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19 things to consider before buying health insurance
Team AckoApr 17, 2026
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Health insurance is one of the best solutions to cope with the expenses of medical issues. But people may avoid buying health insurance unless they need financial backup for medical treatment. Instead of buying insurance at the last minute, be prepared with adequate coverage to ensure a smooth sail through the medical emergency. Let us help you get started with health insurance before a medical contingency hits. Here are things to consider before buying health insurance.
Contents
- Which things to consider before buying health insurance?
- Inclusions and exclusions of the plan
- The waiting period
- Policy premium and sum insured
- Day care procedures
- Room rent limit on the health insurance plan
- Coverage for new-age treatments
- The availability of add-on covers
- Pre/post-hospitalisation coverage
- The co-payment clause
- No Claim Bonus/No Claim Discount
- Coverage for preventive health checkup
- Claim Process
- Final Checklist Before Buying Health Insurance
- What are Red Flags while Choosing a Health Insurance Company?
- Frequently asked questions
Which things to consider before buying health insurance?
A health insurance document is a contract between you and the insurance company. Here, the insurer is agreeing to bear a part of your financial burden when you face a medical emergency. Thus, it is important that you choose a health insurance plan and the company wisely.
Inclusions and exclusions of the plan
The coverage of the health insurance plan (inclusions) and the conditions against which a claim cannot be made (exclusions) determine the scope of the policy. You must have total clarity about both before purchasing health insurance. Being unaware of the coverages can lead to an increase in out-of-pocket expenses. And being unaware of the exclusions can lead to claim rejection.
The waiting period
The waiting period is the time when you cannot raise a claim against the health insurance plan. It is usually applicable to pre-existing diseases and maternity benefits. It can stretch from 9 months to a few years, depending upon the insurance company and the plan that you are looking to purchase. Do check the applicable waiting period on your health insurance plan before buying.
Policy premium and sum insured
You pay premium to purchase a health insurance policy with a certain coverage. The higher and more comprehensive the coverage, the higher the premium amount. Understand the details pertaining to the coverage and the premium amount thoroughly while buying health policies.
Day care procedures
Nowadays, certain medical treatments are completed within a day. Thus, it is important to ensure if such treatments are covered under your health insurance plan. These are small medical procedures like cataracts, tonsillectomy, etc.
Room rent limit on the health insurance plan
A hospital’s room rent may sound like a trivial charge, but it can be exorbitant depending upon the type of hospital. The treatment cost can go high if the patient is admitted to a room that costs more than the allowed limit. The room rent limit in health insurance specifies the maximum room rent coverage allowed under the policy. If the policyholder chooses a hospital room with a higher rent, he would have to proportionately share the load of the entire hospital bill.
Coverage for new-age treatments
These are advanced medical treatments that are more accurate and can result in better outcomes as compared to traditional treatments. Check if your health insurance policy covers such modern procedures. Some examples of new-age treatments are CyberKnife, robotic surgery, and stem cell therapy.
The availability of add-on covers
Add-ons are optional coverages available with health plans for increasing the scope of coverage. You can choose any suitable add-on to customise your health insurance plan. Note that every add-on cover requires an additional premium which is added to the premium of the base policy.
Pre/post-hospitalisation coverage
Pre and post-hospitalisation include any tests, treatment, doctor visits, etc., conducted before or after the hospitalisation. Different insurance companies have different terms and conditions regarding pre and post-hospitalisation. Check if your policy offers this coverage.
The co-payment clause
As per copay clause, the policyholder is bound to pay a predefined percentage amount of the hospital bill. Such policies cost less but also offer less compensation as you have to pay a considerable part of the hospital bill. Make it a point to study this clause in detail if you decide to opt for it.
No Claim Bonus/No Claim Discount
NCB refers to the discount the insurance company provides to you for every claim-free year. The discount amount limit is usually set by the insurance provider. The discount is usually given as an increase in the coverage amount.
Coverage for preventive health checkup
Most health insurance policies now cover preventive health checkups. It is important to check if these tests are covered in your policy. Preventive health checkups for cardiovascular diseases, cancer, lifestyle diseases etc. are very high, it’s key to ensure your policy pays for all these checkups.
Claim Process
Understand the claim process beforehand. Find insurance providers who make it easy and fast for claims to be settled.
Final Checklist Before Buying Health Insurance
Do not hide any critical information from your insurance company.
Declare your medical history correctly while purchasing a health insurance plan.
Go through the policy wordings in detail and get your doubts clarified from the insurance company before you buy the policy.
Select a health plan that suits your needs and those of your dependents.
Also read: Health insurance for family
What are Red Flags while Choosing a Health Insurance Company?
Choosing a health insurance company is not just about finding the cheapest plan. It is important to know red flags that may affect your claim experience and coverage quality.
Key red flags to avoid when choosing a health insurance company:
Low claim settlement ratio (CSR): A consistently low CSR below 90–95% may suggest lower chances of claim approval.
Frequent complaints and delays: A high volume of complaints, particularly around claim delays or rejections, can reflect poor service quality.
Limited cashless hospital network: A small or weak network may restrict access to quality hospitals during emergencies.
Poor customer reviews: Consistent negative feedback about service and claims support indicates reliability issues.
Lack of transparency: Unclear policy terms, exclusions, waiting periods, or sub-limits can lead to unexpected expenses.
Weak customer support: Slow or unavailable support during medical emergencies can create serious difficulties.
To stay protected, always verify that the insurer is registered with IRDAI. Compare insurers based on claim settlement ratio, hospital network, and service quality before buying a health plan.
Frequently asked questions
Here are some common questions that you may have after reading the above article. Do get in touch with us in case of more queries by sending an email to [email protected].
What is the difference between cashless and reimbursement claims?
The mode of payment is the main difference between cashless and reimbursement claims. In a cashless claim, the insurance company pays most of the hospital bills during hospitalisation. In a reimbursement claim, the policyholder pays the entire bill and then raises a claim with the insurance company.
What are network and non-network hospitals?
Network hospitals are empanelled or have a tie-up with the insurance company, whereas non-network hospitals do not have a tie-up with them. A network hospital can provide a cashless claim, whereas the policyholder will have to follow the reimbursement claim process if admitted to a non-network hospital.
What is meant by the No Claim Bonus?
Medical insurance plans are usually annual policies. Health insurance companies offer a No Claim Bonus if there has been no claim during the policy period. This bonus is allowed as an increase in the sum insured or a premium discount, depending on the plan’s features.
How is room rent calculated in health insurance?
The room rent is calculated as per the principle of Proportionate Deductions. The insurance company bears the hospital bill after applying this formula.
Proportionate Deductions = Room Rent Allowed / Actual Room Rent * 100
Thus, your entire hospital bill gets affected if you opt for a room that costs more than the allowed room rent limit.
What is the Maternity Benefit Add-on?
Some insurance companies do not offer maternity benefits as a part of the base plan. The policyholder can choose to opt-in and buy the additional coverage for maternity expenses. This additional coverage is called the Maternity Benefit Add-on.
What are red flags while choosing a health insurance company?
Key red flags include low claim settlement ratios, frequent claim delays, and a high number of customer complaints. Also be cautious of limited hospital networks, unclear policy terms, and poor support during emergencies.
| Disclaimer: This content is for informational purposes only and is based on industry experience and secondary sources. It is not a substitute for professional advice. Please consult a qualified expert for health or insurance-related decisions. Content is subject to change. Refer to current policy wordings for specific ACKO details. |
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