Health insurance is medical coverage that helps you cover your medical expenses by providing financial assistance. Due to the high cost of hospitalization expenses, it is important to have a health insurance plan. In the current pandemic situation, health insurance plays a vital role in protecting your money.
Health insurance is a type of insurance that protects you and your family from medical expenses due to an accident, illness, or serious illness. Most health insurance policies offer benefits such as cashless treatment, coverage for pre and post-treatment expenses, ambulance coverage, etc.
What is Health Insurance? – स्वास्थ्य बीमा क्या है?
Health insurance is the right investment to protect you and everyone in your family. However, still very few people in India have health insurance and if there is insufficient coverage i.e. they do not have adequate coverage. The disease is never told, and in our time, constant increases in pollution, unhealthy eating habits, stressful lifestyles, and exhaustion lead to many serious diseases. Treating them is very expensive. In such a situation, if you have to be hospitalized, the medical expenses could be too high for your savings. Through this article, we seek to make sure that you understand the importance of a medical insurance policy, and that you can choose the right medical insurance for you and your family.
This is a contract where we pay your medical expenses to the hospital when you are sick. It also reimburses expenses related to hospitalization, treatment, surgery, organ transplantation, etc. For this, you have to pay the premium on time. The health policy can be made for you, your spouse, dependent parents, and other family members including children.
Why should you take out a health insurance policy?
A pandemic like COVID-19 and the rising cost of medical expenses can create financial hardship. Thus, having health insurance coverage for you and your family protects you during these times. Here are the important reasons why you need to consider getting health insurance today:
- The high cost of hospitalization and medical expenses that the uninsured can drain your savings.
- Covering the COVID-19 pandemic and critical diseases.
- Immediate hospital admission without cash without spending anything out of your pockets.
- One can avail of tax benefits under section 80d of the Income Tax Act of India.
- You can take care of your health with an annual medical examination.
- You can also get coverage for your family members.
Types of Health Insurance Plans
There are different types of health insurance plans available in the market. We have categorized the schemes into large groups:-
Floating Family Health Plan
The family health insurance plan covers all family members under one insurance policy. You can get insurance coverage for yourself, your children, your spouse, etc., depending on the guaranteed floating amount, and your family can claim up to the full guaranteed amount. The premium amount paid is lower compared to individual health plans.
Critical Illness Health Plans
Critical illness plan provides fixed benefits/payments for critical illnesses like cancer, kidney failure, brain tumors, etc. The plan pays a lump sum once the policyholder is diagnosed with a listed serious illness, allowing them to benefit from comprehensive medical care without worrying about expenses.
Top-up Health Plans
The supplemental health plan acts as a step forward in your current health insurance policy and will save you if you have exceeded your policy limits. These plans come to your rescue if your current health insurance isn’t enough to cover your medical bills. These plans are also attractive to those who receive medical coverage from their employers. The amount of coverage is usually insufficient, so buying a top-up plan helps them fill the gap. These plans are very economical as they only start after the guaranteed principal amount has been exhausted.
Senior Citizen Health Plan
The Seniors Health Plan is specifically designed for people over the age of 60. The plan targets medical emergencies during old age (varies by policy) and allows them to benefit from health treatment without worrying about high medical costs. Since these plans are offered to seniors, they usually come with a co-pay clause (meaning that some percentage of the expenses must be borne by the insured).
Documents Required to Buy Health Insurance
Here is the list of documents required to purchase health insurance:
- Proof of age: PAN card, driver’s license, passport, voter ID, etc.
- Photo ID Proof: Aadhar Card, PAN Card, Driver’s License, Passport, Voter ID, etc.
- Address Proof: Ration Card, Bank Account Details, Electricity Bill, Passport, Voter ID Card, Phone Bill, etc.
- Proof of income: employer certificate, salary slip, form 16, etc.
- Medical examination: if requested by the insurance company.
- Photo proof: A passport size photo of the policyholder.
- If necessary, the company may request or other documents.
What does the health insurance policy cover?
The main benefits of purchasing health insurance are:
- Inpatient Hospitalization Coverage: The health policy covers hospitalization expenses if the hospital stay due to an accident or illness exceeds 24 hours.
- Before and after hospitalization: Covers expenses up to 30 days before a doctor’s consultation, scheduled diagnosis, or hospitalization and 60 days after hospitalization.
- Kovid-19 cover: Now you don’t have to worry if worrying about the coronavirus is not letting you sleep. The health policy also covers hospitalization expenses due to the coronavirus.
- Ambulance Coverage: The policy covers the cost of the ambulance providing the ambulance benefit to any policyholder.
- Intensive care fees: Your health is important. Your ICU fee during hospitalization is covered on a plan basis without any limits.
- Home hospitalization: Home hospitalization means that home treatment is also available when certain specific conditions are met.
- AYUSH BENEFITS: AYUSH (Ayurvedic, Unani, Siddha, Homeopathy) helps you with a permanent cure. The document covers the expenses of hospitalization for the same.
- No Claim Bonus: You can get a No Claim Bonus for every claim-free year under the policy for your good health. This will increase your security deposit by a maximum of 50% in 5 consecutive years.
- Daycare procedures: Many daycare procedures are covered in the policy. This requires hospitalization for less than 24 hours.
- Organ donor cover: Donating an organ takes courage. The document covers the medical and surgical expenses of the transplant.
- Auto Recharge: Don’t worry if your hospital bill exceeds your current security deposit. The automatic recharge feature is also included in your policy.
- Annual Health Check: Why spend unnecessarily on external health check-ups when you can get an annual medical check-up under the policy coverage.
- Second opinion: Sometimes, it may be possible that you need a second opinion. If you are not satisfied with your current treatment plan, you can take advantage of this feature.
- Lifetime Renewal: Once you choose the insurance plans, you can breathe a sigh of relief and continue the policy for life at break-free renewables.
What is not covered by a health insurance policy?
Many medical treatments/procedures are not covered by a health insurance policy. Tell us what the policy does not cover:
- Any diagnosis, treatment, or surgery for diseases occurring within 30 days of the policy term start date.
- Medical expenses related to the treatment of congenital diseases.
- Medical expenses due to IVF or infertility treatment.
- Treatment of pregnancy, childbirth, miscarriage, and abortion and/or treatment of its consequences.
- Hospitalization due to war, riot, strike, or nuclear weapons.
- Medical expenses due to alcohol or drug abuse.
- Expenses arising from self-injury and suicide/attempted suicide.
- Pre-existing illness up to 48 months from the policy start date.
Health insurance claim settlement process
The most important part of an insurance policy is the claims settlement process. Some insurance companies offer a straightforward claims settlement process, while others take the assistance of a TPA (Third Party Administrator) to settle claims. The claims settlement process takes place in two forms which are mentioned below. These are simple steps and can be changed from one insurance company to another.
You can benefit from cashless treatment facilities only in the hospitals of the insurance company’s network. The steps mentioned below are mentioned for the same.
- Notify the insurance company / TPA by call or email (for planned treatment – 48 to 72 hours before hospitalization, depending on the insurance company’s time frame). For emergency treatment, notification is required within 24 hours of hospital admission.
- Show the health card (provided by your insurance company) with proof of identity to the hospital.
- The hospital will verify the identity of the policyholder and submit a pre-authorization form to the insurance company / TPA.
- The insurance company / TPA will check all documents and share their acceptance (if all is well).
- Once the treatment is completed, the insurance company will pay the hospital treatment bills.
- There are likely to be exceptions, i.e. expenses that the TPA/insurance will not pay for. These expenses must be paid by the patient/family directly at the hospital itself.