What is a health insurance policy?

Health insurance also called as Mediclaim, is a way to pay for advance medical treatments that typically require you to be in hospital overnight. It also covers certain other day procedures like cataract surgery, etc. that don't require you to be hospitalized but are expensive nevertheless. A health insurance policy, therefore, covers your medical expenses and gives you financial relief.

Why is Health Insurance Policy important & why should you buy it?

Medical insurance is a form of insurance which covers the medical costs incurred in case of medical emergencies. These plans, thus, take care of the financial burden associated with medical contingencies. In today’s age, when illnesses and diseases are on the rise, a health insurance plan becomes necessary. Though medical developments have provided a cure for most of the illnesses, such as cures and treatments come at very expensive costs. These costs become unbearable for the common middle-class man. A health plan, by covering these costs, takes off the financial strain caused by frequently occurring illnesses. It, therefore, proves to be an essential requirement for every individual looking to secure his finances against medical contingencies.

Types of health insurance we offer

· 1. Individual health insurance plans:

Individual health insurance plans which cover a single individual under the cover

· 2. Family floater health insurance plans:

Family floater health insurance plans which cover the entire family under the plan. A family consists of the policyholder, spouse, dependent children, and dependent parents. One plan covers the entire family on a floater basis. The sum insured is shared by the family members. Any member can make a claim up to the sum insured.

· 3.Critical illness health insurance plans:

Critical illness health insurance plans which cover major critical illnesses. If the insured is diagnosed with any covered illness, the sum insured is paid. The policyholder can use the sum insured to meet the cost of advanced treatments or pay for any other financial obligations

· 4.Top-up health insurance plans:

Top-up health insurance plans which provide supplemental coverage at minimal rates of premiums. If individuals feel that their coverage is low, they can buy top-up plans to increase the coverage. There is a deductible limit under these plans. Any claim which is in excess of the deductible limit is paid.

· 5.Super top-up health insurance:

Super top-up health insurance plans which are also called aggregate health plans. These also help to enhance the sum insured at affordable premium rates. Super top-up plans are like top-up plans. They also have a deductible limit and claims exceeding the limit are only paid. However, while top-up plans consider each instance of claim separately, super top-up plans aggregate the total claims made in a policy year and then apply them against the deductible limit. If the aggregate claims exceed the deductible, the claim is paid

· 6.Senior citizen health insurance plans:

Senior citizen health insurance plans which are meant to cover individuals in their older ages. Individuals who are 61 years and above can be covered under senior citizen health insurance plans. The sum insured under these plans are limited and premiums are affordable.

· 7. Hospital cash plans:

Hospital cash plans which pay a fixed benefit for each day of hospitalisation. If the insured is hospitalised, a daily allowance would be paid every day up to a maximum period.

· 8. Disease-specific health plans

These can be indemnity oriented or fixed benefit health insurance plans which cover specified illnesses like diabetes, cancer, heart-related ailments, dengue, etc.

You should understand the types of medical insurance plans before choosing the best plan suiting your requirements.-

Benefits of Health Insurance Plans & Policies

Medical insurance policies offer various advantages and come with unique features which are as follows –

· Medical insurance plans cover all medical costs incurred right from the time the insured falls sick to his hospitalisation and also after being discharged from the hospital. Thus, the plan has a wide scope of coverage for medical costs

· There are value-added coverage benefits in medical insurance policies too. These include free health check-ups after a specified period, second medical opinion for serious illnesses, etc.

· Health plans allow tax advantages. Premiums paid for medical insurance policies for self, family and dependent parents qualify for tax deduction under Section 80D. The limit of deduction if INR 25, 000 for covering self and family and another INR 25, 000 for covering dependent parents. Moreover, if either the policyholder and/or dependent parents are senior citizens, the maximum limit increases to INR 50, 000 in each instance. Thus, a maximum of INR 1 lakh can be claimed as tax deduction though health insurance plans

· No Claim bonus is allowed in all medical insurance plans if no claim is made in a policy year. This bonus is either allowed as an increase in the sum insured or additional benefits can be availed like gift vouchers, annual health check-ups, etc.

· Lifelong renewals are offered by health plans with no maximum cover ceasing age

· The term of the plan can be for one, two or three years. Moreover, if long term plans are chosen, a premium discount is also allowed

· Individuals can claim premium discounts for covering two or more family members, by choosing a longer duration, by choosing voluntary co-payment, etc.

· Cashless claims are settled by the health insurance company if the policyholder seeks treatments at a hospital which is tied-up with the insurance company. In cashless claims, the policyholder does not have to bear the burden of medical expenses. The expenses are settled directly by the insurance company with the hospital.


Health Insurance policy Inclusions

A basic medical insurance plan provides all the essential coverage features. You would find coverage for the following –

· Inpatient hospitalisation – this includes coverage for room rent, ICU room rent, cost of treatments, doctor’s fees, surgeon’s fees, nurses’ fees, etc.

· Pre and post hospitalisation – expenses incurred before being actually hospitalised and after being discharged from the hospital are covered under this head

· Ambulance costs – costs incurred in transporting the insured to the hospital is covered up to a specified limit

· Daycare treatments – treatments which do not require hospitalisation for a minimum of 24 hours are covered under this section

· Organ donor expenses – expenses incurred on harvesting an organ from a donor are covered

· Domiciliary treatments – treatments taken at home because the insured cannot be moved to the hospital or because there are no vacant beds in the hospital would be covered

· AYUSH treatments – these treatments are alternative, non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy. Most health plans cover medical expenses incurred on these treatments.

Besides these common coverage features, different medical insurance policies provide different coverage features too which make the plan comprehensive in nature.

Health Insurance policy Exclusions

Though medical insurance plans provide coverage for most of the medical expenses, there are some expenses which are not covered. These are called plan exclusions. Some common ones include the following –

· Pre-existing illnesses during the waiting period

· Illnesses occurring within the first 30 or 60 days of buying the policy

· Congenital ailments and diseases

· Cosmetic treatments

· Pregnancy-related treatments, unless specifically covered

· HIV/AIDS infection

· Illnesses or injuries occurring due to war or related perils, aviation, nuclear contamination, self-inflicted injuries, alcohol or drug abuse, etc.

To know the exact exclusions, you should read the policy document. Different medical insurance policies have different inclusions and exclusions. So, understanding the policy details before buying the policy becomes essential. It’s best to disclose your medical history truthfully before you buy a policy to ensure your claim expectations are met. Discuss this with our expert to figure out your best options - we will maintain strict confidentiality.

Factors to consider while deciding the Health Insurance Company and its plan

Since medical insurance plans are important in providing financial security, they are quite popular. Almost all general insurance companies in India offer a wide variety of health insurance plans for individuals. Among the hundreds of plans available, it becomes very difficult for individuals to understand which plan would be the best health plan for them. So, here is a guide to choose the best health insurance in India –

· Understand the type of coverage required – first and foremost, individuals should understand the type of health plan which would suit their needs. If they don’t have any health insurance, a family floater or individual plan is recommended. If there is an existing health plan, a top-up plan is good for enhancing coverage at low health insurance quotes. Critical illness plans are also a must for protection against major illnesses while disease-specific plans are helpful in protecting against specified ailments. Individuals should assess their requirement and choose the most suitable plans for themselves.

· Ensure that all family members are covered – health contingencies can strike anyone and so individuals should endeavour to cover all of their family members under health insurance plans.

· The sum insured should be optimal – the sum insured of the medical insurance plan should be sufficient to pay for the high medical costs which would incur in an emergency.

· Look for comprehensive coverage features – the medical insurance plan which provides the most inclusive coverage benefits would be the best health plan. Individuals should look for such comprehensive plans and see if the coverage benefits are relevant to their needs.

· The premium rate should be reasonable – besides the coverage benefits which should be all-inclusive, the premium of the best health insurance plan should also be reasonable and affordable. If the plan has very high premiums, it would not be the best health insurance plan.

· Compare before buying – to choose the best health insurance plan in India, the best way is to compare the different plans and then buy one. Comparing lets you see the available plans and helps you in choosing one plan which is the best from the rest.

Health Insurance Claim Settlement Procedures

To make a successful claim in a health insurance policy, policyholders are required to follow the below-mentioned process –

In case of cashless claim settlement

· The policyholder should inform the insurance company of the claim. This information is to be given by filling up and submitting a pre-authorisation form. The insurance company analyses the form and approves cashless claim settlements. The form should be submitted at least 4-5 days before a planned hospitalisation. If, on the other hand, the hospitalisation was an emergency, the form should be submitted within 24 hours of hospitalisation

· The health card or the policy bond should be produced to the hospital along with the identity proof of the insured

· The company would then take care of the medical expenses

· All medical documents, reports and bills should be submitted to the insurance company along with the claim form.

In case of reimbursement claims

· The insured should get admitted to a non-network hospital and avail the necessary medical treatments. Payment for the treatments would have to be done by the policyholder himself

· Once the insured is discharged from the hospital, the discharge summary or discharge certificate should be collected

· The claim form should be filled and submitted with the discharge certificate, medical reports and all original medical bills

List of Documents required for Health Insurance Claim settlement

Eligibility Criteria for Health Insurance

Here are some of the important eligibility criteria of health insurance plans –

· A health insurance policy can be bought by an adult aged 18 years and above. The maximum entry age under many plans is 65 years or 70 years while some plans allow lifelong entry. Children can be covered under health insurance plans on an individual basis from 5 years onwards. Under floater coverage, though, dependent children can be covered from 91 days onwards till a maximum of 23 or 25 years of age till they are considered to be dependent on their parents

· Health insurance plans are renewable for life and there is no coverage ceasing age

· The sum insured starts from INR 1,00,000 and the maximum limit depends on the policy that you choose

· Under floater plans, you can cover yourself, spouse, dependent children and parents. Many plans also allow extended coverage for parents-in-law, grandparents, siblings and other close relatives of the family

· The term of health insurance plans is one year but many plans allow you to buy a multi-year policy where the term can be taken for a continuous period of 2 or 3 years

Health Insurance Portability

Health insurance portability means switching to another health insurance plan either offered by the same insurance company or by another insurance company but retaining the no-claim benefits of the earlier plan.

Porting can be done using the following ways -

· The medical insurance company should be informed about the porting request, in writing, at least 45 days before the renewal date

· A porting request should be sent to the insurance company

· Apply with the new insurance company and provide the details of the existing policy

· The company checks the existing policy details and then allows porting

· A new proposal form of the new policy should be filled and submitted with the new insurance company

· The premium should be paid

· The plan would be ported and a new insurance policy would be issued containing the renewal benefits of the existing policy

Only if the above steps are followed will the health plan be ported.

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