Things to Consider Before Buying Health Insurance

June 28, 2025

Things to Consider Before Buying Health Insurance

things to consider before health insurance

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✅ Things to Consider Before Buying Health Insurance

Health insurance is no longer a luxury — it’s a necessity. With rising medical costs and unpredictable health issues, having the right health insurance plan ensures peace of mind and financial security. But with so many options available in the market, how do you choose the right one?

Here are some essential things to consider before buying health insurance:

1. Assess Your Healthcare Needs

Start by understanding your personal and family medical history. Consider:

  • Age and health of family members
  • Any existing medical conditions (like diabetes or hypertension)
  • Possibility of planned surgeries, maternity, or specialized treatments

A young, single professional might need a basic policy, while a family with elderly parents might require a more comprehensive cover.

2. Sum Insured: Choose Adequate Coverage

The sum insured is the maximum amount your insurer will pay in a year. Don’t just go for the cheapest premium — ensure the sum insured is sufficient to cover:

  • Hospitalization costs
  • ICU charges
  • Surgeries and treatments
  • Pre and post-hospitalization expenses

In metro cities, a cover of ₹10–15 lakhs is often recommended for a family of four.

3. Understand the Type of Plan

You can choose from:

  • Individual Plans: Coverage for one person
  • Family Floater Plans: One sum insured shared by the whole family
  • Top-up Plans: Additional coverage over a deductible limit
  • Critical Illness Plans: Lump-sum payout for life-threatening illnesses

Choose a plan that aligns with your lifestyle, age, and family structure.

4. Check Network Hospitals

Every insurer has a list of network hospitals where you can avail cashless treatment. Ensure:

  • There are reputed hospitals near your home
  • The claim process is hassle-free
  • The network includes multi-specialty hospitals

This becomes crucial during emergencies.

5. Room Rent Limits & Sub-Limits

Many policies cap the room rent (e.g., ₹5,000/day or 1% of sum insured). If you opt for a higher category room, you may have to bear a proportionate share of the entire hospital bill.

Also, watch out for sub-limits on procedures like cataract surgery, knee replacement, or maternity. Go for policies without sub-limits if your budget allows.

6. Pre & Post-Hospitalization Cover

Most people focus only on hospitalization, but costs before and after hospitalization can also be significant. Good policies cover:

  • Pre-hospitalization expenses (usually up to 30 days): like diagnostics, consultations, tests
  • Post-hospitalization expenses (usually up to 60–90 days): follow-up checkups, medicines, physiotherapy

Ensure your plan includes this benefit, and check the exact number of days covered.

7. Waiting Periods & Pre-Existing Diseases

Most policies have a waiting period (usually 2–4 years) for:

  • Pre-existing illnesses (like asthma, diabetes)
  • Specific treatments (like hernia, piles, joint replacement)

Choose a policy with the shortest waiting period if you or any family member have known medical issues.

8. Co-payment Clause

Some insurers require you to pay a portion of the hospital bill (e.g., 10–20%), especially for senior citizen plans. While this lowers the premium, it increases your burden at the time of claim.

9. Daycare Treatments & OPD Cover

Modern policies cover daycare procedures (which don’t need 24-hour hospitalization), such as cataracts, chemotherapy, dialysis, etc.

Some plans also offer OPD cover for doctor consultations, diagnostic tests, and medicines — useful for families with frequent visits to clinics.

10. Claim Settlement Ratio (CSR)

This is the percentage of claims an insurer has settled versus the total received. A higher CSR (above 90%) indicates a better track record of honoring claims.

Also, check customer reviews for claim processing speed and ease.

11. Premium vs. Benefits

Don’t base your decision solely on premium. A low-cost policy might exclude important features or have many conditions. Compare:

  • Coverage benefits
  • Room rent/sub-limits
  • Waiting periods
  • Renewability and No-Claim Bonus

A slightly higher premium today can save you lakhs later.

12. What About Annual Health Checkups and Bonuses?

Some insurers reward you for staying healthy with:

  • No-claim bonuses (they increase your coverage each year if you don’t claim)
  • Free annual health check-ups
  • Discounts on renewal premiums

These may seem small, but they add value over time.

Choosing the right health insurance isn’t just about saving tax — it’s about protecting your family’s future and financial stability.

Take time to understand the policy features, read the fine print, and always compare more than just the premium.

✅ Final Thoughts

🤝 Need Help Choosing the Right Health Insurance?

At Prospera Wealth, we understand that every family is unique. We help you:

  • Analyze your health needs
  • Compare the best policies
  • Pick the plan that offers the right balance of coverage and cost
  • Provide ongoing support during claims and renewals

📩 info@prosperawealth.in

📞 +91 7030651651 | WhatsApp: 8329974830

Your Health, Your Wealth — Secured by Prospera.