As we celebrate Universal Health Coverage Day today, it is crucial to ponder upon the ideal size of our health cover and ensure that it meets our needs and provides a safety net for unforeseen medical expenses.
Choosing the ideal size of your health cover is not a one-size-fits-all approach. Each individual’s requirements and circumstances are unique, and therefore, the size of their health coverage should be tailored accordingly. To determine the ideal size, consider factors like your age, current health status, lifestyle choices, medical inflation, hospital of choice and family history of diseases.
Dr. Bhabatosh Mishra, Director – Claims, Underwriting & Product, Niva Bupa Health Insurance says, “The adequate amount of sum insured plan one should opt for primarily depends on three factors – first is place of residence, second is life stage of the person for whom insurance is being taken and thirdly, it should cover the future cost of hospitalisation as well.”
Young individuals with no pre-existing conditions may opt for a lower coverage early in life with the option to increase it as they age, taking advantage of lower premiums. This ensures financial protection in case of unexpected emergencies or illnesses.
Middle-aged individuals might consider comprehensive coverage and for families, opting for floater policies covering the entire family proves more advantageous than individual policies, and a higher sum insured ensures comprehensive coverage.
While senior citizens may require higher coverage due to potential health risks. This should include coverage for pre-existing conditions, regular check-ups, diagnostic tests, medications, hospital stays, and rehabilitation services. Moreover, considering the possible need for assisted living or nursing care in later years, a long-term care insurance policy should also be considered.
Parthanil Ghosh, President- Retail Business, HDFC ERGO General Insurance says, “A prudent guideline is to target health coverage equivalent to approximately 35% to 50% of one’s annual income with minimum coverage of ₹5 lakh to 10 lakh.”
“For individuals aged 18-30, a basic plan covering emergencies and essential medical expenses may suffice. As one transitions into the 31-50 years age bracket, opting for a more comprehensive plan that includes maternity coverage becomes advisable. In the senior years (51 and above), it is wise to choose extensive coverage, encompassing chronic conditions, prescription medications, and potential long-term care needs,” Ghosh added.
“It is recommended to opt for a sum insured of Rs. 10 lakhs or more, as this will provide sufficient coverage in the foreseeable future. Additional top-up covers that augment the sum insured are available at reasonable costs. It’s important to note that nowadays, health insurance coverage can extend up to Rs. 2 crores,” says Dr. Madhumathi Ramakrishnan, Chief Claims Transformation Officer, Star Health And Allied Insurance Co. Ltd.
Furthermore, there are insurance policies tailored specifically for women, providing robust coverage for both women and their newborns. Additionally, there are specialised policies available for individuals with particular diseases like diabetes, heart disease, and cancer, featuring shorter waiting periods.
As medical technology continues to advance, with developments such as robotics, stereotactic surgeries, advanced oncology drugs, and advanced radiotherapies like proton therapy for cancer, it is increasingly important for individuals to consider higher sum insured. Increased insurance coverage is also necessary to cover high end advanced treatments and interventions such as TAVI, ECMO, Impella, and transplantation.
It is important to note that the ideal size of your health cover should also align with your financial capabilities. While it is crucial to have adequate coverage, it should not overly burden your finances. Evaluate your monthly budget and assess how much you can comfortably afford to pay towards insurance premiums. Opting for a health cover that strikes a balance between the coverage you need and what you can afford is key.
To determine the best sum insured and type of policy that meets your individual needs, it is recommended to consult with a financial advisor or insurance professional.
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Published: 12 Dec 2023, 01:34 PM IST