Advice to first-time health insurance buyers

The intermittent recurrence of Covid has started impacting lives yet again with the new Omicron subvariant, BF.7 causing an uptick in cases. This has once again brought the spotlight to the significance of having an adequate health insurance policy. Keeping this in view, the regulatory authority of the Insurance Regulatory and Development Authority of India (IRDAI) has also recently reached out to insurers to take a stock of their preparedness.

Amid the fresh spurt in cases, having a sound financial safety net is of utmost importance. However, if you are someone who’s going to buy health insurance for the first time, it can be a bit perplexing to know what makes your policy truly comprehensive. Here’s a checklist that you can follow to zero in on the right health insurance plan –

Type of policy

While deciding on a health insurance plan, you will ideally have to select between two options-individual or family-floater. The former covers each individual member and has separate premiums and sum insured. In the latter, the coverage is for all family members under one plan, and the premium and the total sum insured are shared. If you have dependent parents and/or a spouse, it is advisable to get a family floater. It will reduce the insurance expense and increase the coverage as a group. As the children grow up, it is recommended to have an individual policy for each member.

Sum insured

This has to be the most critical aspect of your policy and so, it should be chosen wisely. Sum insured is the maximum amount an insurance company will pay the insured in case of a health claim. Given the rising medical inflation, one should always opt for higher sums insured, especially in metro cities. Fortunately, there are now policies that offer a cover of Rs 1 crore for a premium of about Rs 1000-1200 per month. The other factors to consider are family medical history, pre-existing diseases, etc while deciding the sum assured.


Purchasing a health insurance policy at a younger age, preferably as soon as you start earning, is recommended. This is because insurance premiums are charged based on the policyholder’s existing age and disease. Therefore, the earlier you buy, the lower the premium and the more affordable the insurance. Additionally, the chances of benefiting from the no-claims bonus, ie, an incentive to stay healthy without availing of claims, are comparatively higher at this age. Not to forget, buying at an older age limits your choice of plan and increases your premium.

Comprehensive coverage

For the best health insurance policy coverage, it is advisable to choose features that cover maximum blind spots, especially as Covid intensifies once again. Hence, select pre- and post-hospitalisation, OPD, day-care procedure coverage, consumables coverage, domiciliary hospitalization, preventive medical check-ups, ambulance coverage, etc.

Waiting period and PED

Regardless of age, the peril of being impacted by diseases has increased due to lifestyle choices like smoking, an unhealthy diet, and inactivity, increasing the risk of cardiovascular disorders, diabetes, lung and chronic, etc. Hence, when purchasing a health insurance plan, be aware of the waiting period, which may range from 3–4 years, as during this time, no claims can be filed for critical illnesses or pre-existing diseases (PED). Thus, choose plans that cover PED from the first day or within 30 or 40 days of the policy’s purchase.

Claim settlement

Claim settlement is considered the moment of truth. Here’s what you can keep in mind for a better claim experience –

1. Go for a plan that has a broader list of network hospitals so that cashless claims are available.

2. Select an insurance company with a higher claim settlement ratio. A ratio of 95-98% is regarded as ideal.

3. Never hide even the smallest details from your insurer at the time of purchase to avoid the rejection of claims.

To conclude, with Covid-19 making its way back with different variants, it is vital to have a health insurance policy to ease your financial burden. So, follow these golden rules before you select your plan, and always compare the features, inclusions, and exclusions of various policies online and read the terms and conditions.

(The author is the Business Head – Health Insurance,

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