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Individual Health Insurance Plans
What is Health Insurance?
Health insurance provides financial protection against the costs of hospitalization or treatment for sickness. It is an agreement between the policyholder and the insurance company. The firm or insurer agrees to pay the policyholder (the insured) the sum insured or coverage amount to cover medical expenses. The insured must pay a specified amount of money in the form of a premium to receive this benefit. However, health insurance does not cover all types of scenarios and cases. These are referred to as exclusions.
Medical emergencies can occur at any time and to anyone. To make matters worse, growing medical bills have the potential to dig a hole in your wallet. Being prepared by acquiring a health insurance plan is one method to overcome such obstacles. This insurance helps alleviate financial concerns by covering the costs of acute sickness treatment, hospitalization, and other such charges.
Let us understand health insurance in detail.
What’s All The Hype About Health Insurance?
With rising healthcare costs, getting the necessary and high-quality medical treatment can be costly. To protect yourself and your family from these costs, you must enroll everyone in a reputable health insurance plan as soon as possible. Here are some of the main reasons why health insurance is so popular among people.
To fight lifestyle diseases
The prevalence of lifestyle diseases in younger age groups has become a severe issue. Illnesses such as diabetes, obesity, heart disease, and hypertension (high blood pressure), which have traditionally been considered diseases specific to the elderly, have now begun to spread among the young.
While there are many medications and preventive measures to help manage and eliminate the threat of these diseases, what’s most important is to detect them early on to avoid long-term damage and other complications. Regardless of your health status, having a health insurance policy covering regular medical tests and procedures can help prevent these illnesses from progressing past minor infirmities. It leaves you with nothing less to worry about.
Rising Healthcare Expenses
Healthcare costs are currently very high, and it is expected that they will continue to climb in the future due to rising medical inflation. As a result, it is critical to have a health insurance plan to protect yourself from escalating healthcare costs and to remain financially secure.
Financial Safety Net
Every person wishes to live a financially secure life. Although obtaining financial stability is mainly linked to adequately preparing for the future, having yourself insured under a suitable health insurance plan is critical. In the event of a medical emergency, you will be forced to pay out of pocket if you do not have health insurance, which will negatively influence your financial situation. Health insurance plans assist you in efficiently managing your emergency medical needs to make better use of your funds.
According to section 80D of the Income Tax Act, a policyholder can claim a tax deduction of up to Rs. 50,000 for health insurance premiums paid for their parents (senior citizens).
Types of Health Insurance Plans in India
Health insurance comes in a variety of formats. However, all health insurance policies can be divided into two types: indemnity plans and fixed benefit plans. Let’s take a closer look at these two sorts.
A. Indemnity Plan
This plan pays for hospitalization expenditures up to the limit set during the policy’s purchase. Insured may file multiple claims per year, but the total amount paid should not exceed the maximum sum insured limit or the amount you are entitled to receive from the insurance provider. This plan is sometimes referred to as a Mediclaim policy. You can also get cashless treatment at any network hospitals, with the insurance company paying on your behalf.
Types of Indemnity Plans
1) Individual Insurance Plans: This sort of health insurance is for a single person. As a result, the insurance company pays for an individual’s medical bills. These plans typically cover all expenditures paid while hospitalization, both before and after admission, as well as charges for various medical tests and laboratory fees, as well as consultation fees. The premiums for this risk cover are lower than for other plans because it is only for one person. This individual Mediclaim insurance does not cover existing ailments. However, these disorders may be covered by the insurance company when a specific amount of time has passed. Ayurvedic, homeopathic, and other non-allopathic treatments are frequently excluded from insurance policies.
2) Family Floater Insurance Plans: These insurance policies provide coverage for the entire family. Instead of purchasing separate individual plans, you can get a family floater that will cover all of your family’s medical and treatment costs. The insured, their spouse, and children are all covered under these plans. This plan can also protect minor children under the age of two. Siblings and in-laws are also included in specific plans. In a single plan, family floaters can provide health coverage for up to 15 members. As a result, the sum insured provided by the insurer is shared by all family members.
3) Senior Citizen Insurance: These insurance plans cover the costs of medical care or hospitalization for people over the age of 60. After the age of 60, illness and other health-related issues are widespread. Retirement may sometimes leave people without a steady source of income. In such a case, carrying all medical costs could be a significant strain. As a result, senior citizen health insurance policies can assist in managing medical bills in an emergency.
The IRDA requires that the policyholder is between the ages of 60 and 65 when applying for the policy. Before issuing a policy, several insurance firms require people to undergo a medical examination. In particular conditions, the waiting period for this insurance can range from 1-4 years.
4) Maternity Insurance: Maternity insurance is designed for women preparing to have a child or who are already expecting one. It covers all expenses during and after the pregnancy and the cost of the kid, the mother’s care, and any issues that may emerge as a result of the pregnancy. The standard Individual or Family Floater policy can be supplemented with such a plan.
Furthermore, it can be combined with employer-provided Group Insurance plans with a sub-limit of up to Rs. 50,000. By enrolling in this plan, you can save money on tests, drugs, labor, and admittance.
This plan also covers any emergency transportation due to pregnancy-related discomforts and delivery, nursing, and consultation costs. It also includes the diagnosis of a congenital or severe condition in a newborn. The waiting time is up to four years, after which all of the benefits are available. As a result, it’s best to get this plan well before you start trying to conceive. Charges for routine check-ups, diagnostic exams, and consulting costs, as well as any drugs, such as vitamins taken during pregnancy, are excluded.
5) Group Medical/Employee Insurance: Employers give group medical insurance to their employees. Members of any associations, firms, and other organizations are among the groups covered by such a policy. Employees can also extend the plan to cover other family members such as spouses, children, parents, and others by paying an additional fee. The premiums paid under this plan, like those paid under other plans, are tax-deductible.
Some policies additionally cover pre-existing conditions and maternity costs. Employees do not need to present any documentation or pass any medical examinations to obtain the plan, unlike other plans. In addition, the premiums are lower here. The plan can be contributory, with employees contributing a portion of the premium, or non-contributory, with the company paying the entire premium.
B. Fixed Benefit Plan
This plan does not include any hospitalization coverage. It pays a set sum for certain severe diseases and ailments listed, such as cancer, heart disease, and so on. This plan also includes coverage for the diagnosis of specific disorders.
Types of Fixed Benefit Plans
1) Preventive Insurance:
A preventive health plan can help you and your family keep healthy and save money at the same time. Your insurance company is required to provide this benefit so that you can get to your doctor more often. Health care is complicated, perhaps never so much as in recent years. It’s getting more so. But preventive health insurance is precisely what it sounds like a boon.
2) Critical Illness: Ailments that are not covered by health insurance are known as critical illnesses. These are a few conditions that can result in permanent impairment or death. Cancer, organ transplantation and failure, multiple sclerosis, paralysis, blindness, strokes and heart attacks, kidney failure, coma, and significant cardiac procedures are among the ailments covered by the plan. For the treatment of these disorders, the coverage gives a lump sum payment. This policy can be purchased individually or as a supplement to a life insurance policy. If the policyholder is diagnosed with any of the critical illnesses on the list during the policy’s term, they will get the claim reward and other benefits. Because the policyholder cannot work and make an income due to the illness, some businesses also pay a daily allowance benefit. The waiting period for such plans is usually shorter.
3) Hospital Daily Cash Benefit: It provides a set of benefits that are paid out after 24-48 hours of hospitalization. The advantages are in addition to those offered by a health insurance plan. This plan covers charges that aren’t generally covered by health insurance. During your stay in the hospital, you will be paid a set sum each day.
4) Personal Accident: The policy provides coverage for the policyholder’s accidental death as well as permanent whole and partial disability. An approach like this would be an excellent addition to automobile insurance to cover the driver’s death or bodily injury. In the event of the policyholder’s untimely death, the plan also provides a sum assured to the family members to cover various expenses and demands. This coverage does not require any health documentation to be purchased. It is available to individuals as well as groups. In addition, many insurances cover all legal and funeral expenses and any damage caused by terrorist acts.
Features & Benefits
Here’s the list of features and benefits of health insurance.
- Lifetime Renewability: As people get older, it gets more difficult to obtain health insurance, and the premiums also rise. This is when the opportunity to renew for a lifetime comes in handy. Until recently, most insurance firms set a 65-70-year-old age restriction for health insurance. According to the IRDAI’s amended criteria, all health insurance companies must offer lifelong renewal ability.
- Portability Benefits: Policyholders can move their existing health insurance policy to a new health insurance provider using health insurance portability. It protects customers from being taken advantage of by insurance providers, allowing them more flexibility and better options if they are dissatisfied with their current health insurance policies.
- Health Coverage Worldwide: With the advancement of health insurance policies, it is now feasible to access the best health coverage available anywhere in the world. International health insurance can provide seamless emergency health care overseas and medical coverage if you need to go for better health services.
- Day Care & OPD Charges: Until recently, a minimum hospitalization of 24 hours was required to cover health insurance policies in India. However, due to recent advancements in the health insurance industry, many vital procedures/treatments that take a few hours to complete, such as chemotherapy, eye surgery, lithotripsy, and others, are covered by health insurance. Furthermore, out-patient expenses are paid for operations such as dental care that do not come within either day-care or 24-hour hospitalization.
- No Claim Bonus: Insurance companies reward customers who do not file a claim during the insurance year with a No Claim Bonus (NCB). The No Claim Bonus, often known as a cumulative bonus, applies to individual and family floater health insurance policies. However, keep in mind that the No Claim Bonus only allows you to prolong your coverage up to a certain point.
- No Medical Tests up to age 45: To make the process of purchasing health insurance easier, insurance companies are opting for no medical testing for applicants under the age of 45. However, it is vital that candidates thoroughly fill out the form, providing a complete and honest declaration of their medical status. They will face severe penalties, including the cancellation of the policy if there is a discrepancy.
Best Health Insurance Plans
The value of having the correct mix of health insurance coverage for your family cannot be overstated. Before you choose a health plan for your family, take into account your age, the size and structure of your family, and your current insurance coverage, otherwise, you risk being underinsured. Here is the list of some of the best insurance plans that suit your requirement.
We’ve selected these plans because they provide significant amount of sum insured as well as the best claim settlement ratio. The claim settlement ratio (CSR) is the percentage of total claims that an insurance company settles in a year. It serves as a gauge of their trustworthiness. The higher the ratio, the more dependable the insurance is in general. In addition, all these insurance companies have strong connections to a large number of reputable hospitals across the country. Let’s have a look at these plans one by one:
|Health Insurance Plans||Insurer||Sum Insured||Incurred Claim Ratio||Network Hospitals|
|Active Assure Diamond Plan||Aditya Birla||Min- 2 Lakh Max- 2 Crore||59%||8000+|
|Health Guard Plan||Bajaj Allianz||Min- 1.5 Lakh Max- 50 lakh||85%||6500+|
|Smart Health Assure Plan||Bharti AXA||Min- 3 Lakh Max- 5 Lakh||89%||4300+|
|Digital Health Insurance Plan||Digit Health Insurance||Min- 2 Lakh Max- 25 Lakh||11%||5900+|
|Health Protector Plus Plan||IIFCO Tokio||Min- 2 Lakh Max- 25 Lakh||102%||5000+|
|Health Connect Supra Top-up Plan||Liberty Health Insurance||Max- 1 crore||82%||3000+|
|Companion Individual Health Plan||Max Bupa||Min- 3 Lakh Max- 1 crore||54%||4115+|
|Pro Health Plan||ManipalCigna||Min- 2,5 Lakh Max- 1 Crore||62%||6500+|
|Individual Mediclaim Health Plan||Oriental Health Insurance||Min- 1 Lakh Max- 10 Lakh||108.80%||4300+|
|Critical Illness Insurance||Reliance Health Insurance||Min- 5 Lakh Max- 10 Lakh||14%||4000+|
|Family Health Optima Insurance Plan||Star Health Insurance||Min- 1 Lakh Max- 25 Lakh||63%||10200+|
|United India UNI Criticare Health Care||United India Health Insurance||Min- 1 Lakh Max- 10 Lakh||110.95%||7000+|
|Individual Health Plan||Universal Sompo Health Insurance||Max- 10 Lakh||92%||5000+|
|Tata AIG Medicare Plan||Tata AIG Health Insurance||Min- 2 Lakh Max- 10 Lakh||78%||3000+|
|National Parivar Mediclaim Plus||National Health Insurance||Up to 50 Lakh||107.64%||6000+|
Disclaimer– ICR has been taken from the IRDA report and sum insured amount has been taken from respective plan brochures
Does Health Insurance Cover COVID-19?
Yes, COVID-19 is covered by your usual health insurance. India is arguably one of the worst-affected countries, with infections spreading like wildfire, putting medical insurance consumers in a pickle.
All insurers are anticipated to extend COVID-19 coverage to persons who currently hold a health insurance policy during the pandemic. According to the IRDAI criteria, coverage cannot be rejected since it is a new sickness and not a pre-existing condition. It may not cover the cost of consumables like personal protective equipment (PPE), ventilators, masks, and oximeters, which are an essential element of the treatment.
Following the IRDAI standards, two standard health insurance policies, Corona Kavach and Corona Rakshak Policy were introduced and acquired by many people.
1. Corona Kavach Policy
Corona Kavach is an indemnity-oriented coverage covering all COVID hospitalization expenditures and is designed to protect you and your loved ones from COVID-19.
If the policyholder tests positive for COVID-19, the policy intends to cover hospitalization, pre-and post-hospitalization expenses, home care treatment expenses, and AYUSH therapy.
The coverage also covers oxygen, blood, operating room charges, surgical instruments, medicine and pharmaceuticals, diagnostic costs, PPE kit, mask, and other comparable items in addition to hospitalization costs.
- Product Type: Individual/family
- Waiting Period: 15 days
- Sum Insured: Rs. 50 Thousand to 5 lakh
- Policy Tenure: 3.5 months, 6.5 months, and 9.5 months
- Entry Age: 18 years to 65 years
2. Corona Rakshak
Corona Rakshak is a low-cost health insurance plan that provides a lump-sum reward to policyholders diagnosed with COVID-19. If the diagnosis confirms the existence of the virus and needs hospitalization for 72 hours, the plan offers a 100 percent sum insured.
- Product Type: Individual/family
- Waiting Period: 15 days
- Sum Insured: Rs. 50 Thousand to 2.5 lakh
- Policy Tenure: 3.5 months, 6.5 months, and 9.5 months
- Entry Age: 18 years to 65 years
Inclusions & Exclusions
Health insurance providers provide various plans and policies from which to choose depending on your needs and requirements. Before selecting a plan and insurance, you should thoroughly grasp the coverage.
- Pre- and post-hospitalization charges: This insurance covers medical expenses incurred 30 to 60 days before admission to the hospital. These pay for things like medication and medical testing, among other things. This is in addition to the standard coverage, which includes paying for at least 24 hours of hospitalization, room rent, surgical charges, and so on. It also covers medical expenses such as medicine, home treatment, and other costs between 60 and 180 days after being admitted to the hospital.
- Ambulance charge: Ambulance service is usually covered by almost all health insurance policies.
- Day-care charges: Some health insurance plans cover the costs of treatments performed outside of the hospital for up to 24 hours. Dialysis, radiation, chemotherapy, and other therapies fall within this category.
- Health check-ups: Preventive health check-ups are also covered by several health insurance providers.
- Donor expenses: In some health insurance plans, donor expenses are covered. It is possible to take a healthy body part from a living person and transplant it into another person that desperately needs it. This may be necessary to save the life of someone who is in critical need of a healthy organ. Of course, the donation process follows strict medical protocol to ensure a healthy recovery for both the donor and the recipient.
- Maternity or New Born: Providing you with the funding to care for and protect your child, most plans also provide maternity cover to protect you and your new addition. Medical insurance for kids comes in handy should your child fall ill. It covers your child from the cost of hospitalization and medical treatment to vaccinations and even a child cover for maternity benefits.
Health insurance covers various medical bills, treatments, and illnesses, allowing you to manage your budget better. However, health insurance plans do not cover specific conditions and cases, but the list varies by provider. Be sure to grasp these exclusions before committing to a plan so that you don’t run into any issues afterward. Let’s take a look at some of the most popular exclusions.
- Dental treatment, including surgery
- Certain pre-existing diseases and critical illnesses
- Maternity or newborn coverage (You need a rider to get this coverage).
- Cosmetic surgeries
- Vision and Hearing
- Treatment for AIDS and other sexually transmitted diseases
- Non-allopathic treatment
- Suicide attempts
- hospital expense limit
Which Factors Should Be Considered While Buying Health Insurance?
1. Pre-existing Conditions
At the age of 30, a person may or may not suffer from any or only a few major medical disorders. When compared to purchasing medical insurance at the age of 50, this is a favorable condition. Diabetes, high or low blood pressure, or cataracts are all frequent health problems people face as they get older. A health insurance policy’s cost may be affected by the number of pre-existing conditions. If you have such a condition, you must state it truthfully when purchasing the coverage.
Most people reach financial independence by the age of 30. This makes it easy to get an excellent health insurance plan with a wide range of benefits. If you have a sufficient budget for health insurance, consider purchasing different plans, such as a critical illness plan.
3. Family Members
By the time you reach 30, your family may include your parents, siblings, grandparents, and, most likely, a spouse. If you married young, you could add children to this set. You must get a plan that provides enough health insurance for your entire family. Consider looking through the numerous plans on the market to discover one that fits your family’s needs while staying inside your budget.
4. Coverage Offered
A variety of health insurance products are available from a variety of insurance firms. The features and services of these products may vary according to the insurance company’s terms and conditions. You must select the appropriate product for yourself. In this circumstance, comparing medical insurance policies is an excellent idea. Now you may compare the coverage provided by each plan and make an informed decision.
5. Waiting Period
This is a popular medical insurance clause in India. The waiting period is the period during which you are unable to file a claim under your health insurance coverage. You have to wait until this period is over. Typically, the waiting period applies to pre-existing conditions, maternity benefits, and other similar benefits. As a result, it is advisable to purchase health insurance as soon as feasible.
6. Network of Hospitals
When choosing a health insurance carrier, make sure to look into the strength of the insurer’s hospital network. The hospital that is in direct communication with the insurance company is known as a network hospital. In such hospitals, a policyholder may be able to use cashless services. Having a large network of hospitals will be beneficial when filing a claim.
Difference between health insurance, mediclaim, and Arogya Sanjeevni
1. Aarogya Health Insurance Plan
The Arogya Sanjeevani Health Insurance is a basic health insurance plan that covers medical expenses ranging from 3 lakhs to 5 lakhs. Pre- and post-hospitalization fees, hospital room rent (stay and bed charges), ICU services, and even new age treatments are all covered under this policy.
You can select between a family floater plan and individual insurance for you and your family with Arogya Sanjeevani Health Insurance.
Arogya Sanjeevani Policy’s list of New-Age Treatments
- Balloon Sinuplasty
- Deep Brain stimulation
- Oral Chemotherapy
- Robotic surgeries
- Stereotactic radio surgeries
- Bronchial Thermoplasty
- Uterine Artery Embolization and HIFU (High intensity focused ultrasound)
- Immunotherapy – Monoclonal Antibody to be given as an injection
- Intra vitreal injections
- The vaporization of the prostate (Green laser treatment or holmium laser treatment)
- IONM: Intra Operative NeuroMonitoring
- Stem cell therapy
Difference Between Health Insurance and Mediclaim Policy
Health insurance pays for the policyholder’s medical and surgical expenses, whereas a Mediclaim policy solely covers hospitalization and accident-related care.
There is no limit on the number of claims a policyholder can make in a year with health insurance. However, a Mediclaim policy might be processed as a refund or as a cashless treatment.
In the case of health insurance, 100 percent reloading of the sum assured is free, whereas Mediclaim policies have a pre-determined sum assured.
Mediclaim policy doesn’t provide any add-on coverage. Whereas, health insurance plan provides critical illness coverage, accidental disability coverage, personal accident coverage, maternity coverage, etc. to enhance the insurance features.
Health insurance covers everything from pre-hospitalization to post-hospitalization charges, whereas a Mediclaim coverage just covers accidents.
A health insurance policy covers critical illness for more than 20 different diseases, whereas a Mediclaim policy does not.
What’s Health Insurance Portability?
Health Insurance Portability (HIP) is a program that allows policyholders to move their existing health insurance policies from one provider to another. Health insurance companies serving the requirements of millions of people. Portability guarantees that businesses do not take their clients for granted, increasing competition and providing better options for current customers. Customers who choose portability don’t have to worry about losing any benefits they’ve earned, and they have the entire freedom to switch to a better service provider. Why should you compare health insurance plans online?
Is it better to buy health insurance online?
The internet is the most convenient method of buying insurance. While going online, you are able to get all the necessary details and have enough time to read through the details of the product, and select the most suitable policy for coverage and maximum savings. The internet makes it easy to find affordable coverage, no matter where you live. You’ll have immediate access to the most detailed, updated, and comprehensive policies available today.
Benefits of Comparing Health Insurance Online
The following are the benefits of comparing health insurance online.
- You Get various Options To Compare
While comparing health insurance plans, you can get a multitude of options to choose from. You can easily compare and analyze all options with one another and then choose the best plan for you as well as your family.
- It Saves Time
When it comes to purchasing health insurance for yourself or your family, online health insurance comparison is the most efficient approach to save time. There’s no need to fill out extensive paperwork or deal with an agent or insurance executive at the insurance office. You can complete your study online at your leisure, at your own pace, by feeding in data to obtain quotes.
- You Can Obtain Additional Advantages
A health insurance plan comparison can help you learn more about additional advantages. The cost of an ambulance service, for example, may differ. Some insurance companies may provide coverage for AYUSH, alternative therapeutic therapies, and other similar services.
What Can All Factors Impact The Health Insurance Premium?
Age, income, gender, and family history of illnesses are all factors that influence your health insurance price.
It should come as no surprise that your age significantly impacts the amount of premium you pay. You will be forced to pay a lower premium if you are younger. When compared to older persons, young people have fewer health issues and are less likely to require medical aid and coverage. As a result, you recommend that you purchase health insurance policies with enough coverage when you are younger.
2. Medical History
If you have a family history of disorders like cancer, high blood pressure, or heart disease, you are more likely to need medical attention in the future. As a result, persons with a medical family history of such conditions may require additional coverage, such as a cancer insurance plan. They may be obliged to pay higher premiums to receive necessary medical support.
3. Body Mass Index (BMI)
People with a higher BMI pay a more significant insurance premium than those with a normal BMI. This is because people with a high BMI are more prone to develop heart, joint, and other diseases and diabetes, and other issues, making them more likely to seek medical help regularly.
4. Pre-existing health conditions
Individuals with pre-existing health issues are likely to pay higher health insurance rates since they will need more coverage than others. This will be unique to your plan because it will cover you for a pre-existing condition.
One of the most critical aspects of health insurance to consider when choosing a plan is the sub-limit. The overall cost of hospitalization is the sum of numerous things such as room rent, surgical fees, medicine costs, equipment costs, etc. Sub-limit means that the compensation for each of these criteria will be capped separately. Sub-limits are frequently used in conjunction with the choice of a lower premium amount.
6. Geographical location
The premium rate that you will be obliged to pay may also be influenced by where you live. Specific zip codes necessitate a higher premium rate.
7. Type Of Profession
Policyholders who work in workplaces with dangerous substances, radiation, chemicals, or jobs with a high risk of injury, such as construction, must pay higher premiums, according to insurance firms, because they are more likely to develop cardiovascular diseases.
Step By Step Guide for Buying a Health Insurance Policy in India
- Contact The Insurance Provider: Once you have chosen the type of plan you wish to buy, contact the respective insurance company either online or by visiting the branch.
- Filling Essential Forms & Submitting Essential Documents: Fill up all the essential forms and also submit all the necessary documents required for purchasing the policy.
- Verification: The insurance company will then verify the documents.
- Pay Out Premiums: Once the insurance company provides you with a green signal for buying the insurance, start by paying your premiums.
How Much Tax Can You Save With Health Insurance Plan?
Health insurance is an essential purchase. It ensures financial stability for you and your loved ones in the event of a medical emergency. A health insurance policy offers total coverage by assisting you in paying for medical expenses listed in the policy, whether it is an emergency or a planned hospitalization.
Apart from protecting your finances from escalating medical costs, you may be eligible for tax savings on health insurance premiums paid under Section 80D of the Income Tax Act, subject to certain criteria. As a result, health insurance is a wise investment.
Take a look at the tax advantages of purchasing health insurance.
- In case you and your parents are below 60 years of age – Approximately Rs. 50,000.
- In case both of your parents are above 60 years of age – Approximately Rs. 1 Lakh.
- In case you and your family are below 60 and your parents are above 60 years of age – Approximately Rs. 75,000.
How To Claim Your Health Insurance Policy in India?
Health insurance coverage can assist in the management of any unexpected medical bills. As a result, you must properly make claims to receive the benefit in the event of an unforeseen circumstance. Cashless and reimbursement claims are the two categories of claims.
Cashless Claims: To make this type of claim, you must go to one of the network hospitals, which the insurance company has approved. The policyholder is not responsible for the hospitalization costs because the insurance company covers them.
Let us understand the cashless claim process.
- In the event of planned treatment, notify the insurance company ahead of time. This can be done via email or by calling a toll-free number.
- Provide the health card issued by the insurance company and approval from the treating doctor to the hospital’s Third-Party Administrator (TPA) desk upon admission.
- Submit the appropriate documentation as well.
- When the insurance company approves the case, it pays the hospital immediately for the medical charges.
Reimbursement claims: The policyholder is responsible for paying for the treatment and hospitalization. However, after submitting the appropriate documentation, he/she receives the money back as per the sum insured amount.
Let us understand the reimbursement claim process.
- Submit the bills and other needed paperwork to the insurance provider once you have paid the medical expenditures on your own.
- If the insurance company determines the claim to be valid after an evaluation, it will reimburse the insurer.
Document Required For Filing The Claim
- Duly filled claim form with your signature
- Valid identity proof
- Original pharmacy bills
- Doctor’s prescriptions recommending hospitalization, medicines, diagnostic tests, and consultation
- FIR (In police cases)
- Policy details, such as the name of the insured, policy number, etc.
- Ambulance receipt
Frequently Asked Questions
1. Is it taxable to pay premiums for a health insurance plan?
No, the premiums you pay aren’t taxed. Premiums are tax-deductible under Section 80D of the Income Tax Act, 1961.
2. Can I receive insurance for my in-laws?
Yes. Some insurance companies allow you to include your in-laws in your family floater health insurance coverage.
3. Should I buy a health insurance policy when I'm young?
Yes. Enrolling in a health plan at a young age, say 25 years old, is always a good idea. Your premium amounts start to rise as you get older.
4. What is cover restoration?
If you have claimed all of the sum insured in a policy year and need to file another claim in the same year, the business will restore the sum insured. As a result, you can reclaim the entire sum.
5. What insurance of the diseases is covered by critical illness insurance?
Cancer to a degree, organ transplant, first heart attack, significant burns, and other ailments are among them.
6. Is it possible for me to pay my health insurance payment in instalments?
The health insurance premium is usually paid once a year. However, you can pay your fee in monthly, quarterly, or half-yearly instalments.
7. What if I already have health insurance coverage but want to raise the amount of money I'm covered for?
If you already have an insurance policy but want to increase your coverage, you can do so when you renew your policy.
8. If I decide to cancel my health insurance policy after it has been purchased, what should I do?
If you want to cancel your health insurance coverage after purchasing it, you have 15 days from the time you get the policy documentation to do so.
9. Will purchasing health insurance at a young age provided me with greater benefits?
Yes, there are numerous advantages to purchasing health insurance early in life. You may receive a lower premium amount, no waiting period, better options, a bonus, decreased rejection rates, and other benefits as a result of doing so.
10. What does it imply when someone says "donor expenses"?
Donor expenses encompass all hospitalization costs incurred by the donor in connection with organ donation, except the cost of the organ during an organ transplant.
11. Is Medical insurance only designed for individuals who are sick?
Though persons who live a sedentary lifestyle are more susceptible to diseases, accidents, and seasonal illnesses such as malaria, dengue fever, and other mosquito-borne diseases that can strike anyone. As a result, regardless of your health or age, purchasing health insurance is a must. When you are in good health, it is the best time to purchase health insurance. Most health insurance companies do not cover pre-existing conditions. Health insurance coverage with no restrictions can be obtained by buying a policy early in one’s life when one is healthy.
12. Will the insurance company reject the policy if I will reveal my medical condition?
It is often believed that the insurer will reject the policy application or raise the premium rates if one discloses their medical needs. In the event of a claim, however, if the insurer discovers that you have not told your medical issues, your claim may be denied. Whether you’re purchasing individual or family health insurance, it’s critical to reveal your current health status, even if it means paying a higher premium.
13. Are health and critical illness insurance the same?
While health insurance covers medical expenses, critical illness insurance goes a step further and covers non-medical costs. Our standard health plans are indemnity-based, which means you must file a claim for each hospitalisation in order to get benefits. A critical illness health insurance plan, on the other hand, provides you with a lump sum benefit in one payment to cover all of the costs associated with dealing with a life-threatening sickness.
14. Do all health insurance policies provide lifetime coverage?
Most health insurers offer lifetime coverage as long as the policy is renewed. Health insurance can be purchased for one year or two years. It is necessary to restore the insurance at the end of the term to continue receiving coverage.
15. Is the health insurance provided by my company sufficient?
Employer-provided medical insurance has limited coverage and ends when the employee leaves the company. Furthermore, most workplace health insurance plans do not cover you when you retire. Instead of relying entirely on employer-provided health insurance, it is always advisable to acquire an individual health insurance policy.