Points to consider while taking health insurance in India.

Majority of us buy insurance as if we were buying a TV or any other article. We fail to appreciate that insurance is a contract which promises us certain services at the onset of an adverse event. The terms of the contract need to be read and the future implications of the same needs to be understood before signing the dotted lines. We decide based on the marketing literature printed by the insurer or the agent who represent the insurer both in variably would talk about all good things about the product. An insurance broker may talk you through pros and cons of products from different insurers. One should focus on following while choosing the right mediclaim/health insurance. 

1. Coverage – Primary focus should be on what coverage/sum assured for self & family. Whether we need to go for family floater or individual coverage. Coverage for the elderly must be given extra care due to their age, existing medical conditions etc. Decision to  include them in your family floater or to opt for specific senior citizens coverage should be carefully taken comparing the benefits offered by standalone senior citizens policies or family floater policies.
2. Exclusions – Some experts say that you should know your exclusions better than your coverage. Knowing your exclusions well will ensure there are no bad experiences of claim repudiations during a medical emergency. Single largest reason of repudiation of claims (almost 65%) is due to pre-existing ailments, which are not covered for specific periods. This prompted the Govt. to define pre-existing ailments in Health Insurance Regulation 2013.
3. TPA/Network hospitals – If your insurer has a Third Party Administrator(TPA) to service their mediclaim, then the quality of the TPAs service level and network of hospitals would matter as you wouldn’t be dealing with your insurer directly but with the specified TPA as per the contract. Keep in mind that every insurer and every branch of the same insurer may have different TPAs servicing them. Contact your broker to know which TPA is providing service to a particular insurer and the service level of the said TPA.
4. No claim benefits – It is advisable to find out if your insurer offers you no claim benefits for the mediclaim policy you are planning to purchase. There are insurers which offer no claim bonus in terms of increase in basic sum insured or as reduction in the premium you need to pay the next year.
5. Annual Increase in premium due to age bracket change – Premium payable usually increases when the insured changes from one age bracket to another. The age brackets may differ from one insurer to another. Create awareness about the age brackets that your insurer follows.
6. Imposing limits and restricting coverage are tools in the hands of the insurer which can reduce the premium at the inception and control loss during the policy period. Usually these limits and restrictions may not be discussed with you if you’re too much fixated on price and is not looking into the details of the policy coverage. Know the set limits and restrictions properly.
7. Seek proper Representation in the policy – We feel that you should not allow any one sell you a policy. The sellers would only talk about benefits of their products and may not highlight their flaws in comparison with others or if a competitor has a better option for the same price. This brings forward the importance of appointing an insurance broker who is capable of presenting multiple options for you to select from rather than letting someone arm twist you and sell you something you never intended to buy. 
8. Premium/Price – Premium will always depend upon the coverage you have chosen-better the coverage, higher would be the premium. Don’t focus too much on the price; rather concentrate on the coverage you require- after all the policy you have taken should benefit you at the time of an emergency. Always compare an apple to an apple and a pear to a pear and know the difference between both.