Health Insurance Plans: A Comparison of Features and Benefits

Paybima, backed by Mahindra Insurance Brokers Ltd, provides a digital platform that helps you compare health insurance plans from multiple insurers online. With a team of more than 700 certified advisors, Paybima helps you choose the best health insurance plan.  

Here is a detailed guide on factors you should consider while comparing health insurance plans. 

9 Factors to Compare Health Insurance Plans 

Before comparing different health insurance plans, it is important to understand your medical needs first. Knowing your family’s medical history will help you understand your future medical requirements and the type of coverage you will need. Once you are aware of your own needs, consider the following factors that you should compare to select the right health insurance plan. 

1. Coverage  

Coverage doesn’t only mean the sum insured, but it includes all the benefits you will be getting under the health insurance plan. Comprehensive coverage should include expenses for hospitalisation, surgeries, daycare procedures, health checkups, pre and post-hospitalisation expenses, OPD expenses, alternate treatments, critical illness cover and more. Also, check if there are any sub-limits and restoration benefits available. 
 
Pro tip: 

• Look for plans that offer sufficient coverage for hospitalisation, treatment, and post-hospital care. 
• Consider plans with a restoration benefit, which refills your sum insured if it gets exhausted. 

2. Premium 

The sum insured and the premium should be directly proportional. For a lower sum, the insured value premium should also be lower. Higher premium health insurance plans should provide extra benefits. However, make sure you have adequate coverage to cover all your medical needs and avoid out-of-pocket expenses. Don’t just select a plan because it has a low premium. 
 
Pro tip: 

• Opt for plans without capping or those offering higher room rent coverage, even if they are slightly expensive. This will save you a lot of your out-of-pocket expenses at the time of claim. 
• If you need frequent outpatient consultations, choose a plan with OPD coverage, even if that comes with an additional premium. 

3. Pre-existing Diseases and Waiting Period 

When selecting a health insurance plan, pick the one that covers pre-existing diseases and also check the waiting period for these diseases. If you need immediate treatment, look for riders to waive off the waiting period. To avoid claim rejection in future, disclose your medical history accurately and inform the insurer if you have any pre-existing disease. 
 
Pro tip:

• Some insurers offer plans with a shorter waiting period or coverage from day one for select diseases. 

4. Network of Hospitals 

Check the list of network hospitals associated with the insurance company to make sure you get access to cashless treatment in your vicinity, especially during medical emergencies.  
 
Pro tip:

• Check if your preferred hospitals and speciality centres are part of the insurer’s empanelled network for seamless cashless claims. 

5. Renewability 

Always select health insurance plans that offer lifetime renewability so that you have continuous health insurance coverage for your lifetime. Renewability also ensures that your policy is customisable according to your changing medical needs at different life stages. 

6. Additional Benefits and Riders 

Most health insurance plans nowadays offer value-added benefits and riders to enhance your coverage. Some additional benefits include free health checkups, wellness benefits and teleconsultation. Riders may include reduction in waiting period, maternity coverage, critical illness coverage and more. 

7. Exclusions 

There are certain conditions and diseases for which no coverage is provided. Review the exclusions in a health insurance plan so that you have a fair idea of what is covered and what is not. It helps you in making an informed decision. 

8. Co-payment 

Co-payment is the percentage of medical bills that are to be paid by the policyholder. It ranges from 10% to 30%. It can be a good way to lower the premium for senior citizens. However, a high co-payment percentage will increase your out-of-pocket expenses, so select a co-payment value according to your budget. 
 
Pro tip: 

• A lower or zero co-payment policy is preferable for minimising out-of-pocket expenses. 

9. Insurer Credibility 

Check the financial stability and reputation of the insurance company. Look for customer reviews. Check the claim settlement ratio (CSR) and the claims denied by the insurer. A company with a high CSR and stable financials is a reliable company. 

Pro tip: 

• A hassle-free online claim process can make emergency situations smoother. 

How to choose the right health insurance plan for yourself and your family? 

1. Assess Your Medical Needs: Consider age, pre-existing conditions, lifestyle risks, and family medical history before selecting a plan. 
2. Check Policy Terms & Exclusions: Read the fine print to understand what’s covered and what’s not, including sub-limits and exclusions. 
3. Compare Premiums vs. Benefits: Don’t just choose the lowest premium. Look for a balance between affordability and coverage. 
4. Look at Claim Settlement Reputation: Opt for insurers with a strong track record in quick and hassle-free claim approvals. 
5. Seek Expert Advice: If unsure, consult an expert at Paybima for assistance who will guide you in the entire process.