Are You Happy With Your Health Insurance Policy?

Are You Happy With Your Health Insurance Policy?

The fact that more and more people are realizing the need of purchasing a health insurance policy is a sign of improvement. But the cause of concern is that people don’t seem to be very satisfied with the policy they have already purchased.

Dissatisfaction is rife

A recent survey revealed that many policyholders are not happy with their health insurance policies. The policies that are currently available do not satisfy nearly 48% of the insurance-buyers. Discontentment levels are highest among people in the 60-64 years age bracket. Nearly 67% of senior citizens feel that there is much more to be desired from their policies. Insurers cannot simply wish away this staggeringly high number, because, elderly people are much more likely to need their policies to be sound as they are more vulnerable to illnesses. They should get the benefits that they are paying for. If they are unsatisfied, it means that the health insurance policies are not delivering what they had promised. Among the younger generations, especially among those aged 25-45 years, the dissatisfaction rate is 42%.

There could be a few reasons as to why people end up with an inadequate policy. Sometimes, they do not carry out an extensive background check on the insurer and simply rely on the promises of the insurance agents who will, of course, sing the praises of the insurance company that has hired them. Alternatively, sometimes people buy a policy that demands a nominal premium, but the coverage they offer is not extensive. And sometimes, people are in a hurry to cash in on tax benefits guaranteed by the Income Tax Act and are not discerning while choosing the ideal policy.

The survey also found that those who are content with their medical policies actually bought policies from reputed insurance companies and did not allow thrift to determine which policy they should buy.

To help people avert the pitfall of buying the wrong kind of policy, insurers have decided to compile a list of all the features, benefits and caveats of the health policies that they are selling. This will ensure that people make an informed decision. After all, a health insurance policy has far-reaching implications on an individual’s personal finances. So, if you are looking to buy a health insurance policy, do not allow paying a small premium blind you to the merits of a sound and comprehensive policy.

Another way that a person can escape unscathed from the mistake of having purchased an insufficient policy is the free-look period. During this period, you can assess if the policy is working out for you. If you are not satisfied with the provisions, you can bail out and cancel this policy and the insurer will refund you the entire value of the premium you had paid.

Renewal Costs are on the Rise

An unsavoury trend in the insurance sector is the uncontrolled hike in premiums. This is yet another reason why people are not happy with their health insurance policies. It could be because of the steadily rising inflation rates. Medical costs are soaring as well, simultaneously. Hence, insurers have to regularly revise their premium rates to compete with the market trends. While this has made policyholders grumpy, they can actually thank the Insurance Regulatory and Development Authority of India (IRDA) because, in 2013, it did away with the practice of claim based loading. Earlier insurers used to increase the premium renewal price for people who had made a medical claim the previous year.

Consumer activists have noticed that insurers charge reasonable rates when the policyholders are young and healthy. But, once they grow older and become more likely to contract illnesses, the insurance companies raise the premium. This clearly shows why the elderly policyholders are mostly disgruntled.

The best step you can take in such circumstances is to compare the premium rates of different policies for the next ten years and opt for one that seems to be within your reach. But again, don’t let the motive of cost cutting drive you.

Abysmal Claim Settlement

The same survey also threw light on the fact that 60% of the people who made a medical claim were dissatisfied. 65% of the unhappy clientele chalked it up to partial claim fulfilment. 42% were aggrieved because of a delay in the claim settlement process.

All health insurance plans contain exclusions. Some insurers add a few more exclusions to the list at the time of renewal under the ruse of ‘reasonable and customary changes’, which is another cause of justified anger among many policyholders.

But sometimes, insurers are not really at fault. Insured people often forget that though pre-existing illnesses are covered, they can only receive the benefits of their medical policy once the waiting period of 1-4 years has lapsed. And sometimes people aren’t entirely transparent when it comes to pre-policy declarations and in such cases, the insurer reserves the right to reject any medical claim.

So, before purchasing healthcare plans, meticulously examine the terms and conditions and the list of exclusions. Be honest and up-front when you fill out the form to eliminate the possibility of claim rejection. And research the claim settlement record of the insurer.

Moreover, if policyholders have reasons to complain, they can approach the Insurance Ombudsman’s office to seek redressal. And if that does not go in your favour, you can take your grievances to consumer courts.

What do Policyholders want?

The demands of policyholders are not unreasonable. They simply want insurers to deliver what they had promised:

  • They want the terms and conditions to be unambiguous and transparent.
  • Policyholders want access to network hospitals as well as Out Patient Department coverage.
  • They want no sub-limits on room rent.
  • They want loyalty discounts for long-term policyholders.


Customer satisfaction reflects how well insurance companies are faring. It is also instrumental to their success. So before long, the insurance companies should find ways to root out all the hitches lest they begin to lose their customer base.

Choosing the right Health Insurance Policy can be quite the task. The right decision is a well-informed one. Want to know the Current Trends & Public Opinion on Health Insurance in India? Read our infographic to stay aware!

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