India faces the twin problems of having to deal with a high rate of infectious diseases and growing incidences of chronic diseases, which is a result of the sedentary lifestyle we have been leading.

Bhabatosh Mishra, Director – Underwriting, Products and Claims, Niva Bupa Health Insurance says, “The good news, however, is that India has made rapid progress in the field of medicine and most modern treatments are today available in the country. Indian doctors are acclaimed worldwide and the most advanced diagnostic and therapeutic technology is available here.” 

However, these do come at a much higher cost and in order to afford the cost of treatment in today’s times, having health insurance has become an absolute necessity.

While due to Covid, the awareness has gone up substantially, Mishra points out, “many people perhaps are not aware of how to choose the most appropriate health insurance product.” 

Here are some critical factors that one must consider while buying Health Insurance include;

Sum Insured – The decision of adequate sum insured must be made keeping in mind:

• Place of residence - Healthcare consumption is largely local. The cost of treatment varies from city to city. Therefore, Mishra explains, “a person living in a metro city may need a higher sum insured, as the medical costs are more expensive when compared to tier 2 and 3 cities.” 
• Life stage and age - Younger people may need a relatively lesser sum insured as compared to older individuals.
• Family size and composition – Larger families will need higher sum insured coverage as otherwise, one runs the risk of running out of sum insured. 
• Future cost of hospitalization – This would depend on medical inflation and the rising cost of treatment due to the advancement in technology and availability of modern treatment. 

Claims Settlement ratio –This is a good indicator to look at before purchasing. However, Mishra says, “one must be careful not to rely on only this figure as new products due to applicable waiting periods may have a little lower settlement ratios which would increase gradually with time once the company’s renewal book becomes larger.”

Network Hospitals – Instead of going by the number of hospitals in the insurer’s network of hospitals, check how many hospitals in their area and city have a tie-up with the insurer. Mishra explains, “This will ensure that they don’t end up running from one hospital to another during an emergency.” 

He further adds, “Also, look for whether or not the large and reputed multispecialty hospitals are in-network or not. This would be helpful if ever a need for high-end care or treatment arises.”

Terms and Conditions – A policy document in which the T&C is written in simple, non-jargonized and colloquial language removes ambiguity. Claims can be declined in case of pre-existing diseases, exclusions mentioned in the policy, etc. 

Mishra adds, “It is important to understand these conditions well and opt for policies that offer less waiting period and have minimal exclusions. My advice is ‘simple is always better and ‘what is easily understood is easily used’.”