Health Insurance
Features Of Health Insurance
Hospitalization Coverage
Stay in the hospital is protected
Pre- and Post-Hospitalization Coverage
Diagnostics and Consultations
Daycare Procedures
Discharge within 24 Hours is covered
Tax Benefit
Upto Rs 75000 of tax benefits.
Network Hospitals
(Cashless Facility)
Additional Benefits
Ambulance Charges, Health Checkups etc.
Benefits
About Health Insurance
“Health” insurance is a type of insurance policy that provides financial coverage for medical expenses incurred during hospitalization of 24 hours or more. It offers protection against high medical costs and ensures access to quality healthcare.
Hospitalization Coverage
“Health” insurance is a type of insurance policy that provides financial coverage for medical expenses incurred during hospitalization of 24 hours or more. This includes room rent, nursing care, doctor’s fees, surgery costs, ICU charges, and medications. It offers protection against high medical costs and ensures access to quality healthcare.
Pre- and Post-Hospitalization Coverage
“Health” insurance plans cover medical expenses for a specific period before you’re admitted to the hospital (like diagnostic tests and consultations) and after you’re discharged (like follow-up visits, Medicine and physiotherapy).
Daycare Procedures
With medical advancements, many treatments no longer require long hospital stays. Health insurance covers these daycare procedures, where you’re admitted and discharged within 24 hours (e.g., cataract surgery, dialysis)
Tax Benefit
Under Income Tax Section 80(D) in India, you can avail a deduction on health insurance premium. You can claim up to ₹25,000 for yourself and an additional ₹50,000 for your parents if they are senior citizens. So, the total deduction you can claim in this case is ₹75,000.
Network Hospitals (Cashless Facility)
Health insurance companies have tie-ups with a network of hospitals. At these network hospitals, you can avail cashless treatment, meaning the insurance company directly settles the bill with the hospital, so you don’t have to pay out of pocket (up to the sum insured).
Additional Benefits
These can vary widely but often include:
- Ambulance cover: Covers ambulance charges in case of an emergency.
- Health check-ups: Some plans offer free or discounted preventive health check-ups.
- AYUSH treatment: Coverage for alternative treatments like Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
Maternity benefits: Coverage for pregnancy-related expenses.
Why to take health insurance?
It is advisable for every person to have health insurance, because a single hospital bill can push a middle-class family below the poverty line.
Health insurance is essential for both your financial stability and your well-being.
Financially:
Peace of mind
Unexpected medical expenses can be financially devastating. Health insurance mitigates this burden, safeguards your savings, and prevents debt accumulation.
Access to care
Health insurance provides access to specialists, treatments, and preventive services that might otherwise be unaffordable. Early intervention often results in long-term cost savings.
Protection against life's uncertainties
Accidents and illnesses can occur unexpectedly. Health insurance ensures your finances stay strong even if your health isn’t.
Emotionally:
Reduced anxiety
Knowing that your healthcare is financially covered significantly reduces stress, allowing you to focus on treatment and recovery.
Empowerment and proactive healthcare
Health insurance empowers you to seek necessary care without the fear of financial hardship, encouraging proactive health management.
Protection for loved ones
Knowing that your family is protected from the financial burden of medical bills provides reassurance and strengthens your support system.
Add-ons:
Health insurance riders are additional benefits or features that you can add to your base health insurance policy for extended coverage. Common riders include.
Super Top Up:
Extra coverage that kicks in after your main insurance limit is reached, like a safety net.
Critical Illness Cover:
Pays a lump sum if you get a serious illness like cancer or a heart attack.
Maternity Cover:
Covers pregnancy, childbirth, and newborn care.
Accidental Cover:
Protects you financially if you’re hurt in an accident.
Hospital Daily Allowance:
Gives you a fixed amount for each day you’re in the hospital.
No Sub-limit:
Means there are no limits on specific expenses within your overall coverage.
Co-Payment:
The percentage of the medical bill you have to pay yourself.
Waiting Period:
The time you have to wait before you can use certain benefits.
It is very important for you to know.
- When Buying Insurance:
- Assess your needs: Evaluate your health condition, family history, and financial budget to determine the right coverage amount and type of policy.
- Research and compare: Look for policies from different insurers, compare their features, benefits, premium rates, and claim settlement ratios.
- Read the policy document carefully: Understand the inclusions, exclusions, waiting periods, and terms and conditions of the policy.
- Disclose pre-existing conditions: Declare any existing health conditions upfront to avoid claim rejections later.
- Opt for adequate coverage: Choose a sum insured that sufficiently covers potential medical expenses, considering rising healthcare costs.
- Buy the policy early: Purchase health insurance when you are young and healthy to avoid higher premiums and waiting periods.
- Don’t hide any information: Never conceal any medical history or personal details from the insurer.
- Don’t just focus on low premiums: While affordability is important, don’t compromise on essential coverage and benefits for lower premiums.
- Don’t ignore the claim settlement ratio: Choose an insurer with a good claim settlement record to ensure hassle-free claim processing.
- Don’t delay the purchase: Don’t postpone buying health insurance, as medical emergencies can arise anytime.
Don’t rely solely on employer-provided insurance: Employer-sponsored health insurance may not be sufficient for your needs, consider buying an individual policy as well.
By keeping these dos and don’ts in mind, you can ensure a smooth experience while buying a health insurance policy and making a claim.
- When Making a Claim:
- Inform the insurer immediately: Notify the insurance company as soon as a hospitalization or medical treatment is required.
- Choose network hospitals: Opt for treatment at network hospitals for cashless claim settlement.
- Keep all documents handy: Maintain all medical records, bills, receipts, and reports in an organized manner.
- File the claim on time: Submit the claim within the specified timeframe mentioned in the policy document.
- Cooperate with the insurer: Provide all necessary information and documents requested by the insurer during the claim process.
- Seek clarification: If you have any doubts or queries regarding the claim process, contact the insurer for assistance
- Don’t delay intimation: Don’t delay informing the insurer about hospitalization or treatment, as it may lead to claim rejection.
- Don’t submit false information: Never provide any false or misleading information in the claim form or supporting documents.
- Don’t discard any documents: Retain all medical records and bills related to the treatment, even after the claim is settled.
- Don’t hesitate to seek help: If you face any difficulties during the claim process, seek assistance from the insurer or a trusted advisor.
- Don’t give up: If your claim is rejected, you have the right to appeal or seek redressal through the appropriate channels.
By keeping these do’s and don’ts in mind, you can ensure a smooth claim process for you and your beneficiaries.
FAQ - Frequently Asked Questions
Health insurance is a type of insurance policy that provides financial coverage for medical expenses incurred during hospitalization of 24 hours or more. It offers protection against high medical costs and ensures access to quality healthcare.
Healthcare expenses can be significant and can eat up all your savings and future plans, a health insurance policy protects individuals and families against these financial damages efficiently. It provides financial security, access to better healthcare facilities, and peace of mind during medical emergencies, a cashless facility is a cherry on the top.
A: Health insurance policies are of various types, like
- Individual Health Insurance
- Family Floater Health Insurance
- Senior Citizen Health Insurance
- Critical Illness Insurance
- Group Health Insurance
- Top-up and Super Top-up Policies
- Individual Health Insurance: Covers an individual’s medical expenses.
- Family Floater Health Insurance: Covers the entire family under a single policy with a common sum assured.
- Senior Citizen Health Insurance: Specifically designed for elderly individuals to address age-related health concerns.
- Critical Illness Insurance: Pays a lump sum amount on the diagnosis of critical illnesses specified in the policy.
- Group Health Insurance: Provided by employers or organizations to cover their employees’/members’ health needs.
- Top-up and Super Top-up Policies: Provide additional coverage beyond the deductible limit of an existing health insurance policy.
Health insurance policies typically cover hospitalization expenses, pre and post-hospitalization expenses, day-care procedures, ambulance charges, Health check-ups, and certain medical treatments. The coverage varies based on the type of policy and the insurance company.
A waiting period is the duration during which certain illnesses or medical conditions are not covered by the health insurance policy. Waiting periods vary for pre-existing conditions and specific ailments and are meant to prevent immediate claims for existing medical issues.
Disclaimer:
Please note that the information provided here is for general understanding and might not cover all specific scenarios or recent changes in regulations. For detailed and accurate information, it is recommended to contact an insurance provider or consult the Insurance Regulatory and Development Authority of India (IRDAI) website. www.irdai.gov.in
