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What to Expect from a Health Plan Audit

With many health plans available in the market, selecting the best one can be slightly confusing. Click here to know the things to consider before you buy health insurance plan.

  • 1,921 Views | Updated on: Dec 26, 2023

With many health plans available in the insurance sector, selecting the best one can be slightly confusing. Buyer’s awareness will make a difference in choosing the right policy. Instead of considering premium’s affordability as the primary deciding factor, look for more crucial things.

Let’s go through the 7-point checklist that would get you the best suited medical insurance plan -

1. Company Profile

The insurer’s profile is worth checking as it has a direct impact on the claim settlement. The company may be a big-shot business name but may have a newer presence in the insurance sector or vice versa. So, instead of going by its foundation status, check for how many claims it has settled.

2. Demography and Coverage

The coverage of the medical policy should match your demography. The coverage limit should suffice your standard of living and the average medical cost in your area. Study the list of the hospitals affiliated with the insurance company and check for their closest location and approachability.

3. Range of Policy Coverage

Carefully review the range of your medical insurance coverage. Check for cost-caps on doctor’s fees, room rent, ICU charges, ambulance charges, pre, and post-hospitalization, etc. Find out if your policy is offering some added benefits like OPD expenses, maternity coverage, cost of alternate treatments, etc. Opt for an exhaustive coverage list that includes all standard medical processes.

4. Policy Omissions

Generally, people pay such close attention to policy inclusions that they miss the omissions. No plan is a universal plan and does not include all types of medical costs. Some common omissions are cosmetic or dental treatments, congenital diseases, abortions, etc. Pre-existing diseases are also excluded from coverage but only up to a waiting period. Find out the duration of the waiting period, especially if the age is above the forties.

5. Claim Settlement

Get clarity over the method of claim settlement. It is going to be either cashless or via reimbursement. Understandably, the cashless mode is the most preferred. The reimbursement method is inconvenient because the medical bills are paid first, however high they may be. Check the claim settlement record of the insurer to avoid any inconvenience later. Also, check if the policy has put any cap on the number of claims in one year.

6. The Discounts

Make sure you always look for the offered discounts and riders. A reliable medical insurance plan offers lucrative discounts and bonuses on family insurance plans, lump-sum premiums, and buying a policy at a young age. Look for the no-claim bonus that adds the sum assured if the policyholder does not claim anything during the previous year. There may be other value-added benefits like medicine vouchers, free pathological tests, etc.

7. The Riders

Sometimes the health insurance plan may not be enough to cover you and your family in its current form. You can always include add-ons to enhance the coverage of your plan. Some of the add-ons you may consider including in your plan are-

  • Monthly income benefit
  • Daily hospital cash allowance
  • Waiver of premium
  • Critical illness cover

Buy the Best Health Insurance Plan

Now that you are aware of the different things to consider when buying a health insurance policy, ensure that you compare the different policies online and purchase it directly from the insurer’s website. Also, before you complete the purchase, ensure that you carefully read the terms and conditions to avoid any legal hassles in the future.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

Kotak e-Term

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  • Life Cover till 85 years for Life & Life Secure Option
  • 3 Payout Options
  • Special Rates for Women
  • Option to exit the policy with premium refund at the age of 60*
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  • Free Medical Check Up every 5th year**

Ref. No. KLI/22-23/E-BB/2435