Health insurance is something that’s become almost indispensable today given the rising medical costs. However, for many Indians buying adequate health insurance coverage poses several challenges.
Low Insurance Penetration
India has one of the lowest health insurance penetration rates in the world at less than 20% of the population. The majority still have no health coverage leading to high out-of-pocket expenditure. Without insurance, any medical emergency can cause financial catastrophe for families. Several factors like lack of awareness, complex products, misconceptions about covers, and claims keep health insurance adoption low despite policies becoming more affordable now.
Choosing the Right Cover
The health insurance market in India has exploded with numerous policies from insurers promising attractive features and benefits. However, for laymen choosing the right cover that meets their needs from this maze of policies can be very confusing.
Aspects like deductibles, co-pays, sub-limits, waiting periods, inclusions, and exclusions require a deeper understanding to choose appropriate covers and avoid gaps in protection. Understanding the claim settlement process is also vital.
Factor in Pre-existing Conditions
Many people develop health conditions like diabetes, heart issues, and blood pressure problems early in life today due to lifestyle issues. However, getting coverage for such pre-existing conditions under retail health policies becomes difficult and expensive.
Insurers tend to deny coverage for such pre-existing diseases or impose permanent exclusions for related treatments. This leaves people exposed to risk despite buying a policy.
Financial Barriers To Purchase
For lower middle-class families and those working in the informal sector, buying health insurance involves paying a significant recurring premium which adds to the monthly financial burden. Hence many prefer to take a chance rather than spend on a policy.
Most basic indemnity plans cover only hospitalization leaving out OPD expenses which account for the majority of healthcare costs. Hence the value perception of these plans is low for many.
Choosing the Right Sum Insured
Determining an adequate sum insured for health plans is vital, but a difficult decision. While too low an amount leaves one exposed to risk, excessively high covers require paying unnecessarily high premiums.
Factors like family health history, lifestyle diseases, age, income level, and location should be considered to arrive at a prudent sum insured value. But this involves complex assessment for buyers.
Complex Claim Process
While insurers have eased processes lately, submitting claims on health policies still involves considerable paperwork and documentation. Hospitalization events are stressful times and handling the claim process adds to the burden unless support services are availed.
Disputes over claim amounts also happen often due to aspects like limits, non-covered illnesses, inaccurate documents, etc. Policyholders should be prepared to handle such aspects.
How Can Indians Overcome These Challenges?
- Evaluate policy benefits in detail instead of just looking at premiums and make an informed choice of the right cover.
- Buy an adequate sum insured as per your family’s projected health expenses. Also, consider boosters to enhance your base cover.
- Check if pre-existing illness coverage can be availed or if additional conditions are included through proper declaration and additional premiums.
- Seek expert advice from qualified insurance advisors to understand policies and make the right health plan purchase. They can suggest suitable products too.
- Consider value-added services like health check-ups, discounts on OPD/pharmacy expenses, and assistance on claims to enhance policy utility.
- Look at technology-enabled insurers that provide seamless purchase and claims experience through digital channels and platforms.
- Don’t make purchase decisions based purely on pricing. Evaluate aspects like service quality, claim settlement ratios, and reviews before you buy.