Assigning the Weights
Premium (20 points)
This indicates the paying capacity of a senior citizen. With only lifetime savings as a corpus fund and the regular pension amount for fulfilling their daily needs, this age group would look for the cheapest policy with maximum benefits. For weightage, maximum points are awarded for the cheapest premium, while least points have been assigned for the highest premium.
Co-payment (20 points)
Maximum weightage has been assigned for least co-payment, and vice versa.
Pre-existing disease (15 points)
This is a controversial clause – one that has been debated even in the judicial pronouncements. This
clause is interpreted differently for different diseases. We have given prime importance to this clause and assigned maximum points for minimum waiting period, while assigning lesser points for increased waiting period.
No-claim bonus (10 points)
When an insured does not invoke the health policy throughout any year, they are entitled to either a discount on the premium payable during the succeeding year or a hike in sum insured (subject to ceiling). We have assigned maximum points for higher bonus and nil points for no cover.
Day-care cover (10 points)
This is important for the consumer as it reduces their cost or covers additional medical expenses, though it is not going to alter their options in a major way while choosing a policy. Hence, we have assigned maximum points for full coverage of benefit and nil points for no cover.
Domiciliary treatment (5 points)
These are the expenses incurred in case the patient is being treated at home due to non-availability of beds in hospital or due to their not being in a medical condition to be moved to a hospital. For assigning weights, we have taken into account coverage available (maximum points) and no cover extended (nil point).
Organ donor expenses (5 points)
In case of an organ transplant, cost of hospitalization of the donor and the cost of transplant are provided by the insurance cover except for the cost of organ. Maximum weights have been assigned for availability of cover and nil point for no cover.
Pre-hospitalization (5 points)
The expenses incurred for a limited period before the date of hospitalization of the insured (for lab tests, consultation, etc.) are covered. Maximum points have been assigned for maximum period covered and nil points for no cover.
Post-hospitalization (5 points)
The expenses incurred for a limited period after hospitalization (for lab tests, consultation, etc.) are covered. Maximum weights have been assigned for maximum period covered and least points for lesser period covered.
Entry age (5 Points)
The age factor is considered but it is not of prime importance. Hence maximum points have been assigned for any entry age and least points for ceiling on entry age.