What is Health Insurance?

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.