Health Insurance

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What is Health Insurance?

The rising costs of medical care complemented with exorbitant medicine and drugs prices have made health care unaffordable for many. As a result, they have to forego good quality care for their loved ones and risk their lives in the process. As a responsible member of your family, don’t let such barriers come in the way in your case. Opt for an appropriate health insurance and make sure that you are prepared for any unforeseen medical contingencies that may arise in your family.   


A health insurance reimburses the policyholder for medical or surgical expenses of the insured person named in the policy. It can be either done upfront (in the form of cashless treatment) or post treatment (in the form of reimbursement). Don’t let health problems turn into financial breakdown for the household. Get a family health insurance and ensure total peace of mind. This way, you can focus on caring for the hospitalised family member rather than running around gathering funds for the treatment or more disastrously, foregoing treatment altogether due to lack of funds.


Types of Health Insurance in India

With multiple insurance companies offering a range of plans, it becomes important to know the different types of plans that are currently available. Broadly, the plans can be categorised as below


a. Indemnity plans

Indemnity plans seek to bring about zero changes to the financial condition of the policyholder. This is done by reimbursing the actual hospitalisation costs borne by him/her. The extent of the amount borne will be equal to or less than the sum insured amount associated with a given policy. Consider the two scenarios for an indemnity health plan of Rs. 1 lakh–

A – Total costs of hospitalisation and medicines = Rs. 76,000. Amount disbursed by company = Rs. 76,000

B – Total costs of hospitalisation and medicines = Rs. 2,10,000. Amount disbursed by company = Rs. 1 lakh (maximum SI amount allowed)


The two main types of plans include

  • Mediclaim: Get coverage for pre and post hospitalisation, doctor’s fees, operation charges, and medicine costs. Here you can go for
    • Reimbursement based mediclaim: You pay the hospital upon patient’s discharge and then get the amount reimbursed by the company
    • Cashless mediclaim: You get the patient hospitalised at one of the network hospitals. The company will bear all the costs upfront, without you having to pay for the above costs.
  • Top up: Get enhanced coverage by supplementing your main plan with a top-up plan. With the increased cost, your coverage too will increase.


b. Defined benefits plans

As opposed to being compensated for actual expenses under mediclaim, a defined benefit gives you just what its name says – fixed benefits, irrespective of the actual cost incurred. Some options under this plan include:

  • Critical illness: This type of policy works only in case of specific ailments. So if you have taken cover for diabetes, you cannot use it for kidney failure treatment. Most critical illness policies pay a lump sum on diagnosis of the critical illness.
  • Hospital daily cash: This plan provides a fixed sum of money for each day of hospitalisation of the insured person.


Importance of Health Insurance

Today, the medical healthcare ecosystem is characterized by a steep rise in costs of medicines. It is not uncommon to see people selling off assets or taking loans to finance the costs of hospitalisation and treatment. This phenomenon is more pronounced in semi-urban and rural areas. Typically, any major health ailment can be financially draining for you.


This is why taking a health insurance policy can be a good financial move.


Getting health insurance will offer coverage against

1 – Diagnostic tests and doctor fees

2 – Room charges, rental charges for equipment used in the treatment

3 – Ambulance costs

4 – Pre and post hospitalisation costs


Some benefits of taking health insurance include –

1 – Family coverage

You can opt for an umbrella cover in the form of a family health plan. It takes care of the health and treatment needs of multiple people in your family. If you opt for a floater plan, you can use the same policy for treatment of more than one relative in the same tenure.


2 – Peace of mind

You don’t need to worry about your financial situation at the time of unplanned medical contingencies. You can dedicate your energies to getting the best medical care your loved ones deserve and leave the financial worries to a health insurance policy.


3 – Tax benefits

Under section 80D, you can claim income tax exemptions on premiums for a health insurance policy. This is an additional reason why you need to check out health insurance as a viable financial instrument.


4 – Longevity

With proper access to timely medical care, you can ensure the longevity of your loved ones. No longer will superior quality health care need to be a barrier due to lack of funds. Give total care by opting for the appropriate health insurance plan.


In order to avail these benefits you need to consider some important points when buying a health insurance policy for your family:

1 – Talk to an insurance expert to know your precise requirement

2 – Don’t wait till you get sick to get a health insurance. It may happen that the premium would be steep then

3 – Different policies from different providers come with different inclusions and exclusions. You need to be aware of what you are going for

4 – Rather than going for verbal commitment, you need to have a close look at the written terms and conditions before signing up for a new policy

5 – Check out the credibility of the insurer by looking at the claim settlement ratio for health insurance (amount paid vs the total claims made)

6 – Check out the co-pay option applicable. It is basically the percentage of the claims you will have to bear from your pocket (the remaining will be borne by the insurance company). The one with a lower co-pay will be beneficial for you.


What should be the ideal health insurance cover?

Different requirements make it necessary for different health insurance plans to be opted for. We cover a few common scenarios and recommend the right kind of policy.


1 – Newly married family (no kids)

You can go for family floater plan for Rs. 4-5 lakhs. Since the health risk is lower you can get coverage at lower cost


2 – Small family with young kids (kids are around 4 years)

You can go for family floater plan for Rs. 6-7 lakhs. There is a lower risk of all member requiring treatments, and hence works well for this young family 


3 – Older family with young kids (kids are around 15 years)

You can increase the coverage to Rs. 10 lakhs. While the risk may increase with age, the increased coverage will be adequate


4 – Mature family (kids are around 20-22 years)

While both parents may require individual plans, the floater plan can be continued but with a lower coverage of around Rs. 15 lakhs


Do note that this is just an illustrative indication. You need to carefully align the right plan after thorough research. 


Advantages of Buying Health Insurance Online

As already mentioned, different companies offer different types of insurance plans. However, you need to know what is available in order to select the best health insurance plan to protect your family. With online insurance purchase you can get the best quotes and that too for the specific overage you are looking for.


With online health insurance, the best thing is that you can do a side by side comparison of the different plans and then make a research- backed decision. You can check out various parameters like sum insured, add-ons, riders, and premium costs. This will let you take the right purchase decisions. With online insurance you don’t need to travel all the way to different insurance companies’ offices and pick their brochure and then make a decision. With the powerful comparison facility, you can align the right health insurance plans to protect your family.


Documents Required for Health Insurance Policy Claims Reimbursement

When you opt for a health insurance claim reimbursement you need to keep detailed records of all bills. Some documents of the hospitalisation that you would be required to furnish include –

1 – Discharge card

2 – Pre-signed and filled up hospital bills

3 – Bills from the pharmacy and from in-hospital disposables

4 – Claim form filled up properly with the insured signature

5 – Patient reports and charts

6 – ID card of TPA

7 – Insurance policy document copy

8 – Cancelled cheque and ECS authorisation to allow the insurer to make the deposit in your bank account

9 – KYC documents for ID purpose


Process of Health Insurance Claims Settlement

       1. Cashless Claim – for planned hospitalisation

               * Before hospitalisation, check two essential things

                    Is the ailment or illness covered under the insurance?
                    Is the hospital a part of the insurer’s approved network?

               * Before hospitalisation, you will need to inform the company and fill up an authorisation form available with the TPA sitting at a desk inside the hospital. The TPA is like a middleman between the policyholder and the hospital. He forwards the form to begin the approval process.

               * Once you receive approval you can arrange for the hospitalisation and cashless treatment

       2. Reimbursement Claim – For unplanned hospitalisation or treatment at non-network hospital

               * Inform the company and submit a filled up claims form to begin the reimbursement process. This needs to be done within 30 days of discharge
               * Submit all necessary documents (as mentioned earlier) and doctor’s prognosis that led to the hospitalisation
               * Submit all post hospitalisation documentation and prescription.
               * Submit post hospitalisation bills within 60/90/120 days as per your specific policy
               * If all goes well, you can expect the claim to be settled within 2-3 weeks of applying


Important Health Insurance Terms:

* Sum Assured

This is the amount you can expect to receive from the insurer for hospitalisation expenses. If bills are more than the sum assured then you need to bear the amount above the sum assured on your own

* Co-pay

Co-Pay is a certain percentage of the claim you need to bear. The insurer will offer to pay the remaining claim amount.

* Sub-Limits

Within the policy, you will find some sub limits i.e. the maximum you can get even if you aren’t exhausting your overall coverage. Room rent is one component that carries its sub-limit, beyond which you won’t be reimbursed by the insurer

* Comprehensive Cover

A comprehensive plan offers the widest coverage against every illness and thus provide your family with optimal protection

* Critical illness

A serious disease or a chronic condition like Cancer or Heart Attack. For such diseases, it is better to opt for critical illness cover that provides lump-sum amount upon being diagnosed with the illness.

* No claims bonus (NCB)

NCB is an incentive for not raising a claim in the previous year. The incentive can be in the form of reduced premium or enhanced coverage

* Waiting period

The policyholder needs to serve a fixed waiting period for any pre-existing ailments to prevent the policy’s misuse. He cannot apply for claims in this period.

* Maternity

Maternity plans provide cover for pre and post-natal care, expenses towards delivery of baby, and post-delivery baby care. 


You don’t need to worry about which policy to buy. With Renewbuy, you can purchase the best fit health insurance online. Now you can buy health insurance online after doing complete research as per the comprehensive information provided on the site.