Buyers Guide on Health Insurance. Choose between individual or family floater plans. Key points to remember, exclusions and benefits. Health Insurance Product Ratings. Where and how to compare health insurance policies

1. Health
Insurance
8 concepts to assist you in
making informed buying
decision
1 i-save.com

2. 2 i-Save.com
HEALTH INSURANCE
8 concepts to consider when buying Health
insurance in India
www.i-save.com

3. 3 i-Save.com
Some basic Facts
1 in 4 women and 1 in 5 men suffer from
critical illnesses before they reach
retirement age
 Critical illnesses such as heart ailment,
cancer, diabetes, kidney related diseases
are the most common
 Most critical illnesses require high medical
and hospitalization costs
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4. 4 i-Save.com
Tip 1 - Select an adequate
Sum Assured/Sum Insured
 The amount of cover purchased from an
insurer is called Sum Assured
 It is typically for 1 year
 Example: A Rs. 3 lac sum assured will allow
you to claim up to Rs. 3 lac for
hospitalization and other medical
expenses covered by your plan
 Any expenses higher than the sum
assured, will be borne by the insurer
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Tip 2: Decide on Individual vs.
Family Floater
 A family floater policy covers all family members
(Insured, his/her spouse and children) under one
single policy
 There is a limit on the number of children that can be
included and age before and beyond which they are
not covered
 Parents of the insured are typically not included in a
family floater policy
 An individual policy provides coverage to only the
individual for whom the insurance has been
purchased
 While a family floater may turn out to be cheaper
than taking 2 or more individual policies, the
associated cover provided is at a family level
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Tip 3: Look for Cashless
hospitalization
 A feature provided by health insurance
companies where a person can get the required
treatment and the associated medical expenses
are settled by the insurance company directly
with the hospital
 The hospital must come under insurance
companies network
 The treatment should be covered under your plan
and up to a maximum of your Sum Assured
 Compare the associated network of hospitals of
each insurer when comparing products to meet
your needs
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Tip 4: Check on Maximum
Renewal Age
 Thisis the age to which the company
would continue to provide you with
health insurance on payment of
premiums
 A product that offers a higher maximum
age of renewal should be considered
favorably as it allows you to remain
covered under a health insurance plan
especially at ages when it matter the
most
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8. 8 i-Save.com
Tip 5: Check on Exclusions
 Most products come with a set of defined exclusions
 Any costs associated with an excluded medical
condition will not be covered by your health
insurance product
 While exclusions vary across products the following
are most common and are excluded under most
products:
 Expenses arising from HIV or AIDS and related diseases,
use or misuse of liquor
 intoxicating substances or drugs & intentional self injury
 War, riots, strike, nuclear weapon, induced treatment
 Compare exclusion clauses of insurance products
before buying
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9. 9 i-Save.com
Tip 6: Review the Critical Illness
cover
 Generally available as a top-up or rider with your health insurance
policy. These plans cover you for certain specific critical illnesses
that are pre-defined as being covered under the plan
 The insured is paid the Sum Assured as a lump sum amount within a
few days of a critical illnesses being diagnosed. Once this lump sum
is paid, the plan ceases to exist
 Difference between Heath insurance plan & Critical Illness plan
 Health Insurance plans cover costs related to hospitalization on
account of any medical condition or injury
 Critical Illness plans cover only pre-specified illnesses. Both are
bought for a specified Sum Assured (the maximum benefit payable
by the insurance company). They are typically sold for one year with
a renewal option
 A health insurance policy with a critical illness rider will help you
meet your hospitalization expenses for both critical illnesses or even
other diseases/accidents through the health policy
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Tip 7: Understand the Waiting
Periods
 Most health insurance policies have a waiting period
that varies from 30-90 days
 No claims are permissible during this waiting period
 Waiting period does not include any accidental
emergencies which are usually covered from day 1
 The waiting period varies with product and company
and is a feature that you should compare at the time
of purchasing health insurance
 There are also certain diseases that are not covered
for specific waiting periods. These waiting periods as
well as the specified diseases to which these periods
apply vary across companies and products and
range from anywhere between 1 to 4 years
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Tip 8: Determine the Pre-
existing disease cover
 Any disease or ailment already in existence at the
time of purchasing a health insurance policy is
termed as a pre-existing condition
 All pre-existing illnesses at the time of taking the
policy are generally excluded from the health
insurance cover
 In some products pre-existing illnesses may be
covered after a specified waiting period. It means
that if you continue with an insurance product (i.e.
keep renewing your policy) for the specified period,
then certain pre-existing illnesses may be covered on
the completion of the waiting period
 This waiting period varies by product and insurance
company
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12. 12 October 25, 2011
How to get Health Insurance
 Always Compare available plans before
buying
 Check the product benefits, terms and
conditions and company’s service history
 Review the i-save Ratings for insurance
products – as published in India’s leading
newspapers
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