Health Insurance, popularly known as Mediclaim in India, is a form of insurance which covers the expenses incurred on medical treatment and hospitalisation. It covers the policyholder against any financial constraints arising from medical emergencies.In case of hospitalisation due to illness or accident, health insurance takes care of the expenses of medicines, oxygen, ambulance, blood, hospital room, various medical tests, treatment cost and almost all other costs involved.
By paying a small premium every year, you can ensure that any big medical expense, if incurred, will not burn a hole in your pocket. The plan can be taken for an individual or for the family as a ‘Family Floater Health Insurance Plan’. You can also get tax deductions on the premiums paid towards health insurance under Section 80D of the Income Tax Act, 1961.
As the name suggests, this type of health insurance plan covers the entire family. It is similar to an individual policy except that the sum insured in this case is usually higher and is shared between the family members. One of the main advantages of such an insurance plan is that you need not manage
different policies. Moreover, such policies are also more cost-effective than buying an individual policy for each member.
Critical Illness Insurance Plans cover specific life-threatening diseases such as diabetes, kidney ailments, heart related issues, cancer, paralysis, etc. These diseases could require prolonged treatment or even change in the lifestyle of the patient.
A critical illness plan will involve the payout of a guaranteed/assured lump sum amount upon diagnosis of any critical illness covered under the health insurance policy.
These are ‘Benefit’ policies and not ‘Reimbursement’ policies like other health insurance policies. Unlike hospitalization plans, the payout to the insured is made upon diagnosis of the Critical Illness which is covered under the plan opted by the insured and no hospitalization is needed for claiming the money. The cover gives the flexibility to use the monies for changing lifestyle and medicines. Also it’s a substitute for income for the time you could not resume work due to illness. Such a plan is advisable for those who have a history of such illnesses in their family.
Top-up cover, also known as High Deductible Cover, is a new option available for individuals and families to cover expenses in excess of a specified limit, usually called High Deductible.
Usually, Top Up policies are taken by those who already have a regular health insurance policy for a specified sum insured. They usually take a Top Up Policy where the Deductible is equal to their sum insured under the regular health Insurance Policy.
Deductibles (also called ‘excess’) where the initial defined amount of hospital costs are borne by the policyholder after which the coverage starts.
Even those who are not covered by any health insurance policy can take a Top Up cover to meet a high-cost hospitalization, but they must bear the Deductible.
All of us should buy health insurance for all members of our family, according to our needs. Buying health insurance protects us from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent in household savings or even lead to indebtedness. Each of us is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advances, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.
Insurance companies have tie-up arrangements with several hospitals all over the country as part of their network. Under a health insurance policy offering a cashless facility, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the Third-Party Administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits allowed by the insurance policy or expenses not covered under the policy have to be settled by you directly with the hospital. A cashless facility, however, is not available if you take treatment in a hospital that is not in the network.
Yes. When you get a new policy, generally, there will be 30 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurance companies. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal.
It is a medical condition/disease that existed before you obtained a health insurance policy, and it is significant because the insurance companies do not cover such pre-existing conditions, within 48 months prior to the 1st policy. It means pre-existing conditions can be considered for payment after the completion of 48 months of continuous insurance coverage.
The policy will be renewable provided you pay the premium within 30 days (called a Grace Period) of the expiry date. However, coverage would not be available for the period for which no premium is received by the insurance company. The policy will lapse if the premium is not paid within the grace period.
Yes. The Insurance Regulatory and Development Authority (IRDA) has issued a circular making it effective from 1st October 2011, which directs the insurance companies to allow portability from one insurance company to another and from one plan to another, without making the insured lose the renewal credits for pre-existing conditions, enjoyed in the previous policy. However, this credit will be limited to the Sum Insured (including Bonus) under the previous policy. For details, you may check with the insurance company.
Any number of claims is allowed during the policy period unless there is a specific cap prescribed in any policy. However, the sum insured is the maximum limit under the policy.
While the eligibility age for health insurance policies differs, the general eligibility age for adults ranges between 18 years to 65 years. The eligibility age for children lies between 90 days to 18 years.
Health insurance benefits differ from policy to policy. However, basic health insurance benefits include cover for an inpatient hospitalization, pre & post-hospitalization, day-care procedures, emergency ambulance expenses, organ donor expenses, domiciliary hospitalization, OPD expenses, and more.
Yes! Buying health insurance will earn you the eligibility to claim tax benefits under Section 80D of the Income Tax Act, 1961.
If you already have an insurance policy but want to extend your coverage, you can do so frequently at the time of policy renewal.
If you have already been diagnosed with a medical condition, it will be considered a pre-existing disease. In this case, you may have to wait for a specific period (waiting period) until allowed coverage. Based on your insurer, you may be required to pay a higher premium or face policy denial.
Usually, health insurance companies do not cover maternity and related expenses. But a few companies have some particular plans which offer maternity cover after specified waiting periods. The waiting periods generally vary from 2-4 years.
A cumulative bonus is an increase in the sum insured by a specific percentage for every year a claim is not made, up to a certain limit. It is offered by insurers on indemnity-based health insurance plans and only when the policy is renewed without a break.
In an emergency, you might be admitted to a non-network hospital and knowing the claim protocol at that time is imperative. Always remember that treatment in a non-network hospital would be on a reimbursement basis only where you would have to shoulder the medical bills and then get them reimbursed from your insurer. So, find out the reimbursement process, the documents required in this case, and the deadline for informing the insurance company etc for this situation.