This last week, I found myself buying health insurance for myself. My new job would have covered me, but that is out the window, and so is the possibility to get covered under company insurance(Thanks to the pandemic).

Below, I will explain my process I used to come to my choice. You can find plenty of websites explaining how to choose a health insurance, and some of the pointers I mention below may be repeated, but bear with me in the interest of making this comprehensive.

First of all answer this question - Who are you getting a health insurance for? People around me told me that the general thumb rule is - Insurance premium should be 6 times your salary. (You should also consider other factors like your age, dependents, current illnesses etc.). I was only looking for insurance for myself, if more members in my family weren’t covered, then there would be another decision making step here - whether to choose a family floater plan (calculated by using the age of the eldest member in the plan, to calculate premium) or individual plans for each.

The primary factors to consider include the following, if you just want to get a basic idea about the insurance you’re choosing-

1. Cashless hospitalisation (Medical treatment done without paying the bills yourself) Normally, if you get a treatment done the amount will be paid out of your pocket and will be reimbursed later on by the insurance company. Not everyone has that much liquid cash lying around, so now more and more people are actively looking for hospitals which their insurance company can directly cover. See if the best hospitals in your area, are in the list.
2. In-patient hospitalisation coverage (When you stay at the hospital for medication/treatment for more than 24 hours) Most insurance companies provide a 100% coverage, but there are exceptions. Always choose one which has maximum coverage.
3. Coverage for day-care treatment (Procedures that are completed in 24 hours) It’s self-explanatory, the higher it is the better.
4. Room rent allowance Some plans have no capping on room rent, some allow a certain percentage. Try to find what is the maximum allowance is for a hospital room nearby. It’s really peculiar to me why almost no one discloses this information beforehand, because it can vary a lot. I went through old hospital bills of times when my parents were admitted to a hospital, in my city, and I couldn’t get a quote for government hospitals, but in the private hospitals, the charge averaged around INR 2000, and that also involved around a multitde of factors, including food, cleaning charges, television, medications etc.
5. Pre and post hospitalisation expenses (Reimbursement of expenses prior to hospitalisation & post discharge costs) It is typically 30 days before hospitalisation and 60 days after hospitalisation. Though some plans put limitations on coverage amount, so it’s better talk to the customer service to get clarification.
6. Sub limits for certain expenses/treatment (cap of how much a policyholder can claim for a particular expense) Particularly - Cataract surgery may have sub limit per eye, maternity (Normal delivery and Casearean delivery costs differ) Whatever I found, it’s mostly ailments that effects the elderly, something that doesn’t concern me. I skimmed through the document but I will advice reading the fine print in the policy document.

Other factors to consider -

1. Waiting period - Only if you have pre-existing illness. The lower it is the better.
2. Co-payment - Share of claim you need to pay from your own pocket. Mostly seen in senior citizens or specific need plans. No co-pay means that, in theory, you pay nothing and the insurance covers all costs. I say ‘in theory’ because some costs might not be covered by your plan and you might have to pay.
3. Exclusions - These treatments are not covered by health plan. Typically, include Dental, Eye care (unless you were hospitalised) etc. You should be aware of this, so I’m restating this, DO READ THE POLICY DOCUMENT or get clarification from the company.

Benefits to enhance Sum assured -

1. No claim bonus - Insurance companies increase amount of sum assured by some percentage for the next year, if the insurance amount is not claimed for 1 year, 2 years, etc. This is not a must-have but a nice-to-have feature given high medical inflation.
2. Restoration for additional coverage - In case you spend the entire sum assured, the insurer would add more coverage without taking additional premium.

With this criteria, I went on to check plans on policybazaar.com and started screening them. And from the list of options, I also checked the LiveMint Mediclaim Ratings for the past few years, just to see how my choices were performing.

2019 2018 2017

Finally decided with HDFC Ergo (formerly known as Apollo Munich). They were consistently in the top ranks, and were more suitable to my needs, with more number of cashless hospitals in my areas than any other company. The only con here is maybe they charge a lot more than most insurers, however I have some reviews that tell me the reimbursement procedure is hassle-free and comparatively faster, and that is worth the extra amount.