In today's world, it is essential to get yourself and your family covered with Health Insurance. Health insurance is a type of insurance that covers all expenses incurred in the prevention or treatment of injury or disease. Like any other policy, a health insurance policy is a contract between an insurer and an individual or group in which the insurer agrees to provide specified health insurance coverage at a particular premium subject to terms and conditions specified in the policy, and also health insurance is an agreement whereby health insurance company agreed to undertake guarantee of compensation for medical cost if insurer falls sick or meets with an accident which leads to hospitalization of the insured. To provide cashless treatment to the insured, insurance companies have to tie up with leading network hospitals. And in any case, if the insurance company has no tie-up with the hospitals, they have to reimburse the cost of expenses incurred by the insured. Health insurance is being promoted by the government as they provide deductions from income tax. Buy a health policy online and avoid paying a long list of medical bills.
Key Benefits of Health InsuranceThere are multiple benefits of health insurance and these benefits can hold different meanings for different policyholders. It is advantageous for the policyholder to be aware of the benefits while purchasing the policy to avoid any misunderstanding at a later date.
1. Optimum cover for a health-related issue - Buying a health insurance policy will help you tackle health-related issues and avail the best medical treatment without worrying about medical expenses. You will receive coverage for Cashless treatment - When you buy health insurance, you become eligible for cashless treatments at one of the various hospital networks your insurer has tied up with.
Room rent charges - Most insurance policies provide coverage for hospital room expenses based on the premium paid by the insured individual.
2. Affordable Premium for Young Individuals - It is commonly seen that fit and young people don't care about investing in health insurance but ironically it is the best time to buy health insurance. The younger you are the lesser will be the financial burden as the premium will be rolled out over the years.
As our age increases so are the chances of various diseases, and for that reason, one must plan accordingly and buy health insurance at a younger age.
3. Financial safety against the rising medical cost - The cost of healthcare is increasing with each passing day and it's a matter of grave concern among people. It is important to safeguard yourself and your family from future uncertainties, by getting covered with a health insurance policy. A small annual premium will take away a lot of burden from you and will secure your family's future when it comes to health.
4. Cashless claim service - Many insurance companies offer cashless claim benefits and it is one of the major benefits of the health insurance policy. In case of an unpredictable medical emergency where you need to get hospitalized, you can claim cashless benefits provided in your policy. The hospital you are getting admitted into should be a network hospital. You must notify your insurance provider of your hospitalization, sign a pre-authorization form at the hospital, and get treatment once your claim is approved. This facility will allow you to avail of medical treatment without paying it to the hospital. Your Insurer will settle the claim directly to the hospital in which you get hospitalized.
5. Tax Benefits u/s 80D - Under Section 80D of the Income Tax Act, the premium paid for the health insurance plan is deductible from the taxable income, benefiting the insured. Even if you don’t buy health insurance for yourself but buy it for your dependent children, parents, spouse, etc. in that case also you will be able to avail of tax benefits. The amount of Reboot in tax available is up to Rs.25,000 for individuals or Rs.50,000 for senior citizens or dependent parents.
6. Cover for Medical Expenses - With our recent climatic and environmental conditions, lifestyle diseases as well as various other diseases are spreading at a very high rate. For that reason, you must get yourself covered with good health insurance and live your life peacefully. Some of the common benefits that you will be enjoying from health insurance are as follow:
a. Health checkups - With health insurance come free health checkups, depending on your plan type. Some of the insurers provide free health checkups according to the previous no-claim bonus.
b. In-Patient Hospitalisation Expenses: In case you need to get hospitalized for at least 24 hours you can avail of treatment under In-Patient Hospitalization. Expenses incurred under In-Patient hospitalization include- doctor’s fees, tests, nursing expenses, treatments, etc.
c. Pre-hospitalization & Post-Hospitalisation Expenses: These are all the expenses that are involved before and after hospitalization for the same medical condition for a specific number of days. The expenses included are- doctor’s consultations, blood tests, prescribed medicines, X-Ray, etc.
d. Ambulance expenses - Health insurance not only covers you against various medical expenses but provides you with ambulance expenses too.
e. Domiciliary treatment- If you are eligible for domiciliary treatment under your insurance policy then your expenses incurred during treatment at home under medical supervision will be taken care of.
f. Organ Donor Expenses- Health insurance plans also keep you secured from the expenses of organ transplant surgery. Depending on your insurance company, your expenses related to the harvesting of organs will be taken into consideration. Most companies provide it as an in-built feature whereas others may offer it as an add-on benefit.
g. Daycare Expenses- With the advancement of technology, there are certain surgeries that take very less time therefore it is important to add expenses such as daycare expenses. In Daycare expenses, surgical treatments are covered that do not require 24-hour hospitalization. Examples of such surgeries are sinusitis, eyelid incision, orthopedics, cataract surgery, and so on.
h. No claim bonus - One of the benefits of health insurance enjoyed by a policyholder is, a “No Claim Bonus”. For every claim, free year bonus money is added to the sum insured. It's a way for insurance companies to reward their policyholders.
7. High cover at low cost - Fixed benefit health insurance plans give high coverage amount for a comparatively lower premium.
What Is Covered Under Health Insurance?
Health insurance protects you against a multitude of expenses that you need to incur during a health emergency. Coverage of Health Insurance is quite wide and it highly depends on the plan you buy. Some of the services covered under a health insurance plan are as follows:
1. Prescription Drugs: These include all the prescription drugs and medication recommended by the doctor.
2. Emergency services: Patients requiring immediate medical attention are provided with emergency services. In case of an emergency, one should notify their insurance company and avail of cashless benefits. Ambulance Charges, Most of the insurance policies will cover you against ambulance charges or will provide you it as an add-on benefit.
3. Organ Donor: Expenses incurred during the harvesting of organs are also covered by health insurance.
4. In-Patient Hospitalization: Coverage for in-patient hospitalization is provided by all health insurance policies. When a patient gets admitted to a hospital for more than 24 hours, it is considered inpatient hospitalization.
5. Pre and Post-Hospitalization: All the expenses that you incur before getting hospitalized and after getting discharged from the hospital are included in pre and post-hospitalization expenses. Examples of such expenses are- Diagnostic tests, consultation sessions, investigative procedures, etc.
6. Maternity: Insurance companies cover you against maternity expenses too. Depending on the insurer either you need to buy a separate maternity insurance plan or an add-on feature will be provided to you.
7. Alternative or Ayush Benefits: The more we are moving towards modernity, the more we are getting connected to our traditional medical system. Our traditional medical system includes Ayurveda, Yoga, Unani, Siddha, Homeopathy, and Naturopathy. In present times most insurance companies provide coverage for treatments under the traditional medical system.
8. Domiciliary Treatment: Due to certain reasons if the insured person cannot move to the hospital, in such a case also the expenses incurred will be covered under the health insurance plan. The reasons for domiciliary treatment may be a severe illness or lack of accommodation at the hospital.
Exclusions Under Health Insurance
You should be aware of the fact that your health insurance plan does not cover your medical expenses in totality. Therefore it is advisable to read all the inclusions and exclusions carefully beforehand. Some of the common exclusions are as follows:
1. Cosmetic surgery - The primary reason to not include cosmetic surgery in health insurance is that it is not vital for the existence of a person nor it will prevent the functioning of a body part of a person.
2. Dental, Vision, and Hearing- One reason for not including dental treatment in health insurance is that it is considered cosmetic surgery. Apart from dental, vision and hearing are also not included in a health insurance plan. In case of hospitalization for the same, you need to correspond with your health insurer or it can be added as an add-on feature.
3. Lifestyle-Related Diseases- With the advancement of technology and ease of life, there is a dramatic change in the lifestyle of people, due to which there is a sudden rise in lifestyle-related diseases in India. Lifestyle diseases include diseases such as liver cirrhosis, lung-related diseases due to smoking, diabetes, hypertension, etc.
4. Suicide Attempt or Any Self Harm- If in any way, an insurer tries to harm and make a suicide attempt and injured himself/herself in that attempt then it is not covered under the health insurance plan whatever harm comes out of that.
5. Pregnancy and related conditions- Most health insurance policies cover you for pregnancy-related treatment or give you an add-on feature. But at the same time, there are certain health insurance policies that do not include treatment for pregnancy-related conditions in a health insurance plan.
6. Diagnostic tests- Most insurance providers do not provide these services unless the test results are positive.
7. Pre-existing Conditions - Pre-existing conditions are when you already had an existing disease while purchasing a health insurance policy then it is called pre-existing illness. Many insurance companies do not provide facilities for this type of condition or they have a waiting period for this case scenario so you have to consult your insurance provider before buying one.
8. Hospital Expense Limit- Make sure you check your hospital expenses section under your health insurance plan so that there will be no rush during emergencies and you will have a better picture of what hospital expenses your health insurance covers.
Best Indian Health Insurance Companies
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Health Insurance Companies
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Network Hospitals
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HDFC ergo health insurance
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10000+
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Tata Aig
health insurance
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8000+
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Care
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7800+
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Niva Bupa
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10000+
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Things To Consider Before Buying Health Insurance
Buying a health insurance policy is important, confirm before undergoing the subsequent points before making the final decision:
1. Types of sum Insured - Comprehensive health plan with a high coverage of sum insured that is adequate for you and your family.
2. Claim settlement ratio - Choose a wise health insurance provider that has a high CSR(claim settlement ratio). It will be helpful for you to take a claim in the future without any hassle.
3. Copayment & Sub-limits- Always choose the health insurance that comes with minimum co-payment and sub-limits. This will save you lots of money during the time of hospitalization.
4. Top-up facility - A top-up health plan provides additional coverage over and above your base sum insured. Avail top-up facility as it will save your rising medical expenses.
5. A waiting period for the pre-existing disease – Every health insurance plan has a waiting period of 2-3 years after the policy’s inception to cover pre-existing illness.
6. Lifelong renewability options - Look for health coverage that offers lifelong renewability.
7. Leading hospital lists - Choose a health insurance plan that comes with a broad network of cashless hospitals nearby your residence.
Compare Before Buying Health Insurance Online
Before buying a health insurance plan online the first thing you need to do is compare the health insurance plans with their features and benefits. There are lots of health insurance in the market, you should select the best one that suited your needs. Let's take a look at how to compare health insurance online:
1. Premium – The premium is the amount you must pay on a yearly basis for availing of the health insurance. Make sure that you select a high coverage at an affordable premium.
2. Type of cover – Always search for which health insurance plan offers maximum coverage for yourself and your whole family.
3. Online reviews – Before buying a health insurance plan online you must have to check the reviews posted by existing users or policyholders. This will give you an exact idea of the type of customer service being offered by an insurer.
4. Claim settlement – You must choose an insurer that offers a cashless and reimbursement mode of claim settlement.
5. No. of network hospitals – Always goes for only that health insurance provider which has broadly tied up with network hospitals.
Factors Affecting Health Insurance Premiums in India
When it comes to the cost of your health insurance premium, many factors can affect its price. Here are some factors that affect your premium:
1. Age – Age is among the most prominent factors that affect your premium. This is why the financial advisors recommended opting for a health insurance policy when you are younger since premiums increase with advancing age.
2. Family history – If you have a family history of certain chronic diseases like diabetes, cancer or stroke, etc. there’s an opportunity you’ll acquire those diseases later in life.
3. Body Mass Index – Those with a high body mass index may be asked to pay higher premiums due to their chance of falling sick being higher. High BMI individuals normally struggle with hypertension, asthma, and other illness, putting them in a higher risk category.
4. Smoking and drinking – Health insurers put smokers & drinkers (who consume alcohol) in a higher risk category. Smoking increases the risk of developing pulmonary illnesses like bronchitis and lung disorders. Consuming alcohol also increase the risk of developing liver-related disease and more severe conditions. In the case of smoking & drinking your health insurance premium will be high.
5. Pre-Existing Disease – Any diagnosed health condition before you buy health insurance is referred to as pre-existing illness in health insurance policy terminology. Buying health insurance at a point in your life when you do not struggle with any preexisting disease will allow you to skip high premium costs.
How To Claim Under Health Insurance
You can settle your claim under health insurance in two ways:
1. Cashless claim settlement - You get admitted to a network hospital for availing of medical treatment. All you need to do is show your health insurance card to the hospital and Your insurer TPA will take care of the rest. The cost of treatment is directly settled by your insurer to the hospital.
2. Reimbursement claim settlement - Reimbursement means refers to an amount paid to cover the money that has been spent. If you get admitted or avail treatment in any non-panel hospital, you can raise a claim by submitting your all bills and documents to the insurer and after that, all medical costs paid back to you by your insurer.
Document Required For Health Insurance Claim
- Health insurance policy issued by your insurer
- Identity proof of the insured member
- The duly filled claim form and signed by the proposer.
- Discharge summary of the patient
