How to choose the best health insurance cover?

How to choose the best health insurance cover?

by 5paisa Research Team Last Updated: Feb 16, 2023 - 12:29 pm 859 Views

There are numerous health insurance policies, each with its fine print, but how can you choose the best health insurance? The following article offers some advice.

The recent pandemic has highlighted the need for health insurance. Rising inflation has been linked to an increase in the cost of effective preventive healthcare and medical treatment. To successfully address this issue, a large number of ordinary middle-class families are looking for cost-effective alternatives.

Treatment for even minor health issues might now deplete your savings significantly. Comprehensive health insurance coverage is a one-stop solution to such issues. Choosing the best health insurance coverage, on the other hand, is critical. This post will assist you in understanding the characteristics that will assist you in selecting the best health insurance.

Also Read: What are the best health insurance plans in India for 2023?

Type of Plans

In general, there are two types of health insurance plans: indemnity plans and defined-benefit plans. Indemnity plans reimburse the hospital expenditure, whereas defined-benefit plans pay a flat sum amount regardless of the actual hospital expense. An individual health insurance policy or a family floater policy might be the indemnity plan. And it is something that should be included in one's insurance portfolio.

Indemnity Cover

Furthermore, you should understand whether indemnity coverage is appropriate for your needs. An unmarried person looking for health insurance should choose an individual health plan. Those who are married and have children should think about a family floater plan. Remember not to include your parents in your family floater insurance because the premium is calculated using the eldest member's age. Instead, get individual coverage for them and consider establishing a health corpus for them. This is because the premium paid will increase as they become older.

Cover Requirement

There is no hard and fast rule for determining how much health insurance you require. This would ideally be determined by a variety of parameters such as income, dwelling city, family illness history, and so on. An individual residing in a Class A metropolitan city, for example, may require coverage of Rs 20 lakhs due to the high cost of living. Not only is the level of life better in metropolitan areas, but so is the standard of medical care. Individual insurance of Rs 10 lakhs may be sufficient for those living in Class B and Class C cities.  


Sub-limits are now included in the majority of health policies. It is simply a threshold limiting reimbursement under certain expense categories. For example, the room rent is limited to 1% of the sum assured. This implies that regardless of the overall sum insured by this insurance, the hospital expenses must be paid out of pocket until they exceed the imposed sub-limit. Not all health plans have such sub-limits, however, a handful does provide the opportunity to add sub-limits when purchasing the plan. As a result, check to see if your plan includes any such sub-limits.

Pre-Existing Diseases 

The majority of health insurance coverage covers pre-existing conditions, but only after 48 months. However, some companies cover them after 36 months or even less. As a result, it is critical to report any pre-existing conditions when purchasing insurance. This will ensure that the claim settlement procedure runs smoothly. Furthermore, many specific conditions have a waiting time of 12-24 months after which claims can be filed.


Though the co-payment provision is not found in all plans, it is increasingly prevalent in a few health insurance policies. As you get older, your premium rates rise, and a co-payment may provide some relief in terms of cost by assisting in keeping your premiums low. Some plans require a co-payment of up to 20% if the treatment is received at a non-network hospital.

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