Health Insurance Buyers Are Getting More Demanding: What They Now Look For Beyond The Policy

Buying health insurance is increasingly becoming more than a once-a-year exercise of choosing a policy and paying the premium. Policyholders are looking more closely at whether the cover will actually work when they need treatment, how easily they can make a claim, and whether the insurer's hospital network suits their needs.

A Hansa Research study of 4,000 respondents across more than 12 health insurance brands points to this change in behaviour. Protection against rising medical expenses was the main reason for buying health insurance for 54 per cent of respondents in 2026, compared with 48 per cent in 2025.

At the same time, customers appear to expect more from their policies. The experience during a claim, clarity over what the policy covers, access to hospitals and changes in premiums are becoming important considerations.

Says Praveen Nijhara, CEO, Hansa Research: “As adoption expands and medical costs continue to rise, consumers are becoming more discerning about the protection they purchase and the value they receive from it. Their expectations are extending beyond the policy itself to the experience that surrounds it.”

Claims Remain The Real Test Of A Policy

For most policyholders, health insurance is tested properly only when somebody in the family needs hospitalisation. That is also where problems can surface.

According to the study, four out of 10 policyholders who had made a claim reported facing at least one issue. Difficulties involving the hospital or provider network were the most commonly reported problem, followed by delayed payouts and pre-authorisation issues. The majority of claimants, however, said their cases were processed within two weeks.

For consumers, this makes it important to look beyond the sum insured and premium while choosing a policy. The cashless hospital network, particularly hospitals near one's home or those the family is likely to use, can matter during an emergency.

Policyholders should also understand how pre-authorisation works, what documents may be required and how a claim can be tracked. Knowing these details before hospitalisation can prevent confusion at a time when the family is already dealing with a medical situation.

The study found that faster claims and stronger hospital networks are among the improvements customers value most.

More Buyers Are Filling Gaps In Employer Cover

Another change is visible in the way people are building their health cover. Instead of depending entirely on one policy, some are adding another layer of protection.

Around 32 per cent of respondents use additional policies to address gaps in corporate or employer-provided health insurance. This suggests that some consumers are examining whether the cover available through the workplace would be sufficient for their family's requirements.

An employer's group health policy can be useful, but the sum insured, room-rent conditions, coverage for family members and other features may not necessarily match an individual's needs. The cover is also linked to employment.

Consumers considering an additional individual or family floater policy should first examine what their existing cover provides and identify the gaps instead of simply buying another policy.

Premium Surprises Can Push Customers To Switch

Price remains important, but consumers are also concerned about how changes in price are communicated.

The study found that unannounced premium increases and hidden terms are among the leading reasons for policyholders to consider porting or switching their policies.

A renewal notice, therefore, should not be treated merely as a payment reminder. Policyholders can compare the new premium with what they paid previously and check whether there have been changes in the sum insured, benefits, co-payment requirements or other conditions.

Porting should also not be driven by premium alone. A cheaper policy may not necessarily be better if it offers a hospital network or policy terms that do not suit the buyer.

Digital Tools Are Becoming Part Of Policy Management

How customers manage their insurance is changing as well. Mobile apps and self-service platforms are increasingly being used for renewals, policy administration and claim tracking, with younger policyholders showing a greater preference for such channels.

For policyholders, easy access to policy documents, claim status and renewal information can make managing health insurance simpler. But digital convenience should complement, rather than replace, a careful reading of the policy.

The larger shift is towards a more involved health insurance buyer. Rising healthcare costs may prompt the initial purchase, but consumers are increasingly asking what happens afterwards: whether the cover is adequate, whether the right hospitals are available, how smoothly claims work, and whether they understand what they are paying for.

FAQs

What should you check besides the premium while buying health insurance?
Look at the cashless hospital network, claim process, pre-authorisation requirements, policy conditions, and whether the sum insured is adequate for your needs.

Is employer-provided health insurance enough?
Not always. Employer cover may have limits on the sum insured, family coverage or other benefits, so an additional policy can help fill gaps.

Should you switch health insurers if the premium increases?
Not based on premium alone. Compare coverage, co-payment conditions, hospital network and other policy terms before deciding to port your policy.