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GET HEALTH INSURANCE PLANS

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What is Health Insurance?

Health insurance is a good wealth besides money. In a simple form, health insurance is a product that gives you a sense of security from the incurring expenses of hospital bills at the time of emergency. It covers the medical and surgical costs of an insured person. It can either be done upfront (cashless treatment) or post-treatment (reimbursement) by the insurer (the insurance company).

Health insurance has now become essential for the individual of all the age group in today’s life of ever-soaring medical expenses. Moreover, following a rise in lifestyle diseases and double-digit medical inflation in India every year, you must have a health insurance plan that fulfils your requirement. Though private and public-sector employers provide group health insurance, such do not offer all benefits to your family. Therefore, you always need separate health insurance that covers you and your family. Going by medical expenditures of individual health insurance is essential as uninsured people receive less medical care.

Don’t let your health problems become a financial breakdown for your household.

Buy family health insurance plan to ensure you and your family and get total peace of mind. This way, you can focus on looking after the hospitalized family member rather than running around gathering funds for the treatment or, more disastrously, preceding treatment altogether due to lack of funds.

Importance of a Health Insurance Policy-

Falling sick or getting hurt is not on anybody’s to-do list. It is always unplanned as well as uncertain. Nobody wants to get hurt or fall ill, but still, we all need medical care like doctor’s visits, prescribed drugs, lab tests, and so on at some point in time. As advanced technology has taken the place of those old ways in the health care segment, the cost of health facilities has also increased. At that point of time, health insurance solves the purpose by providing us with financial aids either in the form of cashless or reimbursement. In addition to the hospitalization, health insurance also gives us the facilities like outpatient care, medication, laboratory tests cost when needed.

Also read: What is cashless Mediclam Health Insurance Policy?

So, having health insurance is beneficial for one or other reasons. We all know the importance of health insurance, but the fact is that it is still considered as a tax-saving tool only and taken by people only for the sake of getting exempted from the tax slab. But the fact is that other than a tax exemption, health insurance covers essential health benefits critical to maintaining your health and treating illness, accidents, and high medical costs and gives us free preventive care. In India, medical expenses are surging at the rate of 15% to 20% every year.

Types of Health Insurance Plans in India:

With more companies providing health insurance products to suit various lifestyles and personal requirements, it can become somewhat confusing to decide which is the best health insurance and what purpose they serve. For choosing the best health insurance plan, it is essential to know about different types of health insurance policies, coverage extent, features, and customization options.

Let us take you to various health insurance plans in the Indian market:

01

Indivisual Plans

This is the best health insurance policy for a single person or those who only want to take a policy for themselves. It covers hospital and surgical expenses to the extent of the sum insured under the policy.

02

Family Floater Plan or Health Insurance Policy for the Family

This type of health insurance covers the entire Family under one single plan for the payment of a single premium. The policyholder will specify who all are to be protected, including themselves, spouse, children, and parents as required. Such policies cover simultaneous medical events of more than one member of the Family, subject to the claim limit of the maximum sum assured by the insurance company.

Such health insurance plans for families tend to be much more economical than buying individual plans for every member separately.

03

Hospitalization Plans

Also known as basic plans, these policies offer a cashless settlement of claims arising from hospitalization due to disease or illness. Comprehensive plans cover a more extensive range of ailments and medical conditions and offer better protection.

A basic health insurance policy for the Family will typically cover room rent (which could be subject to a sublimit), surgical, nursing, specialist, anaesthetist, diagnostic expenses, and medications. Such policies also usually cover medical costs incurred 30 days before hospitalization and 60 days after discharge**. A policyholder can also opt for various rider plans to create a more enhanced policy offering more protection. Such as maternity cover, domiciliary hospitalization benefits, daily cash allowance, etc. Basic plans usually include day-care procedures – surgical or other interventions that do not need a person to be admitted to the hospital overnight or for extended periods.

04

Top Up and Super Top Up Plans

This is the best health insurance policy for those who already have some amount of health insurance. This type of insurance policy usually has a deductible amount that will be the threshold limit above which the Top-up or Super top-up health insurance plan will be activated.

However, it can be an excellent way to supplement an existing policy, whether self-purchased or offered by an individual's employer. Such a top-up plan also acts as an insurance policy for the Family when employee health insurance is inadequate or covers only one family member. Also, there is an option of super top-up health booster plans that offers additional coverage of a higher sum against an aggregate deductible. The other benefit is that premiums are more affordable in this case.

05

Group Insurance Plans

Many insurance companies offer group plans to specific groups of people, such as the employees of a company, members of a club or social group, and so on. A policyholder can buy this type of insurance in addition to an existing policy, or their employer may provide such insurance. Group insurance can be an economical option since insurance companies would typically offer a bulk discount in respect of such policies.

06

Pre-Existing Disease Plan

For older people or those with specific medical ailments, the best health insurance plan with the highest coverage limit may be inadequate if there is a pre-existing disease exclusion clause. A pre-existing disease is defined as "any condition, ailment, injury or related condition(s) for which you had signs or symptoms, and was diagnosed, and/or received medical advice/treatment, within 48 months before taking your first policy".

This means the insurance company will not pay for claims made about conditions that already exist at the policy purchase time. It is further necessary to note that even with the best health insurance policy, there is typically a waiting period between 12 and 36 months (Varies from insurer to insurer) from the initiation of the insurance policy before the policyholder can claim a pre-existing illness.

The policyholder can prevent this problem by buying a policy covering pre-existing conditions and has no waiting period for making a claim.

07

Indemnity Plans

Indemnity plans seek to bring about zero changes to the policyholder's financial condition. It is done by reimbursing the actual hospitalization 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–Total costs of hospitalization and medicines = Rs. 76,000. Amount disbursed by company = Rs. 76,000

Inclusions and Exclusions of Health Insurance

Inclusions of Health Insurance Policy -

Health insurance plans do offer protection and peace of mind. Still, they have several terms and conditions, inclusions, and exclusions (a basic policy does not provide critical illness insurance, for instance) that determine the circumstances and medical procedures for the insurance company to pay under a policy.

Let’s look at the inclusions of a health insurance plan:

01

Health insurance covers hospitalization expenses arising from a specified illness or disease up to the policy's maximum limit or value. It includes room rent, surgical and operation theatre expenses, nursing, anaesthetist charges, prescription medications, and relevant diagnostic procedures. Most insurance policies require overnight hospital stays for a successful claim.

02

Health Insurance policies also pay for related expenses that a policyholder incurs 30 days before hospitalization and up to 60 days after discharge from hospital (varies from company to company). Under a health insurance policy, the company will pay the expenses incurred by a policyholder 30 days before hospitalization. Up to 90 days (duration varies from company to company) after discharge Tests, consultations with specialists, and prescribed medicines of the costs covered.

03

Whereas individual plans are designed for single people, families can opt for family floater plans. This type of health insurance plan gives you and your whole family coverage under one policy in a single premium. These health insurance plans cover the entire family under one policy for the payment of a single premium. Even if more than one person in the family needs treatment concurrently, the insurance company will pay for both claims so long as valid claims covered by the policy are subject to the maximum amount payable under the policy.

04

Cashless service is one of the attractive features of health insurance. Getting admitted to a network hospital has the advantage of not having to pay cash upfront. The insurance company undertakes to pay the hospital directly for treatment, surgery, and other covered medical expenses. Each health insurance company has a network of hospitals and diagnostic centers where covered individuals can receive cashless treatment.

05

Like other types of insurance, health insurance policies also offer no claims bonus. This means that if the policyholder does not claim the previous insurance term, the company may offer discounts or additional features on policy renewal.

06

Health insurance policy portability is another feature that insurance companies are bound to offer. It allows the policyholder to port their policy from one to another for seamless protection without losing accrued benefits on the plan. The policyholder is free to switch service providers if they feel that another company offers a better deal or additional features at a better price. Insurance companies cannot disallow this.

07

Health insurance policies also offer tax benefits to the policyholder. Under section 80D of the income tax act, policyholders could save Rs 25,000 in taxes and up to Rs 55,000/- if senior citizens are also covered under the policy.

What Is Not Covered/exclusions in Your Health Insurance Policy?

Falling sick or getting hurt is not on anybody’s to-do list. It is always unplanned as well as uncertain. Nobody wants to get hurt or fall ill, but still, we all need medical care like doctor’s visits, prescribed drugs, lab tests, and so on at some point in time.

As advanced technology has taken the place of those old ways in the health care segment, the cost of health facilities has also increased. At that point of time, health insurance solves the purpose by providing us with financial aids either in the form of cashless or reimbursement. In addition to the hospitalization, health insurance also gives us the facilities like outpatient care, medication, laboratory tests cost when needed.

  • Critical illness

    A health insurance policy does not pay for critical diseases such as stroke, cancer, heart attacks, coma, organ failure requiring regular dialysis, major organ or bone marrow transplant, permanent paralysis of the limbs, motor neuron disease, Multiple Sclerosis, and other conditions. These are listed in the definitions set out in the IRDA circular covering Guidelines on Standardization in Health Insurance. However, a policyholder can buy a separate critical illness policy or opt for a rider that adds protection to a basic plan. It is essential to determine exactly what expenses are covered and whether there are set sub-limits within the overall coverage limit.

  • Day-care Procedures

    A health insurance policy does not pay for critical diseases such as stroke, cancer, heart attacks, coma, organ failure requiring regular dialysis, major organ or bone marrow transplant, permanent paralysis of the limbs, motor neuron disease, Multiple Sclerosis, and other conditions. These are listed in the definitions set out in the IRDA circular covering Guidelines on Standardization in Health Insurance. However, a policyholder can buy a separate critical illness policy or opt for a rider that adds protection to a basic plan. It is essential to determine exactly what expenses are covered and whether there are set sub-limits within the overall coverage limit.

  • Maternity and neonatal care

    An individual plan or even health insurance plans for the family will not usually cover expenses incurred for pregnancy, delivery, abortion, miscarriage, and obstetric other expenditures. If there are complications for mother or child after birth, such as neonatal ICU or emergency surgery, these are also not covered. However, some group plans such as employee insurance, do offer maternity coverage. A policyholder can also opt for a maternity and/or neonatal protection rider to acquire additional protection.

  • Pre-existing conditions – A health insurance policy

    will not cover ailments that already exist before the commencement of an insurance policy. Some types of pre-existing diseases may be covered. Still, typically, there is a waiting period between 12 and 36 months (duration varies from company to company) before a policyholder can claim pre-existing disease-related expenses. It is essential to make full disclosure of any pre-existing medical conditions to the insurance company when buying a policy, so the insurance company cannot raise a dispute or dishonor a claim later.

  • Dental and eye care

    Most of the health insurance policies will not cover dental or eye care procedures, such as dental implants, braces, and corrective surgery that are not medically indicated. Though some insurance policies do have dental and eye care provisions, their scope may be limited. Here again, the policyholder must check the terms and conditions, particularly those relating to daycare procedures, since these could be considered daycare or outpatient treatments.

  • Cosmetic surgeries

    Even the most expensive and the best health insurance plan will not offer to pay for plastic surgery, beauty treatments, or any treatment with an only cosmetic application (not medically necessary). However, if cosmetic surgery is required due to an accident, some policies do cover these expenses.

  • Sexually transmitted or lifestyle diseases

    STDs such as HIV or AIDS and others or any conditions arising from STDs are not covered by a health insurance policy, even if the insurance policy provides critical illness insurance. The insurance company will also not pay for diseases or disorders resulting from unhealthy lifestyles or habits such as excessive drinking, drug abuse, or prescription medication abuse.

  • Self-harm or suicide attempt

    Any hospitalization or treatment that arises from illegal acts, self-harm, or an attempt to suicide is outside the purview of a health insurance policy.

The table below can give you a quick picture of inclusions and exclusions of a health insurance policy:

S. No Inclusions Exclusions
1 Health Check up HIV / AIDS and its complications
2 Ambulance charges Suicide or drug abuse
3 Maternity Contamination from Nuclear fuel or radiation
4 Organ donor Foreign invasion or civil war
5 Daily Cash Cosmetic Surgeries

You Need to Know All about Health Insurance Add-Ons/Riders:

Opting for an add-on in a health insurance policy enhances the coverages in case of medical emergency:

01

No Claim Bonus

No Claim Bonus is the discount you get from the insurance company, renewing the policy and not claiming throughout a health insurance policy year. It is of two types:

Discount on Premium and Cumulative Bonus.

  • Discount on Premium:

    Gives you a discount on the policy purchased.

  • Cumulative Bonus

    Depending on insurer to insurer, a certain percentage (5%) of the amount is added to the next sum insured on the policy renewal in every claim-free year

02

Top-Up

Top-up health insurance plans are an add-on plan for your regular health insurance policy. A top-up plan offers you additional coverage when your basic health insurance plan is exhausted. A top-up only covers a single incidence of hospitalization. Insured gets a Tax Benefit, as per the premiums paid on top-ups.

03

Convalescence

After hospitalization, when the patient (insured) is discharged and goes back to live his normal routine, a minimum amount is given to him/her to support him/her for the supplementary cost incurred during his hospitalization term. For example: if the insured is salaried and in case of prolonged hospitalization there is a loss of salary that the person has to bear. A lump-sum amount is given to the insured to recover such loss.

04

Personal Accident, PA Cover

Accidents are unfortunate and uncertain. To provide financial coverage to the victim in case of an unexpected event, Personal Accident comes in handy in a health insurance plan.

05

Critical illness Add-on

Critical illness add-on helps cover the critical illness or any other specified severities like first heart attack, open chest CABG, coma, repair of heart valves, etc. A critical-illness add-on can be taken along with the health insurance policy as an add-on or purchased separately.

06

Daily cash allowance/Hospicash

Under a health insurance plan, a fixed cash benefit is given to the insured every day during hospitalization is known as a daily-cash allowance or hospices. The amount is paid to the insured every day to take care of the incidental expenses in hospitalization.

Terminologies to Know in a Health Insurance Policy:

01

Sum Assured

The amount you can expect to receive from the insurer for hospitalization expenses. If bills are more than the sum assured, then you need to bear the amount above the sum confirmed on your own.

02

Co-payment

Co-Payment is a certain percentage of the insured's claim agrees to pay along with the insurance company. The insurer then pays the remaining claim amount.

03

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 the insurer won't reimburse you.

04

Comprehensive Cover

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

05

Ritical illness

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

How one Can Save on Health Insurance Policy?

Many insurance companies give coverages to various health ailments. All health insurance companies cover terminal illness or critical illness, depending on the coverage the insured has taken. One can always go to a specific insurance company of their own choice or can go to an aggregator. While approaching a particular insurance company limits the option, going to an aggregator gives comparison options and gets the suitable policy of your needs.

As already mentioned, different companies offer different types of insurance plans. However, you need to know which insurance plan is the best health insurance plan for protecting you and your family. Online insurance aggregator offers you various quotes available with insurance companies. With online comparison, you may choose the best coverage for yourself. You can check out multiple parameters like sum insured, add-ons, riders, and premium costs. It will let you make the right purchase decisions.

Ill health, diseases, and sickness come without announcement. Though no one wants to be hospitalized, this becomes necessary from time to time. It can happen to anyone at any age or stage of life. At such time, the family's resources can become severely stressed, and savings may be depleted entirely because of surgery, extended and unnecessary hospital stays, specialist consultation, and prolonged medication protocols. Since health care is costly, buying the right health insurance plans can help mitigate the expenses. Health insurance acts as a safety net for the entire family.

What are the Documents Required to Purchase a Health Insurance Policy?

Any health insurance company can ask for some documents in majorly two scenarios –

on new policy issuance and on making a claim. If you are going to purchase a new/fresh health insurance policy, you are required to have the following documents-

  • Identity proof - Voter ID or Pan card or Driving license
  • IAge Proof- PAN Card or Aadhaar Card or any other document that has your age details
  • Address proof – Driving License or Passport or Rent Agreement (if residing on rent) or PAN card
  • Passport size photographs
  • Medical Reports (if the insurance company demands it)