Health Insurance

What is Health Insurance?

Health Insurance is a type of insurance coverage in which the insurer pays the medical expenditure of the insured person if the insured becomes sick or gets injured in an accident. It offers a protection cover for you as well as your family for any disease or injury-related emergencies like hospitalization, surgical expenses, medical expenses, etc. Health insurance policy is available for individuals as well as groups.

Why go for Health Insurance?

There is nothing in life more treasured than good health. However, you can never know what is around the corner and there are always uncertainties in our life. You can never know when you will suffer from some illness or get involved in an accident. These unforeseen happenings could wipe out all your savings due to the mounting cost of treatment. This is where having a health insurance policy could help you.

Benefits under this policy:

  • Cashless treatment - Every insurer displays a network of hospitals where when treated, the insured does not require to pay anything from his pocket unless it is a voluntary discount case.
  • Pre and post hospitalization - Under the medical plan in India, the insured is paid for the pre and post hospitalization charges which include tenure of 30 to 60 days depending on the insurer.
  • Ambulance charges - The policy holder is free from burden of transportation or ambulance charges.
  • Pre-existing disease cover: After a waiting period of 2-4 years, various policies offer a cover against the pre-existing diseases such as diabetes, hypertension etc.
  • No Claim Bonus - NCB or no claim bonus is a benefit provided if the insured does not claim for any treatment in the previous year. Benefit could be in any form, either an increment in the sum assured or a discount in premium.
  • Medical checkup - Free check up is provided by few insurers if there is a good history of no claim bonus.
  • Tax Benefits - If you are paying premium for medical policy then you are liable to get tax rebate under section 80D of The Income Tax Act for a maximum value of Rs.15000 for regular and Rs.20000 for senior citizen.
  • Co-Payment - Providing you option to cut short your premium amount, medical insurance offers co-payment option wherein there is a define amount of voluntary deductibles mentioned in the policy which are paid by the insured. So in case of treatment, some amount is paid by the insured and rest by the insurer.
  • Critical illness cover - You can extend your cover by opting for critical illness or various riders depending on your age and medical history of your family.

Criteria to Choose Best Health Insurance

Caps and sub-limits - Imposition of sub limits, co-payments or other caps might reduce the premium you pay for the insurance policy but would limit the benefits in a similar or a worse proportion.

Claim settlement record -This might be the ultimate decider for weighing the insurance plan’s credentials. Although this information might not be available publicly or might be present in a manipulated state, specialists expect it to be of more value to the customers in near future than it is currently.

Scope of coverage - Weighing premium vs. plan’s benefits is more necessary while defining the plan to be a comprehensive one. Buying a plan just because it’s cheaper than other plans is a very bad decision.

Renewability - Most of the diseases confront you after you reach a certain age which is bracketed as “old”. Therefore, it becomes highly important to buy a plan which has a very high renewability or lifetime renewability so that you are not left on your own when you need a medical cover the most.

Cashless Hospital Network - Checking the hospitals around to ensure that they are covered as a network hospital by the plan you consider is imperative as this allows you to avail the service of that hospital without getting into the hassles of claim reimbursements from the insurer and benefiting from the cashless facility given by the network hospitals.

Premium Loading - Always check the terms and conditions pertaining to premium loading as this might save you from paying a high incremental premium once you make a claim for the sum insured. The best practice would be to verify the premium fluctuation data of the plan for previous 5 years the least.

Internal team - Check for the plans from insurers which have an internal team for medi-claim. This might help in expediting the claim settlement process to a good extent.

Floater (family) size - Everyone has a different family size, one should always look for the family floater size allowed under the plan before considering buying it so that no member is left uncovered for health related problems.

EXCLUSIONS:

No claim is admissible in the following cases.

  • Pre-existing diseases.
  • Diseases occurred within 30 days of the policy.
  • Certain diseases during the first year of the policy. E.g. Cataract, hernia, Piles etc.
  • AIDS related checkups.
  • Cost of spectacles and dental treatments.
  • Expenses of tonics and vitamins etc.
  • Pregnancy related expenses.
  • Naturotherapy