Healthcare costs in India are rising at an alarming rate, and out-of-pocket expenses can put a massive strain on your savings. According to a report by the Public Health Foundation of India, over 60% of healthcare costs in India are paid out of pocket, making health insurance not just a good idea but an absolute necessity.

Whether you're in your 20s or planning your retirement, having the right health insurance policy can save you from draining your hard-earned savings in case of a medical emergency.

So, how do you choose the right health insurance plan that suits your needs? Let’s walk you through the key features you must consider while selecting a health insurance policy.

Must-Have Features in a Health Insurance Plan

• No Co-Pay

While a co-pay option may lower your premium, it’s not always the best idea. Imagine paying 10% or 20% of your hospital bill for a surgery costing ₹3,00,000. That’s ₹30,000 to ₹60,000 straight out of your pocket! So, choosing a no co-pay policy will ensure you don't have any nasty surprises.

• No Room Rent Limit

Medical bills often spike because of room rent. Many health insurance plans cap the room rent coverage, forcing you to either downgrade your room or bear the excess costs. Opt for policies that do not impose any restrictions on room rent.

• No Sublimit on Diseases

Some plans place a sublimit on coverage for specific illnesses like heart disease or cancer. This can leave you bearing significant expenses if your treatment exceeds the limit. Always go for policies that cover illnesses without these hidden limitations.

• Low PED (Pre-Existing Disease) Waiting Period

Pre-existing conditions such as diabetes or hypertension may not be covered immediately when you buy a policy. This waiting period varies between insurers, so choose a plan with the shortest possible waiting time.

• Pre & Post Hospitalization

Not just hospitalization, but the expenses leading up to and following your hospital stay can add up quickly. Choose a plan that covers both pre and post-hospitalization expenses to avoid shelling out extra.

• Restoration Benefit

Imagine your policy’s sum insured getting replenished each time you make a claim! That’s what the restoration benefit does, and it's a must if you're insuring your family under a single policy.

• Daycare Treatments

Many modern treatments like cataract surgery or chemotherapy don’t require a full day of hospitalization. Check if your policy covers such daycare treatments.

• Consumable Cover

From surgical tape to gloves, consumables are small but essential items used in treatment, and most health insurance plans don’t cover them. Make sure your policy offers consumable cover to avoid additional expenses.

How to Choose Coverage for Your Health Insurance Plan

One of the most common questions is, “How much coverage should I get?” Here’s a simple guide:

• The average claim in India is between ₹5 lakh and ₹6 lakh.

• The minimum recommended cover is ₹10 lakh.

• For comprehensive coverage, it’s advised to go for a policy offering between ₹25 lakh to ₹50 lakh. Choosing a policy with insufficient coverage could mean paying out-of-pocket for treatments, which defeats the purpose of having health insurance in the first place.

Pre-Existing Diseases: Don’t Hide Anything!

It’s tempting to skip disclosing a pre-existing condition to avoid higher premiums, but this is a big mistake. Insurers will underwrite your policy based on your health history, and failure to disclose conditions can result in the rejection of your claim. Be upfront about everything—from minor conditions to major illnesses—so your policy is aligned with your real needs.

Good-to-Have Features in Health Insurance

While the must-have features are non-negotiable, these additional benefits can make your policy even better:

• Free Annual Health Checkups

Preventive care is just as important as coverage for emergencies.

• AYUSH Treatments

Coverage for alternative treatments like Ayurveda, Yoga, and Homeopathy is a great add-on for those who prefer traditional healing methods.

• Domiciliary Care

Covers at-home treatments when hospitalization isn't possible.

• No Claim Bonus

Reward yourself with a bonus for staying healthy by opting for a plan that offers a no-claim bonus.

Picking the Right Insurer: Why Experience Matters

Now that you know what to look for in a health insurance plan, it's time to pick the right insurer. Look for the following:

• An agent with at least five years of experience in the field who can help you navigate the complex world of health insurance policies.

• A company with a strong track record of claim settlements. After all, what’s the point of insurance if it doesn’t come through when you need it the most?

Talk to an Agent Before You Buy

The best advice when selecting a health insurance plan? Talk to an experienced insurance agent. Health insurance policies can be confusing, with varying terms, conditions, and exclusions that can easily trip you up. A knowledgeable agent will understand your specific needs, help you compare policies, and guide you to make the best decision for your health and finances.

Conclusion

In a country where out-of-pocket expenses can lead to financial ruin, having health insurance is crucial. By considering the right features and talking to an experienced agent, you can ensure that you’re not just buying any health insurance plan, but the one that’s perfect for you. Don’t wait until it’s too late—get your health insurance sorted today and protect your future!

Make sure to consult with a trusted expert before finalizing your health insurance policy. A well-chosen plan can save you from paying out-of-pocket for unforeseen medical expenses and give you peace of mind.