Fortis Hospital Gurgaon Dengue Death Case: 6 powerful factors to note while buying health insurance plans in India

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November 22, 2017 6:13 PM

Mediclaim policies don't come cheap, particularly in old age, but they act as a cushion against soaring medical bills.

 Fortis dengue case, health insurance, overcharging by hospitals, 5 factors to keep in mind while buying health insurance, sum insured, claim process, co-paymentThe first and foremost thing thing that should be taken care of while buying health insurance is the sum insured.

The Fortis dengue case has not only become the talk of the town, but perhaps the entire nation. After all, the amount of Rs 16 lakh, reportedly charged by the hospital for the treatment of a case of dengue, is not a small amount. This incident has also led to a probe into the case. Sadly, however, this is not a lone incident of its type. Overcharging by private hospitals has become a routine affair in India these days and hardly anything is being done in this regard, which is scary also.

One option is to move a consumer court in such cases. However, that also is a time-consuming affair and needs patience. Another option, which is a better option perhaps, is to take an adequate medical insurance cover to deal with such situations. Although mediclaim policies also don’t come cheap, particularly in old age, but at least they act as a cushion against soaring medical bills. However, you need to take some precautions while opting for a health insurance policy. Here are some key things to keep in mind while buying health insurance:

1. Sum Insured: The first and foremost thing thing that should be taken care of while buying health insurance is the sum insured. Sum insured is the maximum cover your insurance company will offer in case you fall ill and need hospitalization. “In today’s time when hospitalization charges are soaring high, a single-day hospitalisation in a good hospital can sometimes cost anywhere between Rs 50,000 and Rs 80,000. Hence, while buying a health insurance policy, you must keep in mind the medical inflation and the sum insured. An optimum health insurance should be the one which has a cover of at least Rs 10 lakh,” advises Dhruv Sarin, Head of Health Insurance,

2. Room Rent: Room rent is a major part of your hospitalization expense and many of multispecialty hospitals can charge as much as Rs 10,000 to Rs 20,000 per day for a single private room. Now, what you must take care of is that there is no room rent cap in your policy. Because if there is room rent cap in your policy and you end up taking a room which is beyond the limit your insurance policy allows, then the percentage increase is imposed on your whole hospitalization expense. For example, if you have a room rent cap of Rs 8,000 and you take a room of daily rental Rs 10,000, which is a 20% increase, then at the time of claim settlement, your insurer will only approve the claim of 80% of the total hospitalization charge.

3. Disease-Specific Policy: If you read the fine prints of a health insurance policy, you would come to know that a standard health insurance policy may not cover each and every cost pertaining to an ailment that may occur and getting to know about the same at the time of diagnosis can put you in a great depression. Also, “in some illnesses like dengue which has a couple of forms like dengue fever, dengue hemorrhagic fever and dengue shock, which does not always require hospitalization, and claims towards any such expenses are not covered. The reason behind the same is that a standard health insurance policy only covers hospitalization charges. Hence, it is recommended to buy a standalone disease-specific plan with your health insurance policy to further increase the protection of yourself and your family like disease-specific plans which cover both inpatient and outpatient expenses,” says Sarin.

4. Wide Hospital Network: An ideal health plan should have a wide hospital network so that you can easily take advantage of cashless hospitalization. “It is highly helpful when you need a high cover in an emergency where you can’t afford the treatment from your pocket,” says Naval Goel, CEO & Founder of

5. Co-payment: Co-payment is an option which insurance companies use to reduce your premiums, by asking you to share some percentage of your hospitalization expenses. However, co-payment is majorly asked by an insurance company in case of any pre-existing disease or in case of health insurance for a senior citizen, which is generally 10% to 20%. You must look for a policy without co-payment or a policy which asks for least co-payment.

6. Claim process: Claim settlement time and claim settlement ratio is the most important factor that you must consider. “Higher claim settlement ratio and quicker settlement time normally mean that the insurer is doing a good job,” says Goel.

Apart from keeping these factors in mind, you should try to buy a health cover at an early age, which can easily go well with your needs. Health insurance comes cheap if bought at an early age. Also, there are many insurers who do not entertain old age people. So, it is good to go for it at an early age. Moreover, “if you have a corporate health plan, then you should also go for an individual health plan as the corporate one would not be enough to meet the needs of a big emergency,” advises Goel.

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