Health Insurance

Yes, Health Insurance can help you reduce your taxable income up to Rs. 1 lakh. Tax saving can happen under Section 80D of the Income Tax Act, 1961. As a Policyholder, a deduction of up to Rs. 25,000 per annum can be availed with regards to the premium paid for a health plan. The policy offers a coverage that can be availed by you, your spouse, and dependent children. However, the limit increases up to Rs. 30,000 if you or spouse is 60 years and above. You can also back this by an additional coverage of Rs. 5,000 for hospital related expenses of the family members such as parents, spouse, and dependent children.

Women of all walks of life are now progressing and trying to maintain the fine balance between their personal and professional commitments. Hence, it is important that their medical needs are catered to. Various health insurance providers have now come up with unique health insurance plans that specifically cater to female medical conditions such as breast cancer, ovarian cancer, cervical cancer, complications during pregnancy, childbirth or other forms of critical illnesses. Some of the top companies that provide these kinds of health insurance plans are TATA AIG, Bajaj Allianz, etc.

A cancer insurance plan is a supplement of health insurance that covers the risks associated with cancer and its various manifestations. This kind of plan is devised to mitigate the cost of cancer treatment of a patient.

Overseas health insurance is covered under international travel plans. These plans usually cover bodily injuries caused, medical illnesses or diseases contracted during an international journey.

Yes, According to the current law, your health insurance plan can cover your dependent children., You can now add or keep your dependent children included in your policy, until they turn 26 years old.

Yes. Most employers that provide health insurance benefits to their employees also cover an employee’s spouse and children. However, if the employer does not provide any such health insurance plan, the spouse can be enrolled for an individual health plan from a health insurance provider or you can cover your spouse in your family floater health insurance plans.

In certain cases, yes, health insurance plans also cover the parents of the insured. Under individual health insurance plan, you cannot add any dependents, including your parents. However, if you have a family floater plan, you can also opt to add adult dependents for coverage under the same.

Family floater health insurance plans usually cover parents in India. There are specific plans designed by various health insurance providers that cater to medical needs of parents of 55-60+ years of age. Some of the top providers of such unique plans include Star Health Insurance, Bajaj Allianz, Apollo Munich, Max Bupa health insurance etc.

You can increase the sum insured of your existing health insurance policy at the time of renewal of the health insurance policy. One must keep in mind that sum insured enhancement is not possible in case you have you have made a mediclaim in your previous policy.

This varies on a case to case basis. Both insurance plans aim to cover the medical expenses in case of medical emergencies. Individual health insurance plans cover a single individual whereas family floater plans cover the medical expenses of the entire family. However, individual plans are more expensive than a family floater plan. Also, family floater plans provide a greater sum insured amount in the event of only one claim in the year as compared to individual plans.

Smoking has an adverse effect to health insurance premiums. This means that if you are a smoker, you end up paying higher premiums as you are subjected to greater medical risks.

You can renew your health insurance policy either offline or online. For offline renewal, you would require to contact your health insurance provider at least 30 days before expiration and make a renewal request. Any change in the health condition must also be notified to the provider at the time of renewal. In case of an online renewal, you must provide your basic details along with your insurance policy number and make the payment online via your debit or credit card, or through net banking.

In case you forget to pay your health insurance premiums, the provider gives you a grace period that usually varies from one to three months. However, if you fail to pay the premiums during this time as well, your insurance policy lapses and you are no longer entitled to the health insurance benefits of the policy.

Yes, there is a medical checkup available while applying for health insurance as the insurance provider needs to assess the current health condition of the applicant before they invest in a policy.

Yes, a pre-medical check-up is available before buying health insurance. The pre-medical check-up is a series of tests that the insurance applicant is required to undergo so as to determine the current medical conditions and any pre-existing diseases that the applicant might be suffering from.

Not all health insurance plans mandate a pre-medical checkup. Most insurance providers have a threshold limit of 45 years providing health insurance plans without pre-medical examination. Some of the plans are-

a. Star Health Insurance- Health insurance plans such as Family Health Optima, Mediclassic, Health Gain, Comprehensive or Family Delite require no check-ups are required till 50 years of age.

b. Oriental Insurance- Happy Family Floater plan by Oriental Insurance does not need a pre medical checkup till the age of 60 years.

c. Religare Health Insurance- This insurance provider has a unique Care plan that does not need any medical screening.

There are some insurance providers who have come up with health insurance plans specific to diabetic patients. These health insurance plans cover medical expenses arising from diabetic conditions. One can invest in health insurance plans provided by companies such as Star Health Insurance and National Health Insurance. The procedure of buying health insurance for diabetic people is the same as investing in any other health insurance plan.

Dental treatments are only covered under mediclaim in health insurance if the insured has to undergo the required treatment or surgery because of an accident and not otherwise.

A Third Party Administrator or TPA looks after claim settlement and investigation on behalf of the health insurance provider.

In India, not everyone can afford to invest in health insurance plans provided by private insurance providers. Hence, the government has come up with certain health insurance policies that benefit the ones in medical need. These plans are extremely cost effective and provide basic medical assistance to the poor and needy. Hence, government related health insurance plans are basically to support the ones who can’t afford health insurance plans by private insurers and promote healthcare in India.

A few health insurance plans offered by government of India are-

a. Central Government Health Scheme

b. Employment State Insurance Scheme

c. Rajiv Arogya Bhagya

d. Meghalya Health Insurance Scheme

e. Deen Dayal Swasthya Seva Yojana, Goa

With the increasing shift in alternative forms of medicine, a number of insurance providers are now providing coverage for Ayurvedic treatments in their health insurance policies. However, this is restricted to only certain health insurance providers till now.

Yes, certain health insurance providers cover the cost of cataract treatments in their health insurance policies. However, they are subject to a few exclusions. These exclusions are factored by the waiting period and limit on claim payable. Some insurers that cover cataract expenses are Bajaj Allianz, Religare Health Insurance and Apollo Munich.

Yes, maternity is covered under health insurance plans. In fact there are special health insurance plans such as Apollo Munich Easy Health Family Floater plan, Max Bupa Heartbeat Family Floater and Star Health Wedding Gift Pregnancy cover that take care of medical expenses related to maternity.

Yes, there are special plans that cover the medical expenses incurred in the treatment of dengue. These are called single disease specific plans. No pre medical checkups are required to invest in these plans and the premium paid for the policy remains the same, irrespective of your age.

As the name implies, a top up in health insurance is an additional cover on the health insurance policy, over and above the current available limit, at lower premiums.

A top-up plan has certain limitations which can be resolved by choosing a Super top up plan. One must buy a super top-up plan because while a top-up plan pays only if the threshold limit on a regular policy is exceeded in a single claim, a super top up plan covers the threshold in multiple cases. A Super Top-up policy provides for multiple claims in a year.

Room rent limit is a maximum per day room charges that an insured is eligible for in case of hospitalization. It is important as it affects the premium one pays for a health insurance policy.

Claim settlement ratio is the ratio of the total value of claims paid or settled based on the total premium collected in the year. Claim settlement ratio in health insurance is calculated as Total Claims Settled/ (Total Reported Claims + Outstanding Claims at Start of Year – Outstanding Claims at End of Year)

Waiting period in health insurance is the duration of time specified that must pass before your coverage can begin. Claims cannot be admitted during this waiting period.

You can cancel your health insurance policy by reaching out to your health insurance provider by calling their customer care number. You must have your policy number and identity proof ready. Simply follow the procedure suggested by the health insurance provider and you would be able to cancel your policy seamlessly.

Portability in health insurance is defined by the transfer of an existing health insurance policy from one insurer to another. The steps to port it are-

• Apply for portability within 45 days of the current policy expiring
• Fill up the forms for porting policies with all relevant documents ready for inspection
• Once the new insurer checks the details which enables portability within 7 days
• The insurer then feeds all required information while porting health insurance policies, to the IRDAI portal
• The insurer will then frame a proposal according to their underwriting norms
• The application is processed and you will be provided with their proposal within 15 days. In case that does not happen, the new insurer is obliged to accept your request for porting the policy.

A co-payment or co-pay is a fixed amount that a person pays from his/her own pocket towards the claim raised against the Health Insurance plan. For example, if a health plan has 10% co-pay and the total bill is Rs. 1 lakh, then you will have to pay Rs. 10,000 and the insurer will pay the remaining Rs. 90,000

A No Claim bonus (NCB) is a discount in premium offered by the health insurance provider or an increase in the sum insured in case a claim is not made within one policy year.

You can avail NCB in health insurance either as a cumulative bonus, or at the time of renewal or transferring of the health insurance policy.

Network Hospital means the number of hospitals associated with the insurer that will provide in-patient treatment care and day care treatment of illnesses and injuries on a cashless basis.

A cashless health insurance policy is a type of insurance where the insured can be hospitalized, avail the relevant treatment and be discharged without having to pay anything from their pockets.

While the two terms can seem similar health insurance and mediclaim are distinctively different from each other. Hospitalization is a mandate for mediclaim, whereas health insurance is a lot more comprehensive. Also, the upper cap on mediclaim is up to Rs. 5 lakhs, whereas no such limit is set for health insurance and hence, claims can go up to Rs. 60 lakhs as well. Mediclaim allows the insured to make ‘n’ number of claims whereas specific health insurance plans pay the entire amount in one go.

A health insurance plan is more comprehensive and general in nature as compared to a critical illness plan. Health insurance covers a variety illnesses and injuries, whereas critical illness plans only covers defined critical illnesses such as cancer, heart attack, etc.

Yes Critical illness is covered in health insurance. A number of insurers provide specific health insurance plans that cater to the needs of a critical illness.

While certain adult incontinence products are covered in health insurance, policies in India do not support the cost of diapers for adults.

Pre-existing diseases are these ailments that the insured already suffered from at the time of investing in a health insurance policy. These diseases are covered in the health insurance policy after a stipulated waiting period.

Some top features of a good health insurance plans are

a. The plan is designed according to the needs of the individual

b. The policy is cost effective

c. The facility of a lifelong renewal

d. The facility of cashless hospitalization

e. Seamless and hassle-free claim procedure

f. Good network of hospitals

g. Good reviews of the insurer by insurance web aggregators

When choosing health insurance for parents, one must keep in mind their age, current medical conditions and any pre-existing diseases that they might suffer from. Also, one must factor in the cover offered by the insurance provider as medical treatments in old age are comparatively expensive.

To save money on health insurance, one must compare and select the health insurance plan that does not burn a hole in your pocket. Also, invest in policy directly through an insurance provider, to reduce the cost of an agent involved. Moreover, according to government schemes, one must inquire if they are eligible for any schemes.

To increase the health insurance plan cover, one can invest in a top-up or super top-up plan and increase the sum insured before the expiration of the policy.

If your illness or injury is covered under the health insurance policy, the insured gets the benefits stated in the terms and conditions of the policy. However, in case of death of the insured, the nominee gets the benefits of the health insurance policy.

Health Insurance and Mediclaim are terms that are often used interchangeably. However, both terms are not the same with a major difference being that Mediclaim is limited only to the hospitalization expenses, whereas health insurance is more encompassing and covers pre and post hospitalization expenses among other items.

Consider the following when selecting health insurance

• Sum Insured.

• Minimum Waiting Period for Pre-existing Illness.

• Max Age-renewal.

• High Claim-settlement Ratio.

• Plans with NO Sub-limits and deductibles.

• Premium affordability

India’s per capita expenditure on health stands at INR3500.

The waiting period concept in a health insurance policy is the period of time that needs to pass, lest some or most of your health care coverage starts. During this period, a claim is not considered admissible. This period varies from insurer to insurer and disease to disease. The general waiting period ranges from 2 to 4 years.

The factors that you must consider before zeroing in on the best health insurance are

• Claim Process

• Waiting Period

• Family Health Insurance

• Selecting the right insurance amount

• Network hospitals

• Maternity benefits

• Pre/post hospitalization

• Cumulative bonus

• Lifetime Renewal

• Free Medical Check-up

This is the amount one pays for health care service before his/her health insurance gets applicable. For instance, when your plan's deductible is INR 75,000, you pay 100 percent of eligible health care expense, until the bill becomes INR 75,000. Post this, you get cost by paying co-insurance.

There is no ideal age for getting health insurance. The earlier you start, the better. The premium is dependent on the age and the older you are, the higher you pay. However, the ideal age varies between 18 and 25 years.

The cost of health insurance is based on the sum insured chosen and age of the insured person. Hence, it is difficult to arrive at a generic number, as each person and his needs are different from the other person. However, monthly health insurance premium can be as low as Rs. 100 to 300 for an average person.

• Cashless: The insurance company issues an identity card to the insured and on showing this card on the networked hospital, he/ she can avail cashless system. This means the holder of insurance does not owe anything to the hospital. Here, the insurer has a tie up with most hospitals to facilitate cashless facility.

• Hospitalization cash pros: Every day hospitalization expenses are covered to reduce the financial burden of the insurance holder. This helps the insured, since this amount compensates for the loss in earnings and other cost.

• Before and after hospitalization charges: Usually, pre and post hospitalization expenses are covered up to 60 to 90 days and some insurance company even approve up to 140 days.

• Ambulance costs: These are covered by various insurance companies, and hence, the policyholder does not have to worry about these.

• Health Tests: In case there is no claim for certain number of years, some companies even provide free health check up to the insured.

• Pre-existing diseases: Usually pre-existing diseases are not covered under health insurance policy; however, diabetes is covered, if the insured renews the Policy for 3 or 4 consecutive years.

Salaried employees often enjoy benefit of the employer-provided health cover. This group cover is often provided at zero cost to the employees. Yet, it is always advisable to maintain your own independent health cover.

Most often, health insurance wait duration is 30 days for every policy except for accidents. There is 3 months wait duration for infants or new born babies. Some insurance carriers offer maternity benefits, yet with a waiting period ranging from 9 to 36 months. Pre-existing diseases have a waiting period ranging between 2 to 4 years.

The various types of health insurance plans are

• Individual Health / Mediclaim Insurance Plans

• Family Floater Health / Mediclaim Insurance Plans

• Group Health / Mediclaim Insurance Plans

• Critical Illness/Disease Specific Health Insurance Plans

• Senior Citizen Health Insurance Plans

• Convalescence Benefit: Also known as recuperating or recovery benefit, insurers take care of the insured’s recovery expenses under this head.

• Alternate Treatment: In recent times, the fad of alternative treatment has risen manifold. This has prompted many insurance companies to cover alternative treatments, such as Ayurveda, homeopathy and yoga.

• Expense Related to Organ Donation: The cost of kidney transplant could range between INR 3 lakhs and INR 5 lakhs. Having a health insurance in place ensures that you will not have to worry about your and your donor’s medical expenses before undergoing an organ transplant surgery.

• Domiciliary Treatment: Many insurers have expanded their insurance cover to include treatment taken at home under medical supervision.

• Attendant Allowance: Insurance companies offer attendant allowance to adults accompanying the insured at a hospital, provided the insured is a child.

Yes. Mostly, health care and health insurance is referred to as the same thing.

As a one-stop platform to check all available health insurance plans, the internet offers quick, hassle free and convenient option to buy the best health insurance plan at a mouse click. Unlike earlier days, today’s life is fast paced and many of us don’t bother to buy a health plan due to daunting and tedious paper work. All you have to do visit the insurer or online broker website, provide a few details about the members being insured, select the coverage amount, fill-up the proposal form and pay the premium. Your Health Insurance plan will reach you at the earliest possible.

DOs and DONTs

• Do tell the insurance companies about your pre-existing disease

• Do get a voluntary health check-up done

• Do not hide your pre-existing

• Do not buy a policy without comparison

To make sure that your health insurance gives you adequate cover, do not hide any ailment and clearly declare them before buying the policy. This ensures that you go through a systemic settlement process for all future claims.

Yes, health insurance premiums are eligible for tax deductions up to Rs. 1 lakh under Section 80 D of the Income Tax Act, 1961.

While personal accident insurance is a type of liability insurance plan, there are certain parameters that distinguish the two. They are-

• Medical expenses- Health insurance plans cover medical expenses arising from injury, illness and other medical conditions. Whereas, medical expenses are not covered under a personal accident cover, not even the expenses arising from accidents.

• Pre and Post Hospitalization- A health insurance policy covers pre and post hospitalization charges for a specific number of days, whereas there is no such benefit available for personal accidents

• Death coverage- A personal accident policy covers accidental death and the beneficiary receives 100% benefit. However, not all health insurance plans provide death coverage.

• Disabilities coverage- A personal accident policy provides coverage against disabilities cause due to accidents whereas, not all health insurance policies cover disabilities.

According to IRDAI regulations, a health insurance policyholder can transfer an existing health insurance policy to a new provider. Also, the new policy can be customized to take care of the insured’s medical needs. The following steps are involved in the process-

• One must apply for portability within 45 days of the current policy expiring
• Fill up the forms for porting policies and keep all relevant documents ready for inspection
• The new insurer checks the details which enable portability within 7 days
• The insurer feeds all required information while porting health insurance policies, to the IRDAI portal
• The new insurer then frames a proposal according to their underwriting norms
• The insurer then processes the application and provides you with their proposal within 15 days. In case that does not happen, they are obliged to accept your request for porting the policy.

In order to claim your cashless claim policy, you must submit your policy card to the hospital and fill out relevant details in a pre-hospitalization form. Once the form is submitted, the insurance personal of the hospital scrutinizes the form for authenticity. Note that this facility will only cover illnesses and injuries that are stated in your insurance policy.

People suffering from Hypertension or Blood pressure usually invest in a cardiac health insurance plan as risks associated with both these conditions are the similar. Based on a medical examination, the patient is classified and accordingly the cost involved in the health insurance plan is calculated.

Subsidized health insurance is benefit provided where the premium is at a subsidy or zero cost, for individuals whose incomes are less than a basic level. For instance, schemes like Rashtiya Swasthiya Bima Yojana, Aam Aadmi Bima Yojana, Employment State Insurance Scheme (ESIS), and Central Government Health Scheme (CGHS) etc. are available in India.

A health insurance covers various health costs and offers various other benefits. A health insurance protects beneficiaries from various unexpected medical expenses. When you have a health plan or a mediclaim policy or any other valid health coverage, you won’t have to pay the medical bills from your own pocket.

In India, a health insurance is something that pays for hospitalizations, medical expenses incurred for an in-patient, sometimes out-patient and for the treatment through alternative modes like Ayurveda, etc. The first health policies in India were Mediclaim Policies.