Evaluate Benefits, Coverage Clauses Before Taking Health Cover

Published: 23rd August 2015 04:49 AM  |   Last Updated: 23rd August 2015 04:49 AM   |  A+A-

An essential financial planning tool that every person must possess today is a health insurance policy covering self and the family. It helps mitigate the rising healthcare costs that people incur due to both communicable and non-communicable diseases. Health insurance is an indispensable financial tool that every individual requires at some point in time. Hence, one should be mindful of the following factors while choosing a plan for themselves and their families.

A person’s current health status should be the starting point for choosing a policy. A comprehensive health check-up will enable a person to determine the benefits and features he/she would need in a health insurance policy.

The age of the family members should also be considered while opting for an individual policy versus a family floater policy. One must heed that the premium levied on a family floater is based on the oldest family member, his/her age and also the health status. It is advisable to buy a separate policy for family members with special needs.

I strongly recommend that anyone purchasing a policy, review its terms and conditions before finalizing. One should compare policies based on benefits and coverage clauses, rather than on premium. Choosing the lowest priced policy could result in a bad experience, as low policies often offer little coverage.

While comparing policies, it is important to consider the extent of coverage provided by each. One must evaluate if there are any restrictive clauses present in the policies, in relation to sub-limits or co-pays and any restrictions on room type that can be accessed.


Place of stay plays an integral role while chosing a policy as the cost of healthcare facilities varies in metros, non-metros and small towns. A sum insured level of Rs 5-7.5 lakh (with a 100% no claim bonus) is a satisfactory policy amount for a family of two adults and a child, while an individual should choose a policy ranging from Rs. 3-5 lakhs (with a 100% no claim bonus) depending on his or her health status while purchasing the policy.

Last but not the least, one must ensure that information he/she is providing to the insurer is factually accurate, as companies calculate premium and risk based on this information. Complete transparency must be maintained while filling up the form to ensure a seamless claim procedure when the need arises.

(The writer is CEO, Apollo Munich Health Insurance)

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