Since the incidence of coronavirus outbreak, there is a significant growth in health insurance sales as per the market trend. There are also several new changes in health insurance plans based on the guidelines provided by the Insurance Regulatory and Development Authority of India (IRDAI). IRDAI introduced several new changes to ease the process of selection of the best health insurance plan by keeping common people in mind.

Still, selection of the best health insurance policy is a difficult task for many as there are several players in the market offering health insurance plans. Every health insurance policy may not address all the features that you may be looking for in a policy. If you are planning to buy health insurance, you need to do some research to find out what features are covered and what are not in available health insurance plans offered by different players in the market to arrive at a final selection.

For example, some factors that you must look for in a health insurance plan are coverage, benefits, co-pays, waiting periods, network hospitals, riders. Because you should select the best health insurance policy available based on your requirement and affordability. These days, health insurance policies are also sold online through web aggregators where you can compare all available plans based on your details and select the best plan. We mentioned here some key factors to look at in a health insurance policy to make the best choice. 

Choose a Plan That Provides Adequate Sum Insured Amount

You should select a sufficient amount of premium keeping the inflating medical costs in mind to meet your medical expenses. For example, cardiac surgery can cost around four to five lakhs which could be not an affordable limit for an average income group family. Hence you should get a plan with enough amounts to cover the bills if you have to get treatment in the best hospital.

Choose the right plan based on the number of family members. Health insurance is offered as individual plans or family floater plans. If you have aged parents, the premium for them may be high based on their age. Combining aged people with other family members in a single plan can increase the premium cost. In that case, a separate plan is advised for parents.

Know About the Waiting Periods in the Health Insurance

You must understand the terms and conditions of health insurance and compare all available plans before you finalize your decision. The waiting period is one of the main features you should compare while selecting the best plans.

Generally, there can be different waiting periods in a health insurance plan. If there are any health issues at the time of purchasing health insurance, they are called pre-existing diseases. Coverage for such health issues is generally not covered for a few years from the date of purchasing the policy. This waiting period may range from 2 to 4 years which may vary from plan to plan and company to company. If you have any such pre-existing health issues, aim to choose a plan with less waiting period.

Check If There Is Any Capping On Room Rent Limit

Room rent capping is an important aspect to look for in health insurance. Room rent capping can define the bill amount that your insurer can clear at the time of claim. Because in hospitals, fees for different services can vary based on the type of room you choose. Some health insurance plans define the room rent limit in terms of percentage, some define it in terms of amount, and some define it in terms of room type. If there is such a limit, then you would end up pay some part of bills from your pocket. The insurer would pay only limited bills that fall under the slab based on the room rent limit mentioned in policy documents.

It is better you select plans with room type rather than selecting plans with a limit in terms of percentage or amount. Because room rents in hospitals can change over a period. Room rent in a corporate hospital today would not the same after a few years. You should choose a plan that covers a sufficient amount keeping future medical costs in mind. Plans which mention this feature as of room type are better as the clause of room rent limit is not in terms of amount or percentage.

Understand the Exclusions in a Health Insurance

While purchasing health insurance, most people do market research to understand the features, but they ignore to understand the exclusions. Understanding the exclusions is also equally important to avoid disappointment later and avoid claim rejections. Details about the exclusions and treatments are listed in the policy brochure. Read and understand the term and conditions thoroughly before purchasing health insurance.    

Check Claim Settlement Ratio of the Insurance Provider

Another important aspect to look for is the claim settlement ratio. It is something related to the insurance company. The claim settlement ratio reflects the overall performance of the company. Every health insurance company mentions this on their website. Another option if someone wants to check these details is to visit the IRDAI website.

IRDAI releases an annual report every year where it mentions these details which can be accessed by anyone. If you want to know how the insurance provider is performing, then you can cross-check these details on the IRDAI website.

Check If There Is Cashless Facility

There are two different types of claim settlement in health insurance, one is the cashless claim and another one is reimbursement claim. The claim process would be similar for almost every insurance company except for some minor differences in their functionality.

Cashless facility is applicable if you hospitalize in a recognized hospital by your insurance provider. In a cashless claim settlement, your insurer will clear your bills with the hospital directly. Reimbursement claim settlement is applicable if you get hospitalized in a hospital that is not recognized by your insurer. In reimbursement claim settlement, you would be paying all your medical bills out of your pocket and claim them later for reimbursement which can be a hassle.     

Every insurance company mentions the list of network hospitals it has tie-up with, on their website. Choose a plan from an insurance provider who has a wide network of hospitals. The advantage of selecting plans that have a wider network is at the time of emergency you will have more hospitals to choose from.


While purchasing a health insurance plan it is advised to compare all the available plans that fall under your preferred range based on your budget. Understand the terms and conditions, what features are covered, and what is not. You can minimize the rejection at the time claim process if you know the details of the policy. If you are still not sure, it is advised to take help from your financial advisor or someone from the customer support team.

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