How should the average Indian Middle Class Family choose a Health Plan


Since there is a rise in medical expenses, having an adequate health insurance plan is a must. The necessity of health insurance has increased with an increase in work-life imbalance. In fact, the Indian government has also taken tentative steps towards providing free healthcare to every household across the country through Pradhan Mantri Jan Arogya Yojana (PMJAY) scheme.

However, the PMJAY scheme is for the poor and vulnerable families in India. The middle-class Indian families have to choose a health plan available in the market. This article, however, focuses on how an average Indian family should choose health insurance.

Before you choose a health insurance plans for you and your loved ones, answer these questions –

  1. Do you want to buy individual health insurance plans for every family member or family floater plan?
  2. What will be the sum insured of the health insurance plan you have chosen?

If you are not sure about the type of health plan you need, it is advisable to choose a family floater plan. However, the family members covered under it should not require multiple medical treatments in a year.

Also, individual health insurance can be expensive as you have to pay premiums for each plan taken for each individual. In this case, a family floater plan comes in handy as you pay premiums for only one policy, and the coverage is provided to all the family members. But it is recommended to buy a separate health plan for senior citizens as including them in the family floater plan will increase the premiums.

Ideally, a coverage of INR 5 lakh is sufficient for family health insurance. But in case you want to increase the coverage provided, you can opt for top-up plans by paying a little extra on the existing premiums.

Once you know the type of plan and the coverage you need, start comparing different health insurance plans online. This will give you a fair idea about these plans and the unique features each of it offers. Also, go through the coverage and exclusions in each policy carefully.

Before you decide upon a health plan, consider the following things –

  • Inclusions: The things that the health insurance plan covers. These include the type of treatments, pre and post hospitalisation expenses, in-patient treatments, daycare facility, and so on. Each health plan available in the market may differ in the coverage it offers.
  • Waiting Period: When covering the pre-existing issues, most health plans tend to have a waiting period. Generally, this period is for 30 days before you can claim for the said diseases and its treatments. The waiting period varies from insurer to insurer. So, check the waiting period before you choose the plan.
  • Exclusions: You must be aware of the things and medical treatments that are not covered under your health insurance plans. This will help you choose a plan wisely and as per your medical needs.
  • Incurred Claim Ratio (ICR): The ICR determines the performance of the insurer. In other words, it tells you (the consumer) the possibility of making a successful claim.

With adequate health insurance coverage, rests assured that all the medical expenses of you and your family members will be taken care of. Just make sure that you are reading the terms and conditions of the health plan before you start paying the premiums.