not have sub-limits on room rent and other expenses.

9) Examine the Insurance Company’s Hospital Network

Health insurance plans allow cashless hospitalisation wherein you don’t have to shoulder the hospital bills. The insurance company shoulders such bills on your behalf. Cashless hospitalisation is, thus, convenient and financially liberating. However, the benefit is allowed only if you get admitted in a hospital which is tied-up with the insurance company.

Insurance companies mention the number of networked hospitals that they are tied up with. You can also find the list of hospitals in your city on the insurance company’s website.

Tip: When buying a family health plan, check the list of networked hospitals. Check if the local hospital which you prefer is tied-up with the insurer or not. Also check the pan-India network strength. The stronger the better because it means that you would be able to locate a networked hospital easily, wherever you are.

10) Confirm the Waiting Period for Pre-Existing Conditions

Pre-existing illnesses are those which you or any family member suffers from when buying a new health insurance policy. Since the illnesses are already present, there is a waiting period before the cover is allowed for them. This waiting period is called the pre-existing waiting period and it ranges from 12 months to 48 months.

Tip:If you or any family member suffers from a pre-existing condition, look for plans which have a low waiting period. When the waiting period is low you would be able to avail coverage for your illnesses at the earliest.

However, if no one suffers from any illness and you are buying the plan at a younger age, you can opt for plans with a longer waiting period.

11) Compare the insurance Premiums

Health insurance plans are offered by multiple insurance companies. Every company has its own pricing policies and so, the premiums of health plans differ.

When buying health insurance plans, always compare the different policies on two bases –

The coverage that they offer

The premium that they charge

Tip:Don’t compare the premiums independently because the coverage benefits impact the premium rates. A plan might offer low premiums but it might not be comprehensive in terms of coverage. So, always compare the premiums against the coverage benefits and then choose a plan which offers a comprehensive scope of coverage at affordable premiums.

12) Review the List of Exclusions

Despite the comprehensiveness of a health plan, there are some instances wherein coverage is not allowed. Such instances are called policy exclusions and every health plan has a list of exclusions. When you are buying a health insurance plan for your family, check the exclusion list of the policy.

When you know the exclusions, you would know what is covered by the plan and what is not.

13) Check for better discounts

Health insurance plans offer attractive discounts on premium so as to reduce your premium outgo. Discounts are commonly offered for the following –

  • No claim discount for not making a claim in the previous policy year
  • Discount for adding two or more members to the coverage
  • Discount for buying a long-term policy
  • Discount for buying the policy online
  • Discount for maintaining a healthy lifestyle and practicing healthy habits

Tip: Look for the discounts offered under the plan that you are considering to buy. Choose a plan which offers the maximum possible discounts so that you can save on the premium cost.

14) Search for Additional Benefits of Value

When comparing health insurance plans, look for value-added benefits which different plans offer. Value-added benefits are additional benefits which are offered along with the coverage features. Common benefits include the following –

  • Sum insured restoration
  • Free health check-ups
  • Medical second opinion
  • Telemedicine facilities
  • Free doctor’s consultations
  • Loyalty programs at partnered wellness outlets
  • Assessment of your health

These benefits give something extra with the coverage and enhance your health insurance experience. Wellness is a very important aspect, especially in the post-pandemic situation and can be seriously considered at the time of opting for the same.

Choose a health insurance policy after you have considered all the above-mentioned aspects. This would help you find the most relevant and the best health insurance plan for your family. To buy the best policy, go online.

What Actions to Take When You Have Group Health Insurance Coverage?

If you are an employee at a reputed organisation, chances are that you are covered under your employer’s group health insurance policy. Such coverage can also extend to your family members. If you and your family are already covered under a group health plan, does it mean you don’t need an independent policy?

No it doesn’t.

Even when you have group health insurance coverage, buying an independent health plan for the family is a must. Why? Here are some reasons –

For Sufficient Amount of Insurance Coverage

The group cover would have limited sum insured and cannot be enhanced at your wish. For this you need an individual health plan.

You can also opt for a super top up plan over your group coverage.

For Obtaining a Policy with Relevant Coverage Benefits

Group plans offer standard coverage benefits. If you need a comprehensive and inclusive scope of cover, an independent plan is needed.

For lifetime coverage

Group plans allow coverage only till you are the member of the group. Once you retire, you would lose the coverage which becomes all the more important in older ages.

On the other hand, individual plans have lifelong renewability options.

For Tax Benefits Associated with Health Insurance

You can enjoy tax benefits under Section 80D on the premiums that you pay for an independent health insurance plan upto PKR 25,000 every policy year for premium paid for yourself, spouse and children and an additional amount of PKR 25,000 to PKR 50,000 for parents.

So, use the group health cover as a supplemental cover but it cannot replace the need for an individual insurance plan.

Evaluating Your Health Insurance Policy

Just buying the best health insurance plan for your family is not enough. You should review your coverage every year to ensure that the plan is relevant to your needs. For example, if you get married or have a child, you have a new member who should be added to the coverage. Add the member either during the policy tenure or on renewal.

Similarly, if you want to opt for riders or increase the sum insured with changing needs, do so at the time of renewing your policy.

Regular review of your coverage would ensure that your coverage stays relevant at all stages of your life. Moreover, health insurance plans allow lifelong coverage. So, renew your policy within the due date, without fail, to enjoy uninterrupted coverage against medical emergencies.

A health insurance plan is non-negotiable. When you need to buy the same for family, be careful of choosing the right plan. Consider the afore-mentioned points and compare different plans to find the best and then buy accordingly.

Also, since health insurance plans can be ported, i.e. changed to any insurance company at any renewal, you need not wait for your perfect match. You can always change later. But remember the most important thing is to buy it now, without a delay.

Conclusion

You can use the tips mentioned above to enhance your coverage benefits when buying health insurance for your family. You would be able to make an informed decision. Moreover, you would not need to run from pillar to post at the time claim. 

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