Health Insurance

Health insurance policy is like an annual contract in which the insurance company pays for the medical expenses that occur during the policy tenure. The medical expenses include hospitalization due to sickness, accident, surgeries etc. These expenses can be availed by paying a fixed amount called premium. A medical insurance policy provides these expenses in the form of either reimbursement or cashless treatment.

Health insurance is an agreement wherein the insurance company provides medical coverage to the insured person for a fixed premium amount. Health insurance has become the need of the hour, especially since COVID-19 pandemic started. People have become more aware of the various benefits that come with medical insurance policy.

A health insurance policy protects you from heavy hospitalization expenses during medical emergencies. This includes hospitalization expenses, day-care expenses, ICU charges, and other medical expenses. The benefits offered depend on the health insurance plan and the insurance company you have chosen. You can also avail of tax benefits under Income Tax Act, 1961 if you possess a health insurance policy.

According to the Budget, the spending on 'medical and public health' in 2022-23 is Rs 41,011 crore due to "lower requirement of vaccination." The Union Budget has allotted Rs 86,200.65 crore to the health sector, a 16 percent increase above Rs 73,931 crore in 2021-22.

In addition, while delivering the Union Budget for the fiscal year 2022-23 on February 1, 2022, Finance Minister Nirmala Sitharaman made some significant announcements in the healthcare sector.

This involves the launch of the National Tele-Mental Health Programme and the rollout of an open platform for the National Digital Health Ecosystem. The National Digital Health Ecosystem will include digital registries of health providers and facilities, a unique health identity, a consent framework, and universal access to health care services.

When you have health insurance, you don’t need to have a huge bank balance during medical emergencies. A health insurance plan does the following;

• Provides A Cover Of Up To 1 CR

  You get a cover amount of up to 1 CR every year. You can use this amount for any hospitalization treatment throughout the year.

• Pays 90% Of Your Hospital Bill

  Just get admitted & give your cashless card to the hospital. The hospital takes money from your insurance company while your treatment goes on.

• Pays For Any Accident Bills

  Pays for your accident hospitalization bills from day one of your policy. Both indoor & outdoor accident hospitalization bills are covered.

• Pays For Any Seasonal Illness Hospital Bills

  Pays for any seasonal illnesses like covid19, viral fever, dengue, malaria, typhoid, pneumonia, diarrhoea & many more immediately after 30 days of buying the policy

• Pays For Any Pre-Existing Illness Hospital Bills

  Any pre-existing illness before buying the policy is covered after 3-4 yrs. after buying the policy. These include heart, lung, liver, kidney, diabetes, blood pressure & many more.

• Critical Illnesses Are Covered

  If you don’t have any pre-existing illness before buying the policy & if you suddenly get any critical ailment, it’s covered after 30 days. These include heart, lung, liver, kidney, diabetes, blood pressure & many more.

• Pays For Any General Surgery

  Pays for any general surgery after a waiting period of 2-3 years. These include piles, fissures, gallbladder, kidney stone & any surgeries listed in your health plan.

There is a wide range of health insurance policies & plans in India. Here's a list of some popular health insurance plans:

Individual Health Insurance Plan

An individual health insurance policy or plan provides coverage for a single individual only. This plan covers for your medical expenses related to hospitalization, injury, room rent, and more. This policy offers sum insured which can be used by only one person i.e. the individual covered under the plan.

Family Floater Insurance Plan

Under a family floater health plan, you can cover your entire family under a single policy. The sum insured for these policies are usually higher than regular individual health insurance plans. The sum insured is available for all the family members insured under the plan. The best part about this plan is that you can get cover for your entire family for a small premium amount.

Group Medical Insurance Plans

Group health insurance plans are highly popular in the corporate sector. Medium and large-sized enterprises use this insurance policy to offer cover for their employees in time of a medical crisis. It is a benefit that most employees expect when joining a company and this helps the employer retain their employees.

Critical Illness Insurance Plan

Critical illness health insurance policy offers cover specially for critical illnesses such as stroke, kidney failure, organ transplant, cancer, and more. Treating critical illnesses can get expensive and a policy like this can save a lot of money if you ever were diagnosed with a critical illness. The insurance pays a predetermined amount towards the treatment when the insured is diagnosed with a critical illness.

The decision to acquire the correct medical insurance policy is an important one and requires an in-depth examination on your end to ensure it meets your needs. The following factors must be considered closely to make the right decision:

• Coverage Offered: The insurance coverage and the amount insured will determine the type of illnesses and operations that can be claimed during the policy term. Pay close attention to the benefits offered like hospitalization expenses, daycare expenses, covid 19 coverage, etc. before choosing the policy.

• Adequate Sum Insured: The sum insured must be equivalent to your requirements. It is important to choose the plan with the highest coverage for your needs. In the current situation where covid 19 coverage is crucial, an insured sum between 10 lakh to Rs 1 Crore is recommended. If you are buying a family plan, the higher the sum, the more beneficial it is.

• Type of Policy: It is vital to choose the right type of medical insurance policy online as each policy serves specific needs. As per your requirement, you can select an individual plan, a family floater plan, a group medical insurance, or a critical illness plan.

• Waiting Period: The waiting period is the time you cannot file a claim under your medical insurance coverage. You have to wait for the deadline to expire. The waiting period typically applies to pre-existing illnesses, maternity benefits, etc. Thus, look at the Waiting Period when buying health insurance policy online and choose the one with the least waiting period.

• Co-Payment Clause: Some medical health insurance plans online consist of a Co-Payment clause. Under this clause, a portion of your coverage is borne by you. This does not reduce the total medical insurance coverage but can put pressure on you as you could be paying a part of the expenses out of your pocket when the need arises. The clause does result in a reduction of the premium amount. If you do not wish to opt for this, look for another policy.

• Network Hospitals: Network Hospitals are directly associated with health insurance companies. They help you avail of cashless facilities at the time of need. Take a look at the network hospitals of your insurance company when choosing a medical insurance policy online.

• Lifelong Renewability: Health insurance policies are generally renewed every year. The process of renewal is quite simple & can be done entirely online. As a part of the renewal process you are required to pay your health insurance policy premium. It is important that you choose a health insurance policy coverage that has renewal options on a life-long basis.

• Claim-Settlement Ratio: You should assess your health insurance company’s credibility based on its Claim-settlement ratio. If the ratio is higher, the more confident you can be that your claim can be fulfilled at the time of need. Ideally, a car insurance company with a claim settlement ratio of 80% is a good option.

• Exclusions: Exclusions are the conditions under which the claim cannot be fulfilled. Such exclusions must be examined beforehand by the policyholder. An ideal health insurance policy is the one that meets your requirements, provides adequate coverage, and requires minimum medical insurance premium. But before that, it is essential to know the type of insurance policy suitable according to your needs. Mentioned below are some health plans based on your needs:

As the medical facilities are advancing, so are the health care costs. The primary benefit of health insurance is that it takes care of healthcare costs. It give you a financial security if any unanticipated serious illness or accidental injuries drains all your savings. Learn how the cost of your insurance premium is determined:

• Medical History: Medical history is a major determinant of the health insurance premium. Pre-medical tests are mandatory by almost all insurance providers in India (after a certain age) before buying a health insurance policy. While a few insurance companies don’t make medical screening mandatory, they consider your current medical conditions, lifestyle-related health risks, and the medical history of your family. That is the reason why medical insurance premiums for smokers are higher than other people.
• Gender and Age: Age is an important aspect of determining the medical insurance premium. The premium differs based on the age of the insured person. That is why it is suggested to buy a policy at a young age because the premium cost is low for young applicants. Older adults are vulnerable to cardiovascular diseases and other critical illnesses like kidney problems, cancer, etc.; thus, senior citizen medical insurance premiums are generally higher. Additionally, the cost of the premium for women’s health insurance is lower than the male candidates due to the lower risk of stroke, heart attack, etc.
• Policy Term: The premium for a health insurance plan for 2-year will be more than a 1-year plan. However, nearly all insurance companies offer a discount on long-term medical insurance plans.
• Type of Health Insurance Plans: The kind of health insurance policies you choose also change the cost of the premium. The higher the risks, the higher will be the premium and vice-versa. An online calculator for health insurance premium will allow you to compare different health insurance policy premiums.
• No-Claim-Discounts: If you make zero claims in the policy term period, you can earn a No Claim Bonus (NCB) that can range anywhere from 5% to 50%. This is also considered to be one of the most important factors that are considered while calculating the cost of the premium.
• Lifestyle: If you regularly drink or smoke, the chances are high that you will be charged a more premium amount. In that case, the insurer can even reject your medical insurance policy request.

If the policyholder is hospitalization he/she needs to submit certain documents as mentioned below for making a reimbursement claim:

• Discharge card provided by the hospital
• In-patient hospitalization bills signed by the hospital for authenticity
• The doctors’ prescriptions, along with medical store bills
• Claim-form signed by the insured
• A valid investigation report
• Doctor's prescribed consumables and disposables with complete details
• Doctor's consultation bills
• Copy of the previous year insurance policy and the current year/copy of ID Card of TPA
• Any other document(s) needed by the TPA

A policy holder does not have to carry on with their current health insurance policy provider, if he or she doesn't want to. IRDAI gives you a provision to change the insurance provider. This switch happens without the policy holder having to compromise on the existing policy benefits or accumulated benefits.

Now IRDAI allows you to switch from one insurer to another while the new insurer will have to consider the credits you have gained from your previous insurer, where the credits refer to the completed waiting period in pre-existing conditions. The same thing applies if you switch from one plan to another within the same insurance company.

What can you do

• Switch from health insurance companies.
• Family floater/individual policy can be switched.
• Get insurance cover by your new insurer up to the sum assured as the old policy has.
• Both insurers should mutually complete the formalities as per the IRDAI timeline.

Criteria

• A policy can be ported at the time of renewal only.
• There must not be any break between policy renewals.
• You need to submit a formal porting request to your current insurer at least 45 days before the renewal’s due date.
• With a new policy, the terms and conditions and the premium are at the new insurer’s discretion.
• You must mention the name of the new insurer you are willing to switch to.

A medical insurance policy needs to be renewed annually upon its expiry. On-time health insurance renewal can reap you with the following benefits:

• Tax Benefits: On purchasing or renewing a health insurance policy, the insured person becomes eligible to gain tax benefits under section 80D of the Income Tax Act 1961. In order to get annual tax benefits, one should renew health insurance policy on time.
• Stay protected: Renewing your health insurance policy on time helps ensure that you stay protected and get uninterrupted coverage. A medical emergency can arise at any time which is why you must have a valid medical insurance policy. A lapsed policy means that your medical expenses are not covered and you might also lose your No Claim Bonus.
• Premium Amount: With age, your health insurance premium also increases. Moreover, if your policy lapses you need to buy new insurance policy which comes with higher premium. In order to avoid paying higher premium amount, you need to make sure you do health insurance policy renewal on time.

A health insurance policy is an annual contract which means it is valid for one year after which you need to renew it upon its expiry. If you do not renew health insurance policy on time, you may lose all the benefits that you have accumulated during the past tenure. Here are some basic steps to follow for health insurance renewal process:

Step 1: Visit your insurance company's official website.
Step 2: Within the website, visit the section that deals with health insurance.
Step 3: Put in your previous health insurance plan no. & your registered mobile no.
Step 4: Checkout the health insurance plans details & the plan renewal premium.

Here is the list of documents required while buying or renewing a health insurance policy.

• Valid identity proof (Aadhar Card, Driving License, Passport, Pan Card)
• Age proof
• Address proof (electricity bill)
• Previous policy documents (if applicable)
• Passport size photographs
• Medical history details