Did you know that the current medical inflation in India is around 14% per year? Considering the skyrocketing prices of healthcare, it's important to protect you and your family from medical costs with health insurance.
Thus, choosing the right health insurance policy is one of the most important financial decisions you can make. A comprehensive health plan protects you and your family against unexpected medical expenses and ensures access to quality healthcare. With a variety of policies, coverage options and add-ons, it's important to know what matters most.
This guide answers "how to choose a health insurance plan" with 10 practical tips that help you select a policy tailored to your needs, ensuring adequate coverage, cost-effectiveness and smooth claims support when you need it the most.
How to Pick a Health Insurance Plan: Top 10 Factors to Consider
1. Choose an Adequate Sum Insured
The sum insured is the maximum amount the insurer will pay for your medical expenses in case of a claim. When selecting a policy, consider your healthcare needs, family size, and potential medical costs. For example, if you buy a ₹10 lakh health insurance plan, the maximum amount of coverage you and everyone else covered in the policy will be up to ₹10 lakh.
A higher sum assured can provide better financial protection, especially in the case of serious illnesses or emergencies. Ensure that the sum assured is adequate to cover hospitalisation, treatments and other related medical expenses without placing a financial burden on you and your family
2. Choose a Plan That Covers You and Your Family
Individual plans offer protection for a single individual, whereas a family floater plan allows you to add more members under the same sum insured limit. If you wish to cover your entire family under your plan, make sure the policy includes coverage for your spouse, children and dependent parents if needed.
Some plans also allow adding newborns without you having to buy separate policies. Since all types of coverage have a distinct waiting period, be sure to check the waiting period to ensure you receive coverage when you need it.
3. Check Claim Settlement Ratio (CSR)
The claim settlement ratio shows you the percentage of claims settled by the insurer compared to the total claims received. A high CSR indicates reliability and efficiency.
For instance, we maintain a consistently high claim settlement ratio, showcasing our strong commitment to quick and hassle-free claim processing. Always review this to ensure timely support when you need it most.
4. Understand Incurred Claim Ratio
The Incurred Claim Ratio (ICR) is the ratio of the amount of premium collected and the amount given to you (or the policyholders) during claims. Ideally, choose a company with an ICR in the range of 70-80%.
A lower ICR may suggest fewer claims are being paid, while a very high ICR might indicate poor financial stability. Reliance Health Insurance maintains a healthy balance, ensuring both claim efficiency and sustainability.
5. Check Deductibles and Co-Payment Options
A deductible is the amount you must pay before the insurer starts covering your bills, while a co-payment means sharing a certain percentage of the claim cost.
Plans with higher deductibles or co-payments come with lower premiums but higher out-of-pocket expenses during claims. Choose these options based on your financial comfort and risk tolerance. For instance, we allow flexible co-payment clauses, letting you adjust premiums according to your budget.
6. Pre- and Post-Hospitalisation Coverage
Medical treatment costs go beyond hospitalisation. Ensure your policy includes pre- and post-hospitalisation expenses like diagnostics, medications and follow-up consultations.
Check how many days are covered - Reliance Health Insurance, for example, offers 60 days pre-hospitalisation and 90 days post-hospitalisation coverage*, ensuring complete financial support throughout your recovery.
7. Room Rent and Hospitalisation Limits
Every insurer sets room rent limits depending on the plan - general, semi-private or deluxe rooms. If the room rent of your chosen room in the hospital exceeds the limit set by your insurer, you might have to bear the remaining part of the room rent.
Select a policy that allows room flexibility for a comfortable hospital stay. Our policies provide multiple room options, including single private rooms in higher-tier plans.
8. Look for Critical Illness and Add-On Covers
Add-ons help you enhance the coverage of your standard health insurance policy. For example, maternity-related expenses are excluded under a standard policy. Thus, you can enhance your policy with add-on covers like critical illness,
maternity cover, OPD care, or dental coverage. These riders provide extended protection beyond basic hospitalisation.
In addition to the add-ons, you can also opt for specialised plans that cover specific needs. For example, Reliance
Reliance Critical Illness Insurance covers major illnesses such as cancer, heart attack or kidney failure and offers a lump-sum payout of up to ₹10 lakhs upon diagnosis. This plan is particularly helpful when you have a family history of critical illnesses and would benefit from the payouts during the treatments.
9. Check Network Hospitals and Cashless Facilities
Ensure your insurer has a wide network of hospitals in your city for cashless treatment.
Reliance Health offers access to over 10,000+ network hospitals* across India, providing cashless claim facilities that eliminate reimbursement hassles during emergencies. A wide cashless network also means more streamlined and quick claim processes. Our top-rated network of hospitals ensure quick claims along with the best medical care.
10. Compare Premiums vs Coverage
Don't choose a policy solely because it's cheaper. Evaluate the premium against coverage benefits, exclusions, and service quality. Underinsuring to save on short-term costs may lead to large out-of-pocket expenses later.
Use our Health Insurance Premium Calculator to compare different plans and find one that best suits your needs and budget.
Conclusion
Selecting the right health insurance plan is a crucial financial decision that safeguards your family's health and wealth. By carefully analysing coverage, add-ons and claim settlement ratio, you can make an informed choice.
That's why Reliance Health Insurance offers a balanced mix of comprehensive protection and affordability with plans starting at just ₹243/month*. We offer reliable claim services backed by a high claim settlement ratio of 99.57%*, making us a strong contender for your health insurance needs. We offer plans with a high sum insured of up to ₹5 crores, along with 20+ diverse add-ons* to ensure complete protection.
Frequently Asked Questions (FAQs)
What is a good claim settlement ratio for health insurance?
Anything above 95% is considered excellent. Reliance General Insurance is recognized for its strong claim settlement track record, ensuring dependable and trustworthy service.
Can I add my parents to my existing Reliance family floater plan?
Yes, Reliance Health Insurance allows the inclusion of dependent parents in most family floater plans.
Does Reliance General Insurance offer cashless treatment?
Yes, policyholders can avail of cashless treatment at over 10,000+ network hospitals across India.
How to decide which health insurance factor is the most important one when choosing a plan?
The most important factor when choosing a plan is its coverage. If you have comprehensive coverage, it will effectively cover you and your family's healthcare needs for the premium paid.