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Health Insurance

Health Insurance

What Is Health Insurance?

Health insurance is an agreement whereby insurance company agrees to undertake a guarantee of compensation for medical expenses in case the insured falls ill or meets with an accident which leads to hospitalization of the insured. This can be bought for an individual or for an entire family. The term of the plan is ideally fixed at one year and in some cases one can buy the plan for a term of two to three years as well. With health insurance plan in place, one gets entitled to adequate medical help in case of an emergency or in a pre-planned medical expense, without worrying about the financial costs. Generally, insurance companies have tie-ups with the leading hospitals so as to provide cashless treatment to the insured. In case the insurance company has no tie-ups with the hospital, they reimburse the cost of expenses incurred by the insured. The government also promotes health insurance by providing a deduction from income tax.

Here is how the plan works:

  • Health plan takes care of entire hospitalization expenses subject to maximum sum assured and terms of the policy.
  • Most plans also cover pre and post hospitalization expenses.
  • There is a cashless facility available under which you can avail the best medical care at any of the network hospitals. This way the insured can immediately get treatment without having to wait for arranging the funds.
  • Under certain riders associated with health plans, you get the claim amount on a lump sum basis so you can use it not only for medical expenses, but also to take care of household expenses.
Cashless facility

Cashless Treatment

Medical emergencies come unannounced. When you buy a health insurance plan, you will be relieved of the stress that accompanies troubled times, especially when funds are lacking. You will be able to access quality treatment and will not need to compromise on your health. Your dreams and plans that rely on your hard-earned savings will remain in place while you get the quality healthcare you need.

Coverage

Coverage

Choose from a wide range of sum insured and get health insurance policies with innumerable benefits and features.

Tax Benefits

Tax Benefits

Take advantage of quick cashless claim authorization and access world-class healthcare facilities Pan-India.

Post-Hospitalization Coverage

Pre & Post Hospitalization Coverage

Insurance policy also covers pre and post hospitalization charges up to the period of 60 days, depending on the insurance plans purchased.

Ambulance Cover

Transportation Charges

Insurance policy also covers the amount paid to ambulance towards the transportation of insured.

No-Claim Bonus

No Claim Bonus (NCB)

This is the Bonus element which is paid to the insured if the insured does not file a claim for any treatment in the previous year. A cumulative bonus/No Claim Bonus benefit varies from insurer to insurer that is provided to the policyholder for every claim free year

Lifelong Renewability

Renewal

Health Insurance Policy can be renewed periodically.

Annual Health Check-Up

Medical Checkup

Insurance policy also provide options for health checkups. Free health checkup is also provided by some insurers based on your previous NCBs.

Room Rent

Room Rent

Insurance policy also covers room expenses depending on the premium being paid by the insured.

Convalescence Benefit

Convalescence Benefit

Some health insurance plans offer a daily amount for each day of hospitalization. Do not worry about keeping records of the amount actually spent to claim this daily cash. The daily cash amount does not depend upon the amount actually spent. You can also opt for Convalescence benefit in your health insurance policy. Such a cover pays you a lump sum amount if hospitalization exceeds a certain number of days.

Organ Donor Cover

Expenses related to organ donor

The cost of kidney transplant could range between Rs 3 lakhs and Rs 5 lakhs. Having a health insurance in place ensures that you will not have to worry about your medical expenses before undergoing an organ transplant surgery. Most general insurance companies cover organ transplant surgery as part of their regular health insurance plans. Some insurers reimburse the entire cost, while others put a cap on these expenses or offer it as an add-on benefit.

Attendant allowance

Attendant allowance

Insurance companies offer attendant allowance to adults accompanying the insured at a hospital, provided the insured is a child. In most cases, the number of days for which an insurer pays the attendant allowance is fixed.

Safety

Safety

Ensuring safety of assets such as your Home, Vehicle, Factory is as important as your safety.

Unpredictable Future

Unpredictable Future

Life is unpredictable and we are invariably underprepared for it. With Insurance you are prepared, at least financially

Assistance

Assistance

It assists your family and provides support when they need it most i.e. Either for you or in your Absence

Security

Security

Insurance secures you FINANCIALLY in case of any emergency. With insurance, MONEY is the last thing you will have to worry about.

Maternity Coverage

Maternity Coverage

Few insurance policies cover both pre and post maternal expenses. Health Insurance Policies covering maternity have wide range of hospitals under their network.

Domiciliary Hospitalization

Domiciliary treatment

Many insurers have expanded their insurance cover to include treatment taken at home under medical supervision. However, insurers have capped the amount and the number of days for which the benefit is available.

Daily Hospital Cash Allowance

Daily Hospital Cash Allowance

Health insurance companies nowadays cover the expenses that are not covered under the Mediclaim policy, such as travelling and food. Under daily hospital cash benefit, insurers offer a certain amount of money per day depending on the type of plan and insurance company you choose.

Even alternate treatments are covered

Alternative Treatment

Various health insurance companies in India offer alternative treatment benefits. Presently alternative treatment has gained considerable popularity. Many insurance providers offer alternative treatments such as Homeopathy, Yoga, Ayurveda, etc. under their health insurance plans.

Dental Expenses

Dental Treatment

A number of health insurers offer dental covers and takes care of the dental treatment once in a certain period of years.

Organ Donor Cover

Expenses Related to Organ Donor

Health insurance policy also covers the expenses related to organ donor as well. Given that the basic cost of a kidney transplant could range somewhere between Rs. 3 to 6 Lakhs, health insurance policy takes care of this. Some health insurance companies reimburse the entire cost of an organ donor while some impose a cap on the expenses and offer it as an add-on cover.

Annual Health Check-Up

Free Health Checkup

Another benefit of health insurance policies offers free periodic health checkups to their policyholders after every 4 or 5 claim-free years. Insurers offer cashless health checkup if tests are done at empaneled hospitals or centers

How to Select the Right Insurance Policy?

Its difficult to select the best insurance policies as all insurance company provides a similar type of insurance plan. Hence some of the important points that any Person should look before purchasing any plans are:

  • Maximum Coverage Amount: Choose a health insurance plan that offers maximum coverage amount. These days medical costs are increasing year on year. A simple heart surgery can cost you over Rs 5 Lakhs. Depending on your need, you should consider taking high risk coverage health insurance plan.
  • Prefer Family Floater Health Insurance Plans: Individual plans are good for single individuals, however, if you have a family, consider taking a family floater health insurance plan. These Mediclaim policies come with lower premiums, but cover your entire family.
  • Pick a right sum Insured: Considering taking the right sum insured based on your age and marital status. If you are young, there are less chances that you will get ill, however, when you are older or you have crossed 40, there are chances that you are prone to diseases like diabetes, heart diseases etc., Also, when you get married, the sum insured should be increased with consideration to your spouse’s health.
  • Low waiting period for pre-existing diseases: Many health insurance plans cover pre-existing diseases between 2-4 years. Consider taking a Mediclaim policy which has a low period to cover preexisting diseases.
  • Maximum age Renewal: You may not need health insurance when you are young. However, when you get older, you may need health insurance. Choose a health insurance plan which can renew your policy to the maximum age of 70 or 75 years of age.
  • High Claim Settlement Ratio: Claim settlement ratio is the ratio of claims settled over total claims received. Consider health insurance from an insurance company that has a high claim settlement ratio. This would help you and your family to avoid any rejection of your claims.
  • Policies having sub-limits: Many health plans come with sub limits on room rent, per day expenses etc., Consider taking a Mediclaim policy that offers highest room rent or other expenses. This would help you to avoid paying additional costs from your pocket.
  • Network hospital coverage: A majority of insurance companies offer network hospital coverage for several hospitals in metro cities. However, if you are taking a policy for your parent’s / family members residing in rural areas, considering taking policy which has a wide network in such area.
  • Compare premiums: One of the main criteria is to compare premiums on various Mediclaim policies. There is no point in taking policies which has all the features, but has high premiums.
  • Read what others are saying: One of the best way to choose a health insurance plan, is to read the reviews about health insurance policies. They would give various positive and negative opinions. It would help you to take decision whether to buy a particular policy or not.
  • Exclusions: Many of us fail in looking at this aspect. Some of the insurance companies exclude several diseases and procedures like Cataract, Hernia, Fissures, Joint Replacement, sinusitis, Gastric, Ulcer etc. in the initial period of the policy. Some of them, exclude dental treatment, eyesight-related procedures, HIV/AIDs, Obesity, Sex transmitted diseases, cosmetic surgeries etc., Consider policies that have few exclusions.
  • Critical illness rider’s / accident coverage: The higher the critical illness riders, the more likely it will be that you do not ruin your finances in the future when encountering hospitalization expenses.

Types of Health Insurance

  • Individual Health Insurance: This policy covers the Medical expenses and Hospitalization expenses of Individual who has taken the policy. This Plan provides coverage to an individual against certain illnesses, offering advantages like cashless hospitalization, reimbursement, coverage of Pre-Hospitalization and Post discharge expenses and various add-ons. Premium under this policy is determined as per the age of insured.

  • Family Health Insurance Plan: Family health insurance plan covers entire family in one health insurance plan. It works under assumption that not all member of a family will suffer from illness in one time. It covers all the family members against hospital expense which can be pre and post under a single cover. Family health plan offers a fixed sum assured for the family members, which can be availed by all members of the family or by any one individual in the family.

  • Senior Citizen Health Insurance Plan: As name suggest These kind of health insurance plans are for older people in the family. It provides covers and protection from health issues during old age. According to IRDA guidelines, each insurer should provide cover up to the age of 65 years.

  • Critical Illness Insurance Plan: These are benefit based policies which pay a lump sum (fixed) benefit amount on diagnosis of covered critical illness and medical procedures. These illnesses are generally specific and high severity and low frequency in nature that cost high when compared to day to day medical / treatment need. e.g. heart attack, cancer, stroke etc. Now some insurers have come up with option of staggered payment of claims in combination to upfront lump sum payment.

  • Personal Accident Plan: These personal accident plans are frequently offered as riders. They include hospitalization and bear the medical outlay in the event of an accident. These are issued as fixed benefit policies, where a specified sum is paid on the occurrence of unforeseen events, such as accidents, which can result in death or disability of the person. However, the payout is not related to the sum assured.

  • Pre-Existing Disease Cover Plans: It offers covers against disease that policyholder had before buying health policy. Pre-Existing Disease Cover Plans offers cover against pre-existing disease e.g. diabetes, kidney failure and many more. After Waiting period of 2 to 4 years it gives all covers to insurer.

  • Maternity Health Insurance: Maternity health insurance ensures coverage for maternity and other additional expenses. It takes care of both pre and post-natal care, baby delivery (either normal or caesarean). Like Other Insurance, the maternity insurance provider has wide range of network hospitals and takes care of ambulance expense.

  • Hospital daily cash benefit plans: Daily cash benefits is a defined benefit policy that pays a defined sum of money for every day of hospitalization. The payments for a defined number of days in the policy year and may be subject to a deductible of few days.

  • Disease specific special plans: Some companies offer specially designed disease specific plans like Dengue Care. These are designed keeping in mind the growing occurrence of viral diseases like Dengue in India which has become a cause of concern and thus provide assistance based on medical needs, behavioral and lifestyle factors associated with such conditions. These plans aim to help customers manage their unexpected health expenses better and at a very minimal cost.

A Guide to Health Insurance Portability

Continuity is an important concept in health insurance. Continuation of a policy brings one significant benefit – no waiting period for pre-existing conditions. Earlier, if you were unhappy with your insurance company, you had no way of switching to a new insurer along with the benefits you may have accumulated. Your options were to stay with your existing insurer to enjoy the benefits of continuity or forgo the benefits and switch to a new provider. Health insurance portability changed all that. In 2011, IRDA (Insurance Regulatory and Development Authority of India) introduced portability. Thanks to it, you can now easily switch from one insurer to another and maintain the continuity of your policy, especially with regards to waiting period for pre-existing conditions.

If you are not happy with your health insurance policy, you can switch to another plan of the same insurer or to a different insurer altogether, without losing your accrued benefits. In favor of the interests of policyholders like you, the Insurance Regulatory and Development Authority of India has put certain portability guidelines in place. These guidelines ensure that not only is portability a quick and smooth affair, but it is also something that does not make you lose out on credit gained for serving waiting periods.

Your Portability Rights

In order for you to become an aware health insurance policyholder, we would like to tell you your portability rights!

  • You can port to and from any general or specialized health insurance company.
  • You can port any health insurance policy.
  • Your new insurer needs to give you credit for the waiting period you have served for pre-existing conditions. Hence, if you have served a waiting period of two years for pre-existing conditions in your previous policy and your new insurer has a waiting period of three years for the same, you should only have to serve a waiting period of one more year with the new insurer.
  • Your new insurer would need to insure you for a sum insured that is, at least, up to the sum insured of your old policy.
  • All applications for portability must be acknowledged by the insurers within three working days.

Tax Benefits on Health Insurance

The amount you pay towards health insurance premium claimed as a tax-saving deduction under Section-80D of the Income-tax Act the insured person who takes out the policy can claim for tax deductions. You can claim Rs. 25,000 annually for a health insurance policy for self, spouse and dependent children. Also If you also pay the premium for a health insurance policy for your parents, you can claim up to Rs.50,000 for the same as well.
Earning money is not at all useful if you don’t have a life. Think about yourself and your family and the importance of life. You know the importance and benefits of having a Health Insurance Policy. Start one, if you haven’t already.

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