Can your claim get stuck even in online health insurance?

Many people hesitate to buy health insurance policies on the internet. They are afraid about their claims not being honoured on time. With an agent, there was at least some semblance that they would help in getting the claims fulfilled.

But this is a mistake. People tend to think that with an agent, claim settlement becomes easier, whereas if you buy a policy online, there will be difficulties in getting claims processed. Remember, it is the insurance company and not the agent that pays the claim. Irrespective of the policy being purchased online or offline, you should take care of some crucial factors before buying one. Before delving into what you should look out for in a health insurance policy, let’s understand the online insurance market.

As per a report by market research agency Mordor Intelligence, India’s online insurance segment is estimated to register around $92.60 billion worth of trade in 2023. The market is set to grow to $120.05 billion by 2028, with a projected annual growth rate of 5.23%.

Currently, there are 30 insurance companies that are selling health insurance policies. Out of these, 25 are general insurance companies, while 5 exclusively sell health insurance policies. Together, these companies offer hundreds of health plans. If you are planning to buy your policy offline, you’ll be able to find out only about a few of them. But if you’re searching for them online, you’ll find hundreds of policies within a few seconds.

Whichever policy you shortlist during your online, get to know more details about it through the insurance aggregator, the  website and helpline of the insurance company. Do not buy any insurance policies without comparing different insurance policies. Check the policy’s scope of coverage, that is, compare what is being included and what’s excluded. Ask regarding the waiting period, and check which company has a higher claim settlement ratio.

Another benefit of buying an insurance policy online is that you can get information regarding many useful riders at one place. You can buy them as per your need. For people like Arun, who are hesitant to buy policies online and wonder if their claims will be settled, let’s hear from an expert.

When you buy an insurance policy through an agent, you begin to depend on him or her for all information related to the policy. You tend to believe whatever he or she says as true. On the other hand, you have to undertake some research yourself before buying a policy online. This helps you understand the policy in a better way.

Whether you buy a policy online, or via an agent, you will have to visit the TPA or third party administrator for claim-related issues. TPAs serve as a bridge between the policyholder and insurance company. Their primary job is to facilitate claims and settlement-related processes. Your medical card, which helps you avail cashless treatments,  is also issued by a TPA. All medical bills related to your treatment need to be submitted to the TPA. This can be done online.

When you search for insurance online, your mobile number is captured by insurance companies. After this, their sales agents contact you. Remember, they are merely sales agents, not insurance experts. So, you should not buy insurance policies merely on their insistence. If you have also received such an offer on the phone, take it in writing.

If you are buying a policy online, you need to analyze it in the context of your needs. Carefully read the terms and conditions of the policy, and pay special attention to sub-limits and co-payment clauses. This is because these clauses can mean extra expenditure for you. For instance, under sub-limits, insurance companies determine the maximum amount they will pay for a certain treatment or procedure. Any expenses over and above will have to be borne by you. Under the copayment clause, you are required to pay a certain percentage of the total treatment cost yourself.

While this clause significantly brings down the premium, it can prove costly during claim settlement.

So, hope you’ve also understood that whether you buy your health insurance online or offline, the products and its features remain the same. All you’ve got to do is solid homework. If the features you want are available in a particular policy, you can buy it online. Compared to offline mode, the premium payable is less, since you can get discounts. As far as claim settlement is concerned, you have to visit the TPA, irrespective of whether you’ve bought the policy online or offline. So, you don’t have to worry about claim settlement in online insurance.