Best health insurance plans for you

How do you buy a health insurance plan? If you just settle with the plan your agent sells or are happy knowing you have bought the cheapest plan, there is a bit of unlearning and a lot of learning in store for you. A Medical     Insurance Plans packs in several features and caveats. To give you a ready comparison, we designed Mint Mediclaim Ratings (MMR), which was developed by SecureNow Insurance Broker Pvt. Ltd. In the ratings, for family floater plans, we have considered two sum insured amounts (Rs.10 lakh and Rs.20 lakh) and three age categories in each—eldest insured member is 35, 45 or 65 years old. For individual plans, age categories are the same but the sum assured is Rs.5 lakh. The newest edition of the ratings (January 2015) has a new category of individual plans of Rs.10 lakh for senior citizens aged 70 years.

This week, we spotlight policies for individuals with sum assured of Rs.5 lakh. We also explain some of the important aspects that one should look at while choosing a policy. Let’s look at claims not settled.

A key piece while buying any insurance policy is how good the company is in paying claims. But in India, in the health insurance space, this data is difficult to get in a user-friendly and comparable format. Claims settlement data in public disclosure documents is a consolidated set of numbers. But only a small number of group policies are rejected, and hence if an insurer has a sizeable group portfolio, its claims settlement data may look healthier. So, it is important to segregate this data for better analysis. Also, under claims settlement, insurers state number of claims reported, settled, repudiated, closed and outstanding. It’s important to track the claims payment. The inverse of these measures claims not settled. While claims repudiated and settled are self-explanatory, closed claims need some detailing. According to insurers, closed claims are those unpaid claims that are closed either due to lack of documents from the insured or where the policyholder hasn’t pursued the claim. Closed claims should ideally form a small portion, but if it’s sizeable, there is reason to worry. In our ratings, we have put claims repudiated along with claims closed in the claims not settled basket.