How to choose a health insurance in India? Learn about the subscript and clauses in this video!!
Channel: Simply Insurance India
Date: 2021-10-10

This is the first series of this channel " Simply Insurance".
Our endeavour  is to explain insurance terms in the simplest possible manner so that u can take an informed decision when you buy insurance.

Today we shall be discussing  about health insurance.

Most of us understand  these two terms sum assured which is the maximum  amount paid by the insurance company  in the event of a claim  and premium  which is of course the amount that we pay to the insurance company when we buy these policies.

We usually  check these two parameters.  What is the sum assured and what is the premium 

Say for example insurance company A, the sum assured  is 2 lacs the premium  is rs 5000 and insurance company  b the sum assured is 2 lacs but the premium quoted is 6000

We tend to pick the one with the lowest premium . This definitely  should be a factor but I would suggest you check a few other things as well.

The list which I am going to share is not the most comprehensive  list but in my view the most important  ones which can have an impact in the event of a claim.

The first parameter to check is the sublimits.

Pl ask your insurance agent are there any sub limits in the policy , if so what are they.

The most common  example of the sub limit is the room rent . Some policies  have a sublimit of day 1% of the sum assured as the sub limit

Let's  take our earlier example

Policy a  sum assured 2 lacs premium 5000 room rent sub limit 1% of sum assured per day which works to 2000 per day.

Policy b sum assured 2 lacs premium  6000 and no room rent sub limit.

Now let's  take a claim scenario

Say the insured got admitted in the hospital for a surgery for 5 days and incurred an expense of say 1 lakh. Ideally he should stay only in a room of upto 2000 per day to avoid any deduction in his claim

Supposing he couldn't  find a room for 2000 per day and stayed in a hospital room of 4000 per day

Room rent 5 * 4000  20000
Surgery doctors fees 80000

Total claim made by him is 1 lakh which is well below the sum assured of 2 lakhs

But he will get

Room rent 2000 * 5 10000
Surgery       40000 ( proportionate  deduction of room rent) meaning he exceeded the room rent limit prescribed by the policy 

Total claim payable under policy a is only 40000  

That's  the reason I am asking to carefully  check all the sub limits in the policy.

Now let's  move on to another topic called the waiting period

Waiting period is a certain span if time before which the claim becomes admissible. 

Some policies have a waiting period of say 4 years for pre existing  illness, joint replacement  surgery 

What this effectively  means is that say the policy commences on 1st jan 2021. U have to have four continuous  years of coverage, only after 01 jan 2025, the insurance company will entertain  claim for these illnesses 

So if you are insuring your aged parents, check the waiting period for cataract joint replacement 

Or if you are planning  to start your family check the waiting period for maternity  cover.

Last but not the least item that you should check in the policy is the co payment.

Co payments are the percentage of claim borne by the insured.

Some policies have a 10% co payment of the admissible claim amount.
In the case of our earlier example the admissible claim amount was only 50000 10% works out to 5000, the total claim payable under policy a works out to 45000

Whereas policy b even though the premium was a little  higher, there were no sub limits, no waiting period and no co payments, the entire claim would be admissible. 

To summarise, before buying a health insurance policy pl do make a comparisons between polcies

Please check the sum assured
Premium payable
Sub limits prescribed for oom rent ambulance doctors fees etc

Check the waiting period of the illnesses 

Check the compartment percentage 

And then make an informed choice.

Happy insuring.

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