8 Elements of Health Insurance You Should Know


After Covid-19 incidence, the health insurance sector has shown a spike in the past few months as more people are convinced to buy health insurance. But as a fact, the need for health insurance is there even before the pandemic.

If you are planning to purchase a health insurance policy for you as an individual or a family floater plan, it is advised to do proper market research to choose the best plan that matches your need and requirement. Because a plan that suits your relative or a friend may not be the right match for you.

8 Elements of Health Insurance in detail

In this article let’s discuss some basic elements of health insurance you should check to decide which plan is the right match for you.

Sum Insured Amount

Keeping sky rocking medical costs in mind, choosing a sufficient amount of cover is vital in selecting a health insurance plan. The medical cost may increase after a few years compared to your initial purchase of the policy.

Generally, the premium amount you pay will also increase as the sum insured increases. The premium also depends on a few other features offered by the policy like waiting periods, NCB, recharge benefit, Co-pay, and various sub-limits. Considering all these select a sufficient sum insured limit to serve your future medical needs.

Network Hospital list

It is one of the most important aspects of a health insurance plan to be considered while selecting the policy. Because the whole purpose of buying health insurance is to avail financial aid in case of an unforeseen medical emergency.

A network hospital means a hospital that has a tie-up with the insurer and the claims are settled directly to the hospital by your insurer. All you need to do is provide your policy details and required documents to support the claim. There will be a help desk or TPA at the network hospitals to guide you and organize the claim process. Higher the network of hospitals list means there is a high scope of a cashless treatment facility.

Waiting Periods

The waiting period is a duration after the initial commencement of health insurance during which there would be no cover if there are any existing illnesses at the time of purchasing the policy. These waiting periods may range from 2 years to 4 years and vary from plan to plan and company to company.

Ideally, for young persons, they may go for plans with the less waiting period and senior citizens may choose plans with less waiting period as there would be a risk factor of criticality in elders as the age goes high. Additionally, there would be some fixed waiting period for some treatments and medical problems. There will be a clear description of these in the product brochure of the health insurance plan. It is advised to read these before deciding about the plan. Additionally, there will be a waiting period for non-accidental hospitalization in many health insurance policies. Ideally, it is round 30 days from the commencement of the policy.

Co-Pays and Sub-Limits

Some health insurance plans come with co-pay or sub-limits on different aspects of the medical bills. Co-pay is the number of medical bills to be paid out of pocket by the insured person. The remaining amount is paid by the insurer.

Generally, Co-Pay is mentioned in percentage in many health insurance plans. For example, if there is a co-pay of 20% means, 20% of the medical bills are paid by the insured person and 80% is settled by the insurance company. Health insurance plans with co-pay are generally priced low. Some senior citizen health insurance plans come with compulsory co-pay.

Coverage (What is covered and what is not)

Generally, all health insurance plans cover hospitalization bills. Besides there will be coverage for pre and post hospitalization expenses, medical bills, ambulance cover, home hospitalization cover, alternative treatments like AYUSH (Ayurveda, Unani, Siddha, and Homeopathy) cover, organ donor expenses, OPD expenses cover, daycare treatments expenses which don’t need longer stay at the hospital.

Compare these options in different health insurance plans available based on your requirement and sum insured range to make a wise decision.

Domiciliary Hospitalization

Domiciliary hospitalization is the treatment taken at home if the insured person is not able to move to the hospital for getting the suggested medical treatment. The minimum period of treatment should exceed 3 days in most of the plans and there must be a declaration of the same by the treating doctor.

Based on the age and possibility of health issues that may need home hospitalization, this feature can be considered as one key point. For example, if you are looking for health insurance plans for aged parents, then this option can be considered important.

NCB or Cumulative Bonus

NCB (No Claim Bonus) which is also called Cumulative Bonus is the additional sum insured limit that adds to your existing coverage sum in the succeeding year at the time of renewal if there are no claims in the previous year.

This feature differs based on the plan and the insurer. Not all health insurance plans offer this option. Plans that offer this option are generally priced high compared to other plans in the same range.

Restore Benefit or Recharge Benefit

Restore benefit is one more feature offered in some health insurance plans. If the base sum insured amount gets exhausted in a policy year, then the sum insured amount is restored to its full limit automatically.

Some plans offer it for single time restoration and some offer multiple times. Plans with such benefits cost a bit high comparatively. Keeping the number of insured family members and their general health condition in mind this option may be chosen wisely.


One should consider all these aspects to decide on the best plan that matches their need and budget. Besides once should consider the overall reputation of the insurer in the market. Furthermore claim settlement ratio of the insurer, and ease of claim process. If still not clear about which plan to choose, help from an insurance advisor could be considered to make an informed decision.