‘It’s better to be safe than sorry,’ you must’ve heard this phrase often—it echoes even louder when it comes to healthcare in India. In a country as vast and diverse as ours, ensuring your family’s well-being is a huge responsibility.
Despite the growing awareness of health insurance, over 400 million people in India remain without coverage, leaving families vulnerable to skyrocketing medical expenses.
With the sheer variety of plans available, choosing the right health insurance for your family can feel like navigating a maze.
But understanding a few key factors—like coverage, premiums, and benefits—can make this task simpler. Let’s take a look at how you can choose the right health insurance plan for your family.
11 Things That Truly Matter While Selecting The Right Insurance Plan For Your Family
Whether it’s the rising costs of healthcare or unexpected emergencies, picking the right plan that works for you is utterly crucial. Here’s a quick guide to help you make an informed choice.
1. Lifetime Renewability
Will This Plan Last Forever?
Imagine this: you’ve paid premiums diligently for years, but as you grow older, the insurer decides to stop renewing your policy. Sounds unfair, right? Look for plans with lifetime renewability so you’re never left uncovered when you need it most—especially during retirement.
What to Look For:
Plans that offer lifetime renewability without age restrictions, ensuring continuous coverage even during retirement.
Check if there are any additional charges or restrictions on renewability after a certain age.
2. Claim Settlement Ratio
How Reliable Is the Insurer?
A policy is only as good as the company behind it. If your insurer doesn’t pay claims promptly, what’s the point, right! Check the claim settlement ratio (higher is better) to ensure you’re choosing a reliable partner in times of crisis.
What to Look For:
Opt for insurers with a claim settlement ratio above 90%, as this indicates reliability in honouring claims.
Check the average time taken to settle claims; faster settlements are better in emergencies.
3. Sum Insured
How Much Is Enough?
Hospital bills can quickly spiral out of control, especially in metros. Choosing an adequate sum insured can mean the difference between a quick recovery and a financial headache. Think about factors like your city’s medical costs and your family’s health history before deciding.
What to Look For:
A minimum sum insured of ₹5–10 lakhs for a small family in urban areas; consider higher amounts for metros where medical costs are steeper.
For larger families or high-risk members, opt for ₹15 lakhs or more.
4. The Co-Payment Clause
Are there any Hidden Costs?
Many policies sneak in a co-payment clause, meaning you’ll have to pay a portion of the bill from your pocket. For example, a 10% co-payment on a ₹5 lakh bill would still leave you with ₹50,000 to pay. Choose wisely and know what you're signing up for.
What to Look For:
Prefer policies with no co-payment or a co-payment clause of less than 10%.
Ensure that co-payment is not applied universally but is limited to certain conditions (e.g., specific age groups).
Bonus Tip: Premium Amount While affordability is important, prioritise value over cost. A plan with a slightly higher premium that offers robust coverage and fewer exclusions is often a better choice in the long run. |
5. Right Coverage
Does It Cover Everything?
From maternity benefits to daycare treatments, coverage isn’t one-size-fits-all. If you’re young and planning a family, for instance, maternity coverage is essential. Analyse your family’s specific needs and go for a plan that ticks the right boxes.
What to Look For:
Look for comprehensive coverage that includes hospitalisation, pre- and post-hospitalisation expenses (30 days prior and 60 days post), maternity benefits, daycare treatments, and ambulance charges.
Mental health treatments, telemedicine, and alternative treatments like AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) are added benefits.
6. Network Hospitals
Are the Hospitals Near Me Covered?
The closer the network of hospitals, the easier it is during emergencies. A long drive to an out-of-network hospital could mean you pay out of pocket. Always check the network hospital list before signing up.
What to Look For:
The insurer should have a network of 5,000+ hospitals nationwide, with prominent hospitals in your city or town included.
Ensure cashless treatment is available at these hospitals to avoid out-of-pocket expenses.
7. Sub-Limits
Is There a Cap on Treatments?
Imagine discovering your policy covers only ₹30,000 of a ₹1 lakh surgery bill due to sub-limits on specific treatments. Look for policies without restrictive sub-limits, or at least understand them well.
What to Look For:
Policies without sub-limits are preferable.
If unavoidable, sub-limits on major procedures like cataract surgery should be at least ₹30,000–50,000 or higher.
8. Waiting Period Clauses
How Soon Can I Use the Policy?
Many policies impose waiting periods for pre-existing conditions or certain treatments. For example, maternity benefits may have a waiting period of two years. Be clear about these timelines when choosing your plan.
What to Look For:
A waiting period of 2–4 years for pre-existing diseases is common, but shorter waiting periods are better.
Maternity benefits should have a waiting period of 2 years or less.
9. Critical Illness Coverage
Does It Cover Serious Illnesses?
A regular policy may not suffice for serious conditions like cancer or heart disease. Critical illness riders can provide a lump sum payout for such diagnoses, ensuring you’re not financially drained during a long recovery.
What to Look For:
Coverage for critical illnesses such as cancer, heart attack, stroke, kidney failure, and major organ transplants.
A lump sum payout of at least ₹10–20 lakhs is ideal to cover treatment and recovery costs.
10. Family Floater Plans
Is It Family-Friendly?
Instead of juggling multiple individual plans, a family floater policy can cover everyone under a single sum insured. It’s a practical and often cost-effective option for young families.
What to Look For:
A family floater plan should provide a sum insured of ₹10–20 lakhs or higher for a family of 3–5 members.
Ensure all members are covered equally, and check for newborn coverage.
11. Room Rent Limit
What About Room Charges?
Room rent caps can be a nasty surprise. For instance, if your policy allows ₹5,000 per day but the hospital charges ₹8,000, you’ll be paying the difference. Look for policies with higher or no caps on room rent.
What to Look For:
Policies with no cap on room rent are the best.
If capped, it should cover private rooms (₹5,000–10,000/day) rather than restricting you to shared or general wards.
Disclaimer: This information provided is intended for general informational purposes only. It is not a substitute for professional advice or guidance. For personalised recommendations or specific concerns, please consult a certified professional.
