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IRDAI License No : HCG11821

Health Insurance

We all know the popular proverb which says, “Health is Wealth”. With a healthy body, you can have a healthy life. So, its very important to secure your health the best way possible. With the help of health insurance, your goal to secure your health becomes very easy. In todays changing environment and lifestyle, health issues are now very common.If you lead a healthy life, there is no surity of healthy body any more. Also, the skyrocketing medical cost will leave you with no savings for the future. To overcome this situation smartly, you should go for Health Insurance.

To make it a little easy for us to understand, Health Insurance is an agreement between you (policy buyer/s) and your insurance company that covers fully or partially your medical and surgical expenses. In short, health insurance is a kind of insurance policy which secures you and your families health related problems arising out of any, disease or illness. You need to pay an annual premium and renew the health insurance against which the insurance companies will pay for your hospital bills and other medical expenses (as per the insurance policy). Some health insurance provides coverage of pre and post hospitalization, daycare hospitalization. The health insurance company either pay directly to the health provider or reimburse the medical expense to the insured individual.

You need to keep in mind that there is a specific amount of waiting period for certain illness imposes by the health insurance companies. That means, before the waiting period you will not get the insurance coverage. After the waiting period is over, then only your claim to the insurance policy will be valid.

In order to get the full benefits of Health Insurance policies, you need to insure under that health insurance policy which will fulfill all your requirements. To buy the best suited health insurance policy, you can check and compare different health insurance policy quotes, coverage offers online. You search online and can get information on different quotes of health insurance. This will help you th chose the best health insurance policy.

Importance of Health Insurance

In India, the medical cost is increasing at the rate of 15% to 20% every year. Taking into account the unpredictability in addition to the medical costs, health insurance provides financial stability to a person or his family.

Following are some of the points related to the importance of health insurance-
  • Medical expenses are nowadays very expensive. So, health insurance helps to minimize the expense.
  • Individual with no health insurance tend to get less medical care for lack of money.
  • Uninsured person donot opt for regular health check up and are prone to more risk.
  • Health insurance helps to protect unexpected health related financial situation of an individual or his/her family.
  • Many added benefits like- ambulance cover, critical illness cover etc are provided by the health insurance companies.

Types of Health Insurance Plans in India

Every individuals have different preferences as per their need, so there is a variety of health insurance policies with different health insurance coverage offers.
Here we, have put forward the variety of health insurance plans in India-

Individual Health Insurance Plan

As the name suggests, this plan is designed for a single individual. This insurance policy insure a single individual against various illness as per the norms of insurance policy. This plan involves premium with low risk factor as it is borne for only an single individual. This insurance policy covers the disease or illness as per the terms of policy. The premium of this insurance plan depends on age, location, previous medical history and so on. The expenses which is covered under this plan are- maternity care expenses, pre and post hospitalization, patient care, charges of laboratory tests, medical examination fees and consultation charges.

Critical Illness Plan

This specific plan provides insurance coverage to the policy holder suffering from critical illness specified under the policy. As the medical cost of critical illness like- heart attack, organ transplant, paralysis, cancer, kidney failure is quite high, so the critical illness plan provides financial support to the policy holder suffering from any one of the critical illness listed under this policy. This plan is best suited for those with a medical history of specific illness or disease.

Family Floater Health Insurance Plan

This insurance plan offers insurance coverage of your family members against various illness or diseases. The medical coverage of your parents, spouse and children (minor) are included in this policy plan. This plan can include family members upto 15. It is always wise to go for family floater insurance policy with medical coverage of your family, instead of high premium of individual policies. Each insured members receive an equal coverage amount or all the members receive a combined sum depending on the health insurance provider. If any family member need a specific amount for any medical treatment, they can take it from the entire sum amount under the combined sum. Though the premium of this policy is higher, but it will be a money saving plan instead of spending on multiple things .

Senior Citizen Health Insurance Plan

This plan is exclusive for the medical needs of the senior citizens. This plan is eligible for those who has attained the age 60 years. This plan involves lower premiums or discounts on premiums. Before selling this plan, there is a requirement of medical check up from the insurance company.

Maternity Health Insurance Plan

This plan offers policy coverage for maternity and additional expenses. These policy covers- mother and the newborn baby, pre and post natal care, complication during delivery, hospital charges and sometimes vaccination of the new-born babies. Under this insurance plan, the maternity insurance providers are connected with a wide range of hospitals and also takes care of the ambulance expense.

Preventive Healthcare Plan

This particular plan aims in healthcare provision for preventive care. Preventive Healthcare Plan offers policy coverage of preventive care like- regular check up, consultation fees, concession in X-ray fees etc. This policy ensures prevention of an ailment and it’s early detection.

Personal Accident Cover

Accidents are unforseen incident and can never be expected to happen. This plan can be a benefit of the base plan or is offered as a rider. This insurance policy covers the cost related to personal accident. The medical coverage includes- hospitalization, compensation in case of disablement, injury, mutilation or impairment and even death. Accidents which are covered includes- rail, water, road and air.

Employee/Group Health Insurance Plan

To safeguard the interest of the employees and to minimize the risk, many companies insure their employees with health insurance. As the employees join or leave the company, this policy is designed accordingly.

Eligibility Criteria for Health Insurance

With the help of medical insurance policy, you are secured about one’s health. The medical expenses involved is covered across a huge range of hospitals in India.

Under the health insurance coverage, two parties are insured-
  • The Proposer
  • The Dependent
Following are the set of eligibility criteria to avail the health insurance policy-
  • Policy holder/Proposer- The minimum entry age of an adult policy holder is 18 to 21 years. The maximum entry age is between 60 to 100 years or can be extended.
  • Dependent- Depending on the type of the insurance policy, parents, spouse and childrens are allowed to protect under the same policy. The entry age of the children is as early as 90 days. Under the parent’s policy, the childrens are insured upto the age of 18 years and can be extended upto 25 years.

Process to claim Health Insurance

Previously health insurance claims were really tiresome process and involved a lot of time, huge paperwork and multiple visit to the insurance office. But now, claim process have been modified and made easy for the common man.

Following are the insurance claim processes-

Expense Reimbursement Claim-

Under this process, the insurer needs to pay for his hospital bill until discharge. After the hospital cost incurred by the insurer, he/she have to make a reimbursement claim to the specified insurance company. Under the planned hospitalization case, you need to inform the insurance policy in advance. To claim the reimbursement, the insured person needs to submit the original bills of the hospital to the insurance company. After the audit of the claim, the insurance company decides to approve or reject it. If the claim is rejected, the insurance company will inform the policy holder. Upon the approval, the claim will be made to the policyholder.

Cashless Claim-

Under this claim process, the insured individual need not have to pay his/her medical expense when admitted to the hospital. The policy holders are provided with the wide range of hospitals listed under the specified insurance company. Upon the discharge, the hospital will forward the medical bills to the insurance company. After the expense audit, the insurance company settle the outstanding due payment to the hospital. This payment is between the insurance company and the hospital which is a hassle free process.

Documents required for Health Insurance Claim Reimbursement

Following are the set of documents, the policy holders are required to submit on the event of hospitalization-
  • Valid report of investigation
  • Discharge paper issued by hospital
  • Medical store bills and Doctor’s prescription
  • Claim form with the signature of the insurer
  • Consultation bills of doctor
  • In-patient hospitalization bill with authenticated signature of the policy holder
  • Insurance policy copies of previous year and copy of ID card of TPA of current year
  • Any other documents (if asked by TPA)
  • Doctor’s prescribed consumables and disposables and their complete details

Renewal of Health Insurance Policy

After buying the health insurance, you need to keep in mind to renew the health insurance to continue with the benefit. During the health insurance renewal, you should check the medical coverage, special add-on covers etc. A heallth insurance is valid for 1 year. If you donot pay the premium within the specified time, the policy will lapse. To pay the due premium, a grace period of 15 days are usually given. During the non-payment period, the policy benefit is not available. If your policy lapses, some insurance company gives you the option renew it within 6 months, provided that you pay all the outstanding premiums and reinstatement fees. You need to provide the proof of insurability for reinstatement.

Advantages of Health Insurance

Following are the major advantages of availing Health Insurance-
  • Cashless Treatment

    All insurance company has tie-up with a wide range of hospitals and nursing homes across the country, which is called “empanelled hospitals”. If the policyholder avails the treatment from this channel hospital, they get the facility of cashless treatment. Under this facility, the insurance company bear the medical expenses through direct link between the insurer and the hospital. The customer only have to pay for the expenses that is not under the insurance policy coverage. Also, the policy holder need to pay the extra amount that exceed the expense limit coverage under the insurance policy. If you avail the treatment in the hospital which does not fall under the hospital network listed under the insurance company, then you are not liable to avail the mediclaim.
  • Ambulance Fee

    At the time of emergency, ambulance is the best mode of transportation. The policy holder doesnot have to pay the ambulance fee. This is an add on benefit which you can avail, if you opt for it under the medical insurance plan.
  • Pre and Post Hospitalization expense

    This feature covers the expenses of both and pre and post hospitalization cost. The cost incurred takes into account the number of days prior to and post the hospitalization. This facility is valid from 30 days to 180 days before and after the hospitalization.
  • No Claim Bonus

    No Claim Bonus(NCB) is an exclusive feature of health insurance policy. If the policy holder doesnot claim for his treatment under the policy term for the entire year, then you get the benefit of NCB. This benefit can be either as an increment in the sum assured or a discount on the premium renewal.
  • Tax benefit

    The premium paid for the health insurance is eligible for tax deduction under Income Tax Act 1961 Section 80D. So, health insurance is a smart investment.
  • Co-payment

    This facility helps to lower the health insurance cost. Under this facility, the policy holder will pay a part of the expense and the remaining cost is borne by the insurance company. This facility reduces the premium of the policy but will not affect the sum assured.
  • Regular Medical Check-up

    Under this facility, the policy holder will receive regular medical check up. If you have a good history of NCB, many insurance company provides the facility of free medical check up.
  • International Medical Coverage

    In case of emergencies while you travel abroad, having global medical coverage under your insurance plan is very beneficial. The cost of medical expenses in abroad is quite high which can be covered with the help of health insurance policy with global coverage.
  • Restoration facility

    If your total sum amount is assured , then it will be restored which is provided by many insurance company. The restored amount can be used for treating a different illness from the one which the policy holder has used before. Some insurance companies offer the restoration options of up to 3 times in one policy period with no extra premium.