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What is Health Insurance?

Health Insurance relates to a type of insurance that essentially covers your medical expenses. A health insurance policy like other policies is a contract between an insurer and an individual/group in which the insurer agrees to provide specified health insurance cover at a particular “premium” subject to terms and conditions specified in the policy.

Basic Health Plan

This provides for the hospitalization expenses you might face in case of accidents, day-care procedures, surgical treatments or critical illnesses. However, the features, limits and sum assured will vary from insurer to insurer.

Super Top-Up Health Plan

Similar to top-ups for mobile network services, this adds supplementary coverage to your existing health plan. The aim is to increase overall sum assured with its corresponding coverage by paying a relatively lower premium.

Frequently Asked Questions

    Health Insurance in India can be broadly classified into the following types-

    1. Individual Health Plans: Hospitalization plans reimburse the hospitalization and medical costs of an individual, subject to the sum insured. Thus, it takes care of all medical contingencies and the policyholder needs to pay a certain premium every year.

    2. Family Floater Plans: Family floater health insurance plans cover the complete family in a single health insurance plan. It works under the assumption that not all members of a particular family will suffer from any ailment or disease at one time. These plans cover hospital-related expenses which can be pre and post hospitalization. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.

    3. Senior Citizens Plans: As the name suggests, senior citizen health insurance plans are for the older people of the family. This is sometimes also known as parents Health Insurance Plan. These plans cover health problems related to old age. As per IRDAI guidelines, each insurer must provide cover up to the age of 65years.

    4. Maternity Plans: Maternity health insurance plans provide coverage for pregnancy and other additional expenses. The policies take care of both pre and post-natal care, and delivery of baby i.e. normal or caesarean deliveries. Just like other health insurance plans, maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses.

    5. Critical Illness Plans for Diabetes: These plans are benefit-based policies, where a lump sum benefit amount is paid on diagnosis of covered critical illness. The treatment cost is high when compared with day to day medical treatment costs. Similar plans are also there for other illnesses including heart attack, cancer, stroke etc.

    Why Health Insurance

    Health insurance, more commonly known as Mediclaim, provides a comprehensive cover for medical expenses related to sickness and accidents. Unlike other investments, health insurance does not help in achieving any definite future goal, but nevertheless, it is an extremely important component of a sound financial plan. Changing lifestyles, stressful jobs and rising healthcare costs are some of the many reasons that health insurance plans are becoming more and more popular. A health insurance plan can cover you and your family financially in times of serious illnesses or injuries.

    What is covered in Health Insurance

    1. Cashless facility: The insurance company issues an identity card to the Insured and on showing this card on the networked hospital, he/ she can avail cashless facility meaning insurance holder need not pay anything to the hospital. The Insurer would have a tie-up on almost all the hospitals already to facilitate cashless facility.

    2. Hospitalization cash benefits: Every day hospitalization expenses are covered to reduce the financial burden of the insurance holder. This would be a great help to the insured as this amount would compensate for the loss of earnings and other costs.

    3. Pre and post hospitalization costs: Usually pre and post hospitalization expenses are covered up to 60 to 90 days and some insurance company even approve up to 140 days.

    4. Ambulance charges: Even ambulance charges are covered by some insurance company and the insurance holder need not worry about those charges.

    5. Health checks up: In case there is no claim for a certain number of years, some company even provides a free health check-up to the insured.6. Pre-existing diseases: Usually pre-existing diseases are not covered under health insurance policy; however, diabetes is covered if the insured renews the Policy for 3 or 4 consecutive years.

    6. Pre-existing diseases: Usually pre-existing diseases are not covered under health insurance policy; however diabetes is covered if the insured renews the Policy for 3 or 4 consecutive years.

    What is not covered in Health Insurance

    1. Pre existing diseases: Pre-existing diseases are which you may have had prior taking the policy such as high blood pressure diabetes etc will not be covered under the health insurance policy; also the complications arising in the future due to pre-existing diseases would not be covered. However, some companies do cover pre-existing diseases after the continuous renewal of policy without any breaks.

    2. Cosmetic surgery: Cosmetic surgery is usually not covered in health insurance as it does not affect an individual life and it is not life-threatening. Cosmetic surgery like liposuction, Botox and others are not part of the health insurance cover.

    3. Abortion: Abortion is still in debate, whether to legally approve it or not so it is excluded from the health insurance package.

    4. Pregnancy: Pregnancy treatment and any emergency arising in due course like caesarean section are not covered under health insurance.

    5. Cost for Alternative therapy: Alternative therapy like massage, aromatherapy, reflexology, acupuncture, acupressure, naturopathy and other related therapies are not supported since these are not part of conventional medicines.

    6. Supplements: Costs for vitamins and other health tonics which are not part of the treatment for any disease or injury is not considered for reimbursement. However, if these supplements are given by the physician for the part of the treatment when a person is hospitalized, then it would be covered in medical insurance.

    Choosing the best health plan for your family

    Health Insurance Plan Checklist Is the coverage level sufficient?

    Every health insurance plan available in the market differs in the context of the coverage it offers. While the basic tenets of the coverage remain same, their absolute limits vary. Furthermore, health insurance plans also boast of additional unique coverage options like maternity cover which is available in certain plans, restoration of the sum assured if it is exhausted, no sub-limits, coverage for alternative treatments, etc. So, before you opt for any plan, its scope of coverage should be your primary focus. Also, you need the weigh what features you may need and then choose the plan as over-burden of features is also not necessary.

    1. The limit on covered expenses: We often tend to overlook this tiny detail when we buy the plan and later regret at the time of claim. There are certain expenses which have a limit on them. For instance, the limit on ambulance charges, sub-limits on room rent, limits on specific surgeries, etc. are inherent in most health plans. You should check these sub-limits to assess whether the limited cover wouldn’t be hard on your pockets at the time of claim.

    2. Check the waiting period: Some health insurance plans have a limited period exclusion for certain ailments. This exclusion period is called a Waiting Period and different plans have different waiting period. For example, ailments like fissure, piles, hip-bone replacement, etc. have a 2 year waiting period before it is covered. However, if you have any pre-existing ailments, like diabetes, hypertension, etc., you should look for the plan with the lowest waiting period or buy specialized plans designed to cover your ailments.

    3. Cashless claim facility: Cashless Claim is a direct settlement of the bill between the hospital and the insurance company. Though most health plans have a cashless settlement of claim, the same should be checked before you commit to the plan.

    4. Network of Hospitals: Also, the Network of Hospitals, i.e. places where the Cashless Claim is available needs to be checked so that you are mentally prepared where to go in case of an emergency!

    5. Entry age (minimum and maximum): This particular point is applicable if you are opting for a family floater plan. Family floater plans have a limit on the maximum age of dependent children and parents and in-laws if applicable. You should check for this as there may be a need to include family members at a later date.

    6. Renewability: Gone are the days when after reaching a certain age your health cover lapsed. Thanks to the regulation passed by the Insurance Regulatory and Development Authority health insurance plans have become renewable for the entire lifetime. Now you can renew your plan without any maximum age limit. However, some plans still have a limiting age on renewal and such renewability feature should be checked.

    7. List of ExclusionsEvery health plan has a list of expenses which are excluded from the scope of coverage. Though the exclusion list is more or less similar, some facets might differ. For instance, dental expenses other than that in an accident, maternity coverage in some plans, pregnancy-related ailments, etc. are excluded from some plans while covered in others. So, this exclusion list of the plan should be checked before you buy the plan.

    8. Additional Benefits: While checking the policy, it makes sense to opt for certain necessary riders as additional benefits at an additional cost so as to increase the scope of coverage and increase the benefits of the comprehensive coverage. Premium: #PremiumPayable The last but not the least point in your checklist should be the premium rate which the plan is charging for the cover provided. It should be competitive and justified in comparison with other similar plans.

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