5 things to know for the first time health insurance buyers | LKP Securities
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Insurance | January 11
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5 things to know for the first time health insurance buyers

Health insurance is a kind of insurance plan that covers the insurance holder’s surgical, medical, prescription medicinal expenses and even dental costs in a few cases. Having individual health insurance or health insurance for family is beneficial if the insurance holder or his family is undergoing certain treatment, illness or has a  medical emergency. As in such situations, the chosen health insurance company will reimburse the entire amount paid by the holder or directly pay the respective clinic or hospital. Having health insurance best plan for family can protect you and your family from unforeseen medical crises. This can additionally save you from the hassle of paying the entire bill at once from your savings. 


Life is unpredictable and uncertain, which makes it all the more important to pick the health insurance best plan for family. But while selecting a policy for the first time, you should be aware of the five most important aspects that are given below. 

Age criterion

Age is the most important factor which decides the insurance premium, especially if you are looking for family health insurance plans. For instance, if you are planning to choose a family floater, then the premium cost will depend on the eldest family member’s age. Besides, do not forget to find out about the age limit of the particular policy. This is because some plans have an age limit barrier which can be anywhere between 91 days to 60 years. But there are a lot of plans where the age limit does not stand as a factor. You can accordingly choose health insurance for family. 

Choosing the right coverage and premium

While purchasing a health insurance plan, you may think that choosing a plan with a low premium is profitable. However, that is not always true. Sometimes plans with low premiums do not come with a lot of benefits. But if you are well aware of different policy plans, then it can be a gain. Look for plans that offer substantial coverage within a budget-friendly premium. Always remember to check the clauses of deductibles and co-payments. It should be well in proportion, else you will have to pay more than the sum assured while making a claim. That should not be the case. The best health insurance plan will offer substantial coverage along with attractive benefits at an affordable premium. 

Waiting period

This is an important clause that an individual must be well aware of. Under this clause, the insurance company will not entertain certain specific diseases or existing illnesses that might occur during the waiting period. This period can range between 2 years to 4 years depending on the policy and the company. Moreover, a claim can only be made after the waiting period is completed by the insured. Always choose a plan where the waiting period is minimal so that you can make a claim if any emergency arises. 

Deductibles and co-payments

According to the clauses of deductibles and copayments, the insured has to pay a part of the initial medical expenses that was agreed upon at the time of signing the policy contract. This means a portion of the expenses will be deducted from the sum assured and the rest will be paid by the insurer. Moreover, the higher the deductible, the lesser is the premium. 

How health insurance works

Health insurance pays your treatment bills and in times of medical emergencies, it can come to your rescue. But while thinking about buying family health insurance plans, you must also know how exactly it works and here is how. 

The procedure

The entire procedure of health insurance begins right after it is purchased by the individual. You can choose any insurance plan of your choice based on the features of the plan and its premium. Purchasing the best health insurance creates an alliance between the policyholder and the insurance firm. 

Determination of premium

The insurance firm decides the premium of your insurance policy that you are obliged to pay based on your income and age. Moreover, the company is likely to ask you to undergo a medical test to evaluate your health in general. Post the evaluations of these aspects, the firm will declare the sum assured by the company and the annual premium the individual has to bear. 

Making a claim

An insurance holder can make a cashless claim for hospitalisation in the network health centre if it is supported by the insurance company. This can be done by approaching the Third Party Administrator. The TPA will reimburse the bills directly. In case the cashless facility is not available, the individual has to pay all the expenses and the insurance company will reimburse it after all the payment is made. For making a reimbursement claim, the policyholder has to submit an application form along with the copy of hospital bills and other relevant documents. This application will be then filed by the health care centre and sent to the respective health insurance firm.

Claim settlement

Once the claim has been made by the individual, the insurance company will take up to 30 days to settle it for the policyholder. But, if the company feels the need to investigate the matter, then it might take up to 45 days for the claim to get settled. It is important to note that, not the entire amount is paid by the insurance firm, a part of it has to be incurred by the individual which is known as co-payment. There might be some deductibles as well, in which the company will reimburse a proportion of the bill and deduct the remaining amount. 

Wrapping Up 

It is always better to choose a plan that supports cashless hospitalisation as the insurer will directly pay the expenses to the hospital. This will save your time and effort as you do not have to go through the process of making a claim during the time of admission. Moreover, unlike reimbursement, in cashless hospitalisation, you do not have to have to make prior arrangements for funds.


Health is wealth! Thus you need to do everything possible to take care of your health. It should be secured and protected against all odds. The importance of having health insurance is only realised when you need it the most. Moreover, not having health insurance can cost you a fortune or even result in deferred treatments. Thus it is important that you buy a good insurance plan to shield your family and yourself from unexpected medical crises.


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