Health insurance policy made easy
What is health insurance?
Health insurance policy is one policy that ensures that you get the best services in case you are caught up with any medical emergency. All your treatment costs are born by your insurance provider including your hospitalisation and other expenses.
You can avail the cashless hospitalisation from any of the network hospitals, or a reimbursement in case of hospitalisation by your policy provider. You should also know that the cost has been subsidised to the insured in the form tax exemption under section 80 D of income tax, 1961.
Medical insurance is the need of the hour because medical costs are sky touching. Save your pocket from the undue pressure and burden in case certain medical calamity befalls you.
Here is a list of reasons that justify the need of a health insurance plan for family:
- Brings top you the lowest premium policies from top insurers
- Helps you to compare various policies
- Get the best medical insurance
Basic Health Plan
This provides for the hospitalisation 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.
Features of a health insurance plan:
A health plan covers in-patient hospitalisation costs occur due to an accident, illness, or a medical/surgical procedure. Typically, your health insurer will pay for room rent, nursing, medical practitioner, anaesthesia, blood, oxygen, surgical appliances, operation theatre charges, medicines, drugs, consumables, and other devices required during a surgical procedure.
Pre and post Hospitalisation expenses:
It covers medical expenses that occur due to illness for 30 days before the insured person was hospitalised. It covers medical expenses that occur due to illness for 60 days after the insured person was discharged. The number of days for pre and post hospitalisation differs from one to another company.
No claim bonus:
No Claim Bonus (NCB) is a benefit under your health plan if the insured person has a claim-free policy year. The advantage of NCB transfers to the insured is either through an increase in the sum assured or specified discount on the premium charges for the succeeding year. Being a healthy individual, you can enjoy a claim-free year and take benefits of NCB under your health plan.
Medical expenses for treatments, which do not require 24 hours hospitalisation due to technological advancement.
Covers the expenses for treatment done at home for which hospitalisation would be needed.
Health insurance policies cover expenses for ambulance service.
General health check-ups as a preventive measure are covered by some health insurance plans.
Certain health insurance plans cover vaccination costs for bee stings, dog bites, etc.
Under emergency situations when a patient needs to be transferred from one hospital to another, health insurance plans cover expenses involved in the relocation process.
Why is health insurance important?
Health insurance is one of the fastest growing industries in India, yet there are only limited number of people who can afford to buy or rather are interested in a health insurance plan. According to the latest report as released by National Sample Survey Organisation, only 20% of the Indian population has the health insurance coverage.
Thus, in a country like India where diseases and illness are a day to day thing and the medical costs are sky rocketing, it thus becomes necessary to buy a health insurance policy.
Here are some really important reasons to lure you to buy a health insurance policy
- Medical treatments are a fiscal burden on the family
- Uninsured people may receive less medical care due to lack of funds
- They are prone to more risks as they do not have access to regular medical checkups.
- It protects one’s family through unexpected, unforeseen health-related financial situations.
But with so many health insurance policy available in the market, it becomes mind boggling situation to choose one policy that suits your pocket and also give you all the required benefits.
But comparing too is important thing and a lot factors have to be considered while going for a health insurance policy compare. Certain parameters that should be considered while comparing health insurance plans include the features of the health insurance plan, the add on benefits offered by the insurance provider, the sum insured under the policy and the network of hospitals allied with the insurance provider.
Tips and benefits of comparing health insurance policy:
- Don’t just focus on the annual premiums- there are other things that one also focus on so that all the areas get covered.
- Access to accurate information: comparing online gives you an advantage that is you can get the access information, which otherwise couldn’t have been hidden from the you by the agents. Because comparing online is the best option that you can get where all the information is easily available to you.
- Cost effective : because you can do this online, there is no such cost involved in health insurance policy compare, it is one of the most cost effective method of selecting a perfect plan for yourself.
- You also get to save a lot of time with the health insurance policy compare and are spared of a lot headache that you might otherwise have to suffer.
- Understand the claim process: though the claim of all the process is general, yet you should always check the nutty grittiest of the process before you invest, to save yourself from future problems.
- ICR or the insurance claim ratio is the most important thing to check before you invest. The formula for this is:
ICR= amount settled as claim/ amount received as premiums
- Focus on the sum assured: the medical inflation is rising with an average of 17% to 20% annually. Thus you should look for the maximum sum assured in the lowest rates.
- Look for the customer feedback: health insurance is a thing that you do not invest in time again. Make sure that the policy you invest in, doesn’t become a headache for you. Take mass opinion, read the reviews online, and if you find that there are many unhappy customers of a policy, stay alert because that might be due to poor services provided by it.
- Take help of a health insurance premium calculator: This tool is highly effective to understand the amount of money you need to keep aside from your budget to cover your health insurance needs. Before investing in a health insurance plan, you must always calculate the premium using the health premium calculator so as to choose the plan that best suits your needs and at the same time does not burn a hole in your pocket.
Types of health insurance available:
- Individual health insurance plan: this plan seeks to insure the life of a single individual and pays for the hospitalisations expenses, reimbursement, coverage of room rent etc. it is available for certain illnesses for a single individual only.
- Family health insurance plan; this plan covers the expenses-medical and accidental of more than one member of the family. The premiums that you pay are generally higher for family floater plans than the individual health plans. It is one plan that takes care of all members from the youngest to the eldest in your family.
- Senior citizen plan: this plan includes the members up to the age of 65 because they are more prone to serious and critical illness. According to IRDAI, every health insurance must include the people up to age of 65 years.
- Maternity plans: Maternity health insurance plans provide coverage for maternity and other additional expenses. These policies take care of both pre and post-natal care, and delivery of baby i.e. normal or cesarean deliveries. Just like other health insurance plans, the maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses.
- Hospital Daily Cash Benefit Plans-Hospital Daily cash benefits is a defined benefit policy that provides a certain sum of money for every day of hospitalisation.
- Critical Illness Plans- These plans are benefit-based policies, where a lump sum benefit amount is paid on diagnosis of covered critical illness. These diseases are usually specific, with high severity and low frequency in nature. Hence, the treatment cost is high when compared to day to day medical / treatment need. Some of these illnesses include heart attack, cancer, stroke etc.
There are many more plans available such as: preventive health care, pre- existing disease coverage, personal accident and many more. However, the above mentioned plans are just very important plans and others can be additional to your existing plan.
Points to remember
Coverage level: the basic coverage remain the same however, there are things that might be covered with your policy but you do not need. Thus it is important to see what you need and what your policy covers so that you are not paying for things that you do not require.
Entry age: for plans such as the family insurance which has a lot of members covered, you must know what is the minimum and the maximum entry age for you to get the policy. Also check the age of the dependent children or adults etc so that you do not face issues.
Waiting period: one must check the waiting period of the policy before investing so that you since different policies have different waiting periods. Also, waiting period is the limited period where exclusions of certain ailments are applicable.
Sub limits of your policy: it is important to check the limits on ambulance charges, room rent and other expenses so that these don’t end up burning a hole in your pocket later.
Renew-ability: an ideal policy is renewable throughout your life. Thus it plays a really important in deciding a policy for yourself and your loved ones.
Premium-The premium payable should always be kept in mind before investing in a health insurance policy. The amount payable for your health insurance plan should be justifiable and appropriate in comparison to other plans in the health insurance space.
These are some of very important points that you must consider before you invest in.
Factors that affect your premiums
A health insurance policy is a plan that secures your health and gives you financial security. There are certain factors that you must keep in mind which, affect the premium that you decide on.
Medical history: the amount you pay will also be determined by your medical history. While certain policies ask you to go through certain medical tests, some do not. But your medical history does determine the premium that you shall pay.
Age: your age too affects the amount you pay as your premium. It is suggested that one should in policy early in his life because the premium then is low as compared to the old age. An elderly person is more prone to the deadly diseases and thus higher the premium. Also, females have lower risk to heart stroke etc, thus the premiums for females is lower as compared to males.
Type of policy: the higher the risk involved, the higher the premium. So the premium the critical illness plans would be higher than just individual insurance plan.
Life style: your lifestyle too determines the premium amount because, if you are an avid drinker or smoker, chances are that you have higher risk of serious illnesses. Thus people with simpler lifestyle have less risk of diseases and less premium to pay.
Things to avoid while buying a health insurance plan
- Purchasing a policy without asking questions and clarifying doubts
- Delaying the purchase of an effective health insurance policy
- Not opting for sufficient coverage defeats the purpose of purchasing a health insurance plan
- Opting for coverage and riders that is not relevant for your unique health insurance needs
- Not reading the health insurance policy document thoroughly
- Purchasing a policy without adequate research
- Depending only on the health insurance policy offered by your employer
- Being unaware of the network hospitals of your health insurance company
Cashless claim process: one should keep in mind that of one has to avail this option, one should get the treatment done in any of the network hospital. Upon presentation of the e-card, details of the health insurance policy or any other physical proof of insurance, the insured can avail the benefit of cashless treatment and hospitalisation. This facility can be availed only if the injury or illness is covered in the health insurance policy. On discharge of the patient, the medical bills are sent to the insurance provider by the hospital. The company then evaluates the expenses and settles the payment.
Reimbursement claim process: this usually happens when the insured is treated in the hospital that doesn’t fall under the category of network hospitals. Health insurance companies also reimburse up to the sum insured, the amount initially paid by the insured in times of illness or accidents. Initially, the entire amount to paid by the insurer, and bills are to be submitted to insurance which will then analyse them and reimburse the amount up to the sum insured.In case the treatment is not covered in the policy, the claim is rejected.
The following documents need to be submitted during the reimbursement claim process.
- Duly filled claim form
- Medical Certificate or form which is signed by the treating doctor.
- Patient’s Discharge summary or card (original), availed from the hospital.
- Prescription and cash memos from pharmacies/ the hospital.
- Bills and receipts (original)
- Investigation report
- In case of an accident, the FIR or Medico Legal Certificate (MLC) is also required.
With a health insurance policy explained, you now know all that was necessary and you must buy a health insurance policy as soon as possible.
Here is a list of various insurance Companies and the plans that they offer:
|Star Health and Allied Insurance||Reliance General Insurance||Apollo Munich|
|HDFC Ergo||Royal Sundaram Health Insurance||Universal Sompo|
|Religare Health Insurance||Iffco Tokio General Insurance||Bharti AXA General Insurance|
|Cigna TTK Health Insurance||Max Bupa Health Insurance||Raheja QBE Health Insurance|