With medical costs spiraling out of control and the increase in shift to lifestyle diseases, healthcare today is at its all-time high in terms of treatment costs. In the event of an unforeseen illness, you may have no option other than to utilize your hard-earned savings, built over your lifetime. Finally, whatâ€™s more important than your health and what better way to protect it than with the right Health Insurance Plan.
What is Health Insurance Policy?
Health insurance, also called Mediclaim, is a way to pay for medical treatments that typically require you to be in hospital overnight. It also covers certain other day care 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.
Health insurance: Importance & why to 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 todayâ€™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 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. A Health Insurance plan ensures complete peace of mind and makes sure that you use your hard-earned savings for the real reasons â€“ Be it your childâ€™s higher education or his dream wedding or just about anything you dreamt of all your life.
Types of Health Insurance Plans:
- Individual health insurance plans: Individual health insurance plans which cover a single individual under the cover
- 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.
- 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.
- 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.
- 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.
- 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.
One should understand the types of medical insurance plans before choosing the best plan suiting their requirements.
Things to be Keep in Mind While Buying Health Insurance 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 donâ€™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
- The sum insured should be optimal
- Look for comprehensive coverage features
- The premium rate should be reasonable
- 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.
Factors that affect Health Insurance Premiums:
There are certain major factors that affect the type of coverage you will receive on your insurance. Some of the most important of them are as follows-
- Age: The general thumb rule is, higher the age higher the premium. It is because older people are more likely to suffer and claim the insurance than young people.
- Past Medical History: It highly affects the amount of premium you are going to pay. If you have a pre-medical condition, then the premium charged is higher. However, if you are relatively healthy, the premium is less.
- Occupation: Your occupation highly influences your premium rates. For example, if you are a corporate employee or a teacher, the premium would be less, however, if you work at a construction site or factory, premiums are generally high. This happened due to the degree of risk factor that is involved with both kinds of task.
- Body Mass Index (BMI): People with a higher BMI are prone to more ailments like heart diseases, type 2 diabetes, breathing problems, high blood pressure and cancer than people with lower body mass index. Hence the premium is higher for the people with more BMI.
- Smoking habits: Insurance companies view smokers as high-risk insurance buyers since they are more inclined towards health risks. Therefore, smokers are charged more premium in comparison to non-smokers.
- Geographical Location: The location where you stay affects your premium cost since certain regions lack proper healthy food options, climate and health facilities.
- Policy Duration: If you choose a longer-term plan, the premium would be less that is why investing earlier in health insurance is always suggested.
- Co-insurance feature: If you choose the co-insurance feature of the company while purchasing the policy, your premiums reduce to a great extent.
Key features of Health Insurance:
- Coverage: The coverage includes the comprehensive expense of everything that can happen during a health emergency. It includes pre-hospitalization, post-hospitalization and ambulance charges. Most insurances also cover critical health diseases like cancer, stroke, heart attack, etc.
- Renewal Benefits: Most companies offer a no claim bonus benefit to its customers if no claim request is made by them in the previous year. Some companies also offer benefits in the form of discounted premiums or increased cover or a complete free health check up every year as well.
- Co-payment: It is one of the great features offered by good health insurance companies, helping to reduce the yearly premium. You have to pay a percentage of the total expense while the company will pay the balance.
- Cashless Treatment: Most health insurance companies have a collaboration with a number of healthcare centers and hospitals. When you seek treatment in a network hospital, the insurance company will pay your bills directly and you will have to pay only for the uncovered expenses.
- Tax Benefits: Under section 80D of Tax Act 1961, you will enjoy tax exemptions for paying premiums on health insurance. The tax benefit can be enjoyed both by you and your family members. 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.
- Flexibility: You can change the premiums to be paid every month or the term life of your policy after a certain period.
Inclusions: What is Covered in Health Insurance Plan
Inclusions are one of the most important aspects of a health insurance policy. These situations help you understand when you can raise a claim against your policy. Here are the general inclusions or coverages of a Health insurance policy. However, this may vary for different health insurance plans.
- In-patient Treatment: This covers the cost of hospitalisation for the policyholder. Things like room rent, nursing charges, ICU charges, doctor visits, etc. are included under the in-patient treatment.
- Daycare Procedures: Minor surgeries like cataract, tonsil removal, or similar procedures that do not require more than 24 hours of hospitalisation are covered under daycare procedures.
- Pre-hospitalisation: Some surgeries or medical issues require a patient to avail treatment before getting hospitalised. The cost of such treatments can be availed under health insurance as per the terms and conditions of the policy.
- Post-hospitalisation: The cost of follow-up treatment is covered under health insurance plans as per the terms and conditions of the policy.
- Domiciliary Treatment: The cost of receiving treatment at home can be covered under special circumstances for a predetermined number of days.
- Organ Donation: The cost of medical treatment related to donating an organ is covered as per the policy terms.
- Ambulance: The cost of hiring an ambulance for transportation to the hospital will be borne as per the terms and conditions of the policy.
- AYUSH Benefits: The cost of availing Ayurveda, Unani, Sidha or Homeopathy (AYUSH) treatment can be claimed as per the policy document.
- Maternity and Newborn Coverage: Coverage for the cost of childbirth and insurance coverage for the newborn baby is covered as per the policy terms.
- Daily Cash Benefit: Normally, it comes as an add-on cover. This amount can be used to buy medicines or other things as required by you.
Exclusions: What is Not Covered in Health Insurance Plan
Every insurance company has a set of situations where the policyholder cannot raise a claim. These situations are called exclusions. Here is a list of exclusions of medical insurance policy that you should know.
- Intentional Injuries: The cost of treating intentional injuries in attempting suicide is excluded from the policy.
- Adventure Sports: Injuries arising out of taking part in adventure sports are not covered.
- Criminal Activities: Medical attention required because of taking part in criminal activity is not covered.
- Cosmetic Surgeries: The cost of cosmetic surgeries unless required due to an accident is excluded.
- Infertility Treatment: Health insurance does not usually cover the cost of treatment for infertility.
- Not Mentioned in Policy: Any other medical treatments/surgeries that are not mentioned in the policy document will not be covered.
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
- 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
- The claim form should be filled and submitted with the discharge certificate, medical reports and all original medical bills
- The insurance company analyses the documents submitted and reimburses the claim amount to the policyholderâ€™s bank account.