Health Insurance Review Process

Reviews, be it product reviews, movie reviews, restaurant reviews, or any other category are inherently subjective. The features in a product which a reviewer likes might not be of interest to the general public or vice-versa. Due to this in-built feature of review mechanism, oftentimes reviewing becomes a futile exercise and don’t serve the intended purpose. To overcome this aspect of the whole process, I have decided to create process to review the health insurance policies.

A good insurance policy is the one which offers the essential benefits, is pocket friendly, and does not offer fringe benefits which ultimately might not be of any use but nevertheless impacts the pocket. At the end of day, health insurance are utility product, it should adequately cover your health expenses at times of need and you hope never to use it. It should be a product which lets you sleep peacefully at night safe in the knowledge that if required, a health scare would not bankrupt my family.

All health insurance review would be on the below mentioned parameters to ensure objectiveness.

1. Co-payment: Co-payment is a feature under which the insured needs to pay a part of the bill out of their own pocket. For e.g. in a policy with 10% co-payment, the insured would need to pay Rs. 10,000 from their own pocket for a hospitalization bill of Rs. 1 Lac. A policy with Co-payment is not a good policy and should ideally not be bought unless your budget does not allow you to buy one without co-payment and you don’t have any other option.
2. Room rent limit or room type limit: Room rent limit or room type limit allows the insured to be hospitalized in certain types of rooms only or rooms with lower per night rent than the one specified in the health insurance policy. They also have implication on the claim amount. Room rent limit is not desirable in a health insurance policy. In case of room type, if a health insurance plan allows Single AC room or above category of rooms, it is a good policy.
3. Treatment Capping: Treatment capping means there would a maximum amount which would be paid by the health insurance company for certain treatments or diseases, as mentioned in the policy. This is not a desirable feature and health insurance plans with this feature should be avoided.
4. Waiting period: All health policies have waiting periods. Waiting periods are of different categories like specific disease waiting periods and pre-existing disease waiting periods. Plans will be reviews basis the waiting period applied for different categories.
5. No Claim Bonus: Most of the health insurance policies offer a No Claim Bonus. In case no claim is made in a policy year, the sum insured for the policy is increased in the subsequent year. The health insurance policies will be rated as per the quantum of No Claim Bonus offered by the policy.
6. Restore Benefit: Most of the health insurance policies have Restore Benefit. The exact mechanism of Restore Benefit defers for the policies, and the health insurance policies will be reviewed on the way Restore Benefit is offered.
7. Maternity Benefit: Very few health insurance policies offer maternity benefit, and even those which do have a limit on the amount which can be claimed for maternity expenses. Such policies also have a waiting period and the premiums are higher than a similar policy without maternity benefit. Owing to these reasons, a policy with maternity benefit will only be rated higher if there is a clear benefit for the consumers.
8. Preventive Health Check-up: Preventive health check-up is offer by many policies but the mechanism to avail it differs from one policy to another. The health insurance policies will be rated higher based on the way this benefit is offered to the users.
9. OPD Coverage: Outpatient treatment is offered in very few health insurance policies. A policy with out-patient treatment does not automatically become a better policy owing to the attached terms and conditions. For the sake of uniformity, a policy will be rated higher if it offer unrestricted out-patient treatment without steep extra premium.
10. Deductible: Deductible is the feature wherein the insured needs to pay the bill up to a certain amount out of their own pocket. A comprehensive health insurance policy should not have deductible feature.
11. Extra Benefits: A health insurance policy might have extra benefits in addition to the above features. These benefits might or might not be of use to the insured depending on what is offered and the mechanism through which they are offered. This will be a subjective criterion to rate the policy.

As you would have noticed, claim experience, or claim ratio would not been taken into consideration while reviewing the policy. This is due to the fact that claim reporting is a technical term and claim experiences are very personal. Two different people might have claim experiences at the opposite end of spectrum for the same policy with the same company. In addition, I have certain biases towards certain companies, and it would not be correct for me to impose the same on the readers. For claim experiences regarding any particular company, you can always get in touch with me and I will try to guide you in the best direction.