Key Questions to ask Your Health Insurance Agent

No matter what we purchase or how we transact with a business, there’s nothing like a personal touch. In the health insurance industry, it is the insurance agents or representatives of insurance companies who bring this personal touch. 

An insurance agent is a professional who helps customers understand, buy, and manage insurance products in the most effective way. The best health insurance agents or advisors are trustworthy and knowledgeable and bring many benefits to their clients.

Benefits of having with an insurance agent

• Provides in-depth knowledge of health insurance products
• Deep expertise in understanding individual insurance needs
• Keeps clients updated with existing and new insurance products 
• Helps choose the most beneficial insurance products
• Helps tailor health insurance needs according to different goals and expectations
• The best health insurance agents communicate and keep in touch with clients to keep them updated every step of the way
• Brings in clarity, transparency and is a link between an insurance company and the customer 
• Helps to develop long-term healthcare and insurance strategies
• Keeps the customer updated on the implications of the latest regulatory changes put out by IRDA from time to time
• Helps make informed decisions based on thorough calculations

A recent report reveals that more than 60% of customers that bought health insurance plans on the basis of the recommendations of insurance agents were not satisfied with their purchase. Why does this happen?

When dealing with insurance agents, it is important to remember that agents’ advice may be guided by commissions they earn from selling products. Hence they may be inclined to push products that promises them more commissions that the product that is right for you. 

Of course, insurance agents also have a reputation to protect, but you can make the relationship with the agent more fruitful by asking the right questions. The next time you interact with your insurance agent for making a purchase or renewing your health insurance plan, make sure you ask these pertinent questions.

Related blog: A Layman’s Guide to How Health Insurance Works

What are the claim settlement ratios of different insurance companies and how to make buying decisions based on them?

Claim settlement ratio of an insurance company is a critical factor that can help determine the reliability of a company in paying claims. It is the ratio of claims paid to claims made in a particular year. It shows the efficiency and the commitment of the insurance company.

Ask your insurance agent to share the claim settlement history of health insurance companies for at least the last five years. If the claim settlement ratio is good – usually 85% and above is considered a good ratio – the insurance company is worth considering and maybe less risky compared to those with a low claim settlement ratio. You can be sure that you want get caught up procedural delays when making claims. The best health insurance agents are generally candid about the claim settlement ratio of the insurer company they’re representing.

What are the limitations of health insurance plans?

The lack of trust between policyholders and insurers boils down to the fact that insurance customers are ill informed or lack awareness of policy terms and clauses. 

Ask your insurance agent about the limitations of your chosen health insurance plans. One way of doing this is by imagining a worst case scenario and whether or not your chosen policy will be helpful enough during the time. Some of the limitations to probe the agent are:

•     Minimum hospitalization requirements
•     Limits on certain medical treatment procedures
•     Waiting period for certain kinds of diseases
•     Renewability of a health insurance policy and age limits
•     Limitations on sum insured
•     Co-payment and sub-limits clauses and limitations

 These are some of the most important questions to ask health insurance agent to ensure that you get the best health insurance policy for yourself.

What are the exclusions in your selected health insurance plans?

As explained in this report, the priority for most policyholders is clear and simple explanation of restrictions and exclusions in a health insurance plan. Questions about exclusions and restrictions in the health insurance policy are also essential questions to ask health insurance agent. These are the exclusions that you must specifically ask your insurance agent to explain in detail, perhaps explain with calculations.

•     Pre-existing diseases
•     Maternity coverage
•     Treatments not covered, e.g. cosmetic, dental, physiotherapy, etc.
•     Lifestyle related diseases not covered
•     Diagnostic tests not covered
•     OPD expenses not covered

What is the claim process of your selected health insurance plan?

You do not want to worry about figuring out the claim process at the time of a medical emergency or at the time of actually making a claim. It is better to understand the claim process before buying an insurance plan. Questions to ask health insurance agent about the claim process must be thorough since the claim process defines the majority of your customer experience with the insurer.

At times, the insurance company may reject claims. The most common reasons for claim rejection are:

•     Claim made before the end of waiting period
•     Claim made for expenses not covered by the policy
•     Delay in making the claim within the specified period

Insurers follow two types of claim processes:

1.   Cashless claim
2.   Reimbursement claim

Some insurance companies also offer online health plans that offer swift and convenient online claim settlement procedures.

A note of caution: beware of entities and individuals that call themselves ‘claim advisers’. The IRDAI has informed that these claim advisers are not associated with insurance companies and policyholders that avail their services, do so at their own risk. 

Which clauses are the most important to understand?

Health insurance policy documents are filled with clauses, so much so that it can overwhelm any layman. Go through all the clauses and ask your insurance agent to specially explain the more important clauses.

Renewability clause

You may have bought an insurance policy 15 years ago at the age of 45 and so you may not remember the renewability clause. A number of times, policyholders have been turned down at the time of renewal of their insurance policy due to the age limit clause. It is better to check if there is any renewability age limit. It is better to choose health insurance that offers lifelong renewability.

Sub-limit and co-payment clause

In the case of sub-limit, policyholders can claim up to a specified amount towards specific expenses. E.g. maternity insurance usually has a sub-limit.

In the case of co-payment, policyholders are responsible to pay a pre-specified part of the expenses; the insurer’s liabilities are limited. Sub-limit is mostly applicable to health insurance for senior citizens.

You do not want to be caught about these clauses unawares. It is important to study these clauses carefully and understand the math behind the specified amount. Hence, ask your insurance agent to explain these in elaborate detail and don’t leave anything to chance. Ideally, you should choose health insurance that doesn’t have any restrictive sub-limits and the lowest co-payment ratios.

What are the benefits that enhance the sum insured of the insurance plan?

Life expectancy has increased and the costs of medical treatments have also escalated in a big way. It is essential to have a health insurance policy of a sufficient amount. But this doesn’t mean that one has to buy a high sum insured policy at the start. Benefits such as no-claim bonus and restoration can help you enhance the sum insured over a period of time without having to pay more. 

Are you ready with your set of questions to ask your health insurance agent? The above six questions will help you probe deeper and explore the real benefits of your health insurance policy, which you might have missed. Don’t forget to consider online health plans that offer various benefits like convenience, ease of purchase and transaction, security, etc., to the policy buyers.