5 key features of health insurance policy
5 key features of health insurance policy

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5 key features of health insurance policy

Max Bupa

11 November 2020

Health is wealth, period. Ever since global pandemic hit us, the need for a well-balanced medical insurance plan has become higher than ever. And this requirement is always followed by a lot of questions from the first time buyer. Starting with the obvious one, ‘how much does it cost?’, ‘what does the policy cover?’, ‘the list of hospitals’ and so it goes on.


So, here are top five features of Health Insurance Policies; one should look at when buying them - 


1. How much does a Health Insurance Policy cost?

Emergencies come unannounced and health insurance is the key, which allows you access to best medical facilities despite the rising hospitalisation expenses. The premium of the policy increases with age, so start young. Bear in mind the type of policy that you would like to take. It could be a critical illness insurance, a family health insurance, or a personal accident insurance - there are several kinds of health insurance plans that can be availed based on your need. For some insurance plans, you may be asked to undergo a health check-up for the insurer to get a sense of your health status.


2. Do you have any Pre-Existing Conditions?

Pre-existing conditions are health problems that exist before you invest in a health insurance policy. Some common examples of such cases are, heart diseases, asthma, hypertension, or they can be as small as an injury from a previous accident. So before you avail a health insurance policy be it for you or your family, check with your provider which of the pre-existing conditions are included and excluded - as they wouldn’t cover them for a minimum of 48 months to a maximum of 4 years once you have purchased the policy. Some may also add more according to the medical condition.  


3. Types of Health Insurance Plans and its benefits

Are you availing a health insurance policy for yourself or are you taking one that covers your family’s health as well? Is it a policy that you are taking because of an underlying critical illness? Based on your current need or your future planning, you need to carefully select your health insurance keeping in mind the different benefits of health insurance. There are various types of individual health insurance plans and family health insurance plans. So compare health insurance plans and choose a policy that covers all your needs or if you are taking a family health insurance, make sure it covers them all adequately. 

You should also look for options such as, hospital rent capping, and co-payment. Yes, some plans say that the policyholder must bear a certain percentage of the total expenses or the bill. This can sometimes put you at a disadvantage so you need to make sure that your health insurance policy doesn’t have one, and even if it does, then it shouldn’t be more than 10%.


4. Capping of your Health Insurance Policy

Say you have bought a policy whose cover is Rs.5 lakhs, your insurance provider would have added a feature or clause known as ‘disease wise capping’. This adds a restriction to the amount of pay-out you can avail on a list of specific illnesses which may be set to Rs 1 lakh. So, to bring it to your advantage make sure the cap is high. So, be it your individual health insurance policy or your family health insurance policy - check the sub-limits in the policy before buying your health insurance plan. 


5. What’s the Claim Settlement Ratio of your Policy?

The most vital feature you need to know and check for is, what is the percentage of claims for the insurer in question that gets declined and how many get through when a claim is raised? With rising hospital expenses, always remember to get a policy which has a high claim settlement ratio. Which means, your policy needs to be above 90 to 95% and if it is less than 80% then you need to look for a new provider or a new policy.



When you avail a health insurance plan, you need to bear in mind these five key features before you sign the policy documents. Today you can even avail them online in a day or two, with or without basic health check-ups, especially if it is an individual health insurance plan. 

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