7 Things to know before buying a health insurance policy

No one plans to get hurt or sick. However, we all need medical care at some point. After all, life is full of uncertainties. That said, health insurance can help cover medical care costs and protect you from high expenses.

However, finding the right health insurance policy for your needs can be daunting and confusing with numerous options available. Not to worry, though, this article shares seven things to know and consider before buying a health insurance policy.

1. Insurance coverage

When choosing the right policy, you first need to understand the coverage benefits offered in the plan. Although most plans offer a basic healthcare coverage benefit, you want to look for insurance plans that offer unique features.

You need to assess your coverage requirements and look for insurance policies that meet those needs. For instance, if you’re planning to have kids soon, you need to choose a plan that provides maternity coverage. If you need regular dental checkups and procedures, look for policies with dental coverage.

According to Aria Dental, a reputable dental clinic in Western Australia, some procedures, such as dental implants, may be specifically excluded from periodontal cover. So, even if you have primary dental cover in your health insurance policy, it makes sense to check for exclusions.

In addition, you should consider additional features that can enhance the scope of health coverage. For instance, a high no-claim bonus, sum insured restoration, annual health checkups, and more can help maximize the scope of coverage, giving you better financial security and minimizing your out-of-pocket expenses when claiming.

2. Family floater vs. individual health insurance

When choosing a health insurance plan, you’ll have two options: an individual policy and a family floater.

As its name implies, an individual policy is dedicated to only one person. The individual will be responsible for paying the health insurance premium, and the sum insured is provided to that person only. If you’re unmarried and don’t have kids, have a history of medical complications, or are engaged in a high-risk job, then an individual health insurance policy is a great option.

Meanwhile, a family floater means that all family members are protected under a single plan. This means that the premium and sum insured are split amongst family members. Ideally, an individual with a spouse and dependent kids should have health insurance under a family floater plan since it’s much more economical.

3. Age specifications

If you choose a family floater plan, age is one of the most critical aspects to consider. It would help if you considered the age of the family members you want to be covered when buying health insurance. In general, the premium of the policy is calculated based on the age of the oldest member.

Age specifications

So, if you have dependent parents not covered under any health insurance policy, it’s best to buy them a separate plan and not include them under a family floater plan. Since the premium is based on age, covering your parents within a family floater means you have to pay more for your premium.

However, note that some health insurance plans don’t have any age limits.

4. Waiting period clause

Most health insurance policies have waiting periods. This means that you can’t make a claim for specific coverage for a particular duration or waiting period.

For instance, the average maternity waiting period might range from 9 – 48 months. Most insurance policies also include the first 30-60 days of the waiting period, often known as the cooling-off period, for the coverage of chronic illnesses. Depending on your insurance provider, the waiting period for specific treatments and pre-existing illnesses can vary. However, accidental injuries are often covered from day one.

Waiting periods are inevitable. But you can find insurance policies with a shorter waiting period. This is particularly relevant if you seek coverage for pre-existing conditions or maternity and need it quickly.

5. Premium amount

The insurance premium amount is one of the most important things to know when looking for the right policy. You want an insurance policy that offers you the necessary coverage but still fits your budget.

Don’t forget always to check the premium charged against the coverage offered. To better understand, you can always compare the premiums of different providers who provide similar coverage benefits you need. Check if the premium is overpriced or competitive based on the coverage.

6. Co-Payment clause

A health insurance provider may include a co-payment clause in your policy. Co-payments mean that you have to pay a specified percentage of every claim you make from your pockets. For instance, if your insurance policy requires a 5% co-payment, you’ll need to pay 5% of every claim you make from your provider.

In general, insurance providers add a co-payment clause if:

  • You buy the policy in a city belonging to a lower Tier and get treatments in a city of a higher tier.
  • You’re 61 years old or older when getting the policy.
  • You have pre-existing illnesses or require specific treatment.

health insurance policy

If possible, look for a health insurance plan that doesn’t have a co-payment clause. However, if it’s unavoidable, you may want to choose a plan with a lower co-payment rate.

7. Claim process

Nothing is more annoying than paying your premiums on time only to have slow processing when it’s time to make a claim. To prevent this, it would be best to check the provider’s claim process and claim settlement ratio.

You want to choose an insurance provider that has a straightforward claim process for quicker claim settlements. Make sure to check their claim settlement ratio, which is the number of claims settled by the insurance provider against the total number of claims filed by clients within a financial year. This is an effective way for clients to identify the ability of the provider to settle claims.


Choosing and buying a health insurance policy doesn’t have to be a nightmare. While there are hundreds of health insurance providers in the industry, we hope this article has made it easier for you to choose the right one for your needs. The above points and factors should guide you along the process and help you make a well-informed decision for your healthcare needs.

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