Step-by-Step Guide to Buying a Health Insurance Policy

However, the journey towards buying a competent health plan may seem a bit overwhelming, especially for first-timers. But the Paybima team is determined to make your journey as smooth as possible from the very start.  

Step-by-Step Guide to Buying a Health Insurance Policy

If you follow this comprehensive guide, you can easily buy health insurance in the most hassle-free manner: 

1. Choose the Right Coverage and Plan Variant: 

The primary target of health insurance is to ensure a smooth hospitalisation and treatment process. Before buying, you must critically analyse your requirements well. Do I need PED coverage or maternity protection cover? Is there any recurrent hereditary ailment running in my family? Ask these questions to yourself first before proceeding.  

Regarding the plan variant, you have the following: 

• Individual plan: This covers a single individual. 
• Family floater plan: This is where you can cover all the family members (usually self, spouse, dependent children and dependent parents) under a single umbrella plan by paying a single premium.  

Coverage: Ideally, your health insurance coverage must be 6 times your current monthly income. However, this is not mandatory; your necessities will be your primary determinant.  

Tip: Your Paybima advisor can guide you to make a clear assessment of your needs and help you select the most suitable health plan.

2. Comparing Policies: 

This is a very critical step to understand the market scenario well and make an informed decision. The important factors that you must consider: 

Coverage offered: This involves 4 critical factors to ensure a smooth journey: 

• In-patient hospitalisation: This is the technical term for hospitalisation of a patient for over 24 hours. Select a plan that offers optimum coverage at the most affordable rate. 
• Daycare treatment: This implies hospitalisation for less than 24 hours like cataract operation, chemotherapy, dialysis, etc. Choose plans with maximum daycare coverage protection. 
• Room rent allowance: Certain health plans maintain room-rent capping. It is either a specific amount or 1% of the total coverage amount. Try to opt for policies with zero room rent capping, or even if it is there, the amount should be nominal.  
• Pre- and post-hospitalisation coverage: The expenses incurred before and after hospitalisation are termed as pre- and post-hospitalisation coverage, respectively. The respective policy mentions the specific tenure. Usually, the pre-hospitalisation cover for 30 days, and 60-90 days post-hospitalisation cover. However, these may alter with the specific permissions of the plan.  

Waiting period: This is the hibernation period where you cannot raise or settle any claim for costs incurred for treating certain specific ailments within that tenure mentioned in the plan. There are 3 types of waiting periods: 

• Initial waiting period: This usually lasts for 1 month, within which you cannot make any claim. 
• Specific ailments: There are specific waiting periods for different types of illness and this list varies with policy and insurer. Some common ailments considered here include an appendix, knee surgery, cataracts, etc. 
• PEDs: This refers to the waiting period for certain specific pre-existing health conditions like hypertension, diabetes, thyroid, etc. It usually ranges between 2 and 4 years. However, it is variable depending on the terms of the chosen plan.  

Co-payment clause: Certain health plans come with a co-payment clause, where you need to settle a part of the total claim amount while the remaining amount will be settled by your insurer. This ratio varies with plan and company. Try to seek a plan with a lower co-payment clause. 

Sub-limit: A health plan may come with restrictions on certain specific illnesses/facilities/procedures. Clarify the details before finalising. 

Tip: This is a critical procedure to ensure the most suitable policy. Paybima advisors are dedicated to navigating these avenues to help get the best policy. 

3. Checking Exclusions 

Not even the best health plan will offer 100% coverage protection under any circumstances. Although the list of exclusions varies with every plan and insurer concerned, certain common exclusions include: 

STDs 

• Cosmetic surgery 
• PEDs (as applicable) 
• Dental treatment (as applicable) 
• Adventure sports 
• Congenital disorders 
• Lifestyle diseases (as applicable) 
• Infertility treatment 

Apart from these, certain plans exclusively restrict coverage for certain typical ailments/procedures. You must clarify these details before the final selection.  

Tip: Considering your circumstances, Paybima advisors will lead you in choosing the most suitable health policy.  

4. Using Online Tools:  

Nowadays, you can easily use handy digital tools like premium calculators. You simply enter the necessary details, and it will reveal the probable premium payable amount, helping you prepare a healthy financial portfolio.  

Tip: You can do it or request Paybima experts to perform it on your behalf.  

5. Finalising Purchase:  

After careful research and comparative study, you can zero in on your chosen plan to complete the purchase.  

Tip: Following this process, you can ensure a smooth purchase, more so if you have Paybima support.  

6. Claim Process Basics: 

This is another crucial factor to consider before finalising your purchase, as the primary aim for any insurance lies in claim settlement. You must consider: 

• Claim settlement procedure: Ideally, the insurer must maintain a simple and user-friendly claims settlement procedure.  
• Claim settlement ratio: Your chosen insurer must ideally maintain a high CSR. This ratio represents the total number of claims filed vs. the total number of claims settled. If 100 claims have been filed and 98 settled, then the insurer maintains 98% CSR.  

Tip: Paybima’s expert guidance will help you enjoy a smooth sail.  

Contact  

You can easily visit the Paybima portal and choose the health insurance from the available options: 

• First, visit the Paybima homepage to click on “Health insurance” from the dropdown menu 
• Enter the necessary details and request a callback. 
• The Paybima expert team will guide you to buy the best health insurance. 
• You can also call us at 1800 267 67 67 from 10 AM - 7 PM  

You can also visit the nearest Paybima office for in-person consultation.