Ajay raj
Good info
Nice info.......
18 Feb
- Insurance
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The thing about medical emergencies is that they can hit anyone, anytime regardless of age, gender or lifestyle. Since it can't be predicted, one can always be prepared for it. Health Insurance protects everyone in your family against financial loss from the unexpected.It's an agreement between you and your insurance company, where for an annual premium, the insurer pays for your hospitalization and other medical expenses as mentioned in your policy.
This provides for the hospitalization expenses you might face in case of accidents, day-care procedures, surgical treatments or critical illnesses. However, the features, limits and sum assured will vary from insurer to insurer.
Similar to top-ups for mobile network services, this adds supplementary coverage to your existing health plan. The aim is to increase overall sum assured with its corresponding coverage by paying a relatively lower premium.
Health insurance is a type of insurance that fully or partially covers an individual's medical and surgical expenses. It's an agreement between you and your insurance company, where for an annual premium, the insurer pays for your hospitalization and other medical expenses as mentioned in your policy.
If you are admitted for treatment in a network or a non-network hospital for more than 24 hours.
Medical expenses including diagnostic reports, medicines etc. for the treatment you are hospitalized.
OPD treatments are not included, but procedures such as cataract and kidney stone removal are covered (even if they don't need 24-hour hospitalization).
For medical and other out-of-pocket costs in case of an accidental injury. In fact, this cover is active from the very first day of policy issuance.
Health insurance companies offer a wide range of policies, tailor-made to suit the unique health requirements of their customers. Hence, varied plans include different features related to medical treatments, surgeries, etc. Here are some of the salient features of health insurance policies:
✚ Pre-hospitalization expenditures: Coverage extends to medical expenses incurred between 30 to 60 days before hospitalization is covered like medical diagnostic tests, medication, etc.Hospitalization expenditures: Includes expenses incurred during hospitalization for a minimum period of 24 hours. Expenses generally covered are hospital room rent charges, operation theatre charges, ICU charges, doctors’ consultation fee, surgery charges, and other important expenses like blood, anaesthesia, oxygen, etc.
✚ Post-hospitalization expenditures: Expenditures incurred between 60 days and 180 days after hospitalization is generally covered by most insurance companies. These charges include follow-up doctors’ consultation fees, medical diagnostic tests, medication, etc.
✚ Domiciliary Hospitalization: Medical expenses incurred due to treatments undertaken at home for a period of more than 3 days.
✚ Day Care Procedures: Day care procedures or medical treatments like dialysis, angiography, radiotherapy, chemotherapy, appendectomy, colonoscopy, lithotripsy, hydrocele, eye surgery, amongst others. Certain high-end health insurance plans cover all day care procedures.
✚ Expenses for Organ Donation: Some health insurance companies cover medical expenses incurred in the process of organ donation. If you are being donated an organ, your donor will be financially secured by your health insurance plan.
✚ Critical Illnesses: Some critical illnesses that are usually covered by health insurance companies are cancer, heart attack, coronary artery disease, stroke, paralysis, major organ transplant, chronic lung disease, Parkinson’s, etc.
✚ AYUSH Treatment: Alternative medical treatments or AYUSH, which stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy are covered for those policyholders who have opted for it.
✚ Hospital Cash: Daily expenditures for food, hospital stay, etc. that are incurred by your caretaker during your hospitalization may be offered on health insurance plans or may be available as a rider. Health insurance plans also offer compensation for the loss of income due to health issues.
✚ Ambulance Cover: Health insurance policies cover expenses for ambulance service.
✚ Check-ups: General health check-ups as a preventive measure are covered by some health insurance plans.
✚ Vaccinations: Certain health insurance plans cover vaccination costs for bee stings, dog bites, etc.
✚ Emergency Evacuation: Under emergency situations when a patient needs to be transferred from one hospital to another, health insurance plans cover expenses involved in the relocation process.
✚ Secure Health and Finances: Majority of the health-related expenditures in the country are borne out-of-pocket. A lot of people rely heavily on their savings, and sometimes even borrow money, to fund medical treatment. Health insurance products are designed to ensure that one's savings does not dwindle since the insurance company will bear this cost. With health insurance, one can benefit from quick cashless treatment, medical reimbursement, emergency ambulance cover and daily cash during hospital stay.
✚ Cashless Treatment: Most health insurance companies offer cashless claim facility. Under such an arrangement, the insured individual does not have to make any out-of-pocket payments in case of hospitalization. The medical bills will be settled by the insurance company directly with the hospital. In order to avail of this benefit, it is necessary that the individual get admitted at one of the insurer’s network hospitals.
✚ Tax Benefits: The premium paid towards a health insurance policy qualifies for tax deduction under Section 80D of the Income Tax Act, 1961. A taxpayer (less than 60 years of age), who has availed a health insurance policy for himself or herself and parents (senior citizens) can claim a tax deduction up to Rs. 75,000. Policyholders (above 60 years) who are paying health insurance premium for self and parents can claim up to Rs. 1,00,000 under Section 80D of the Income Tax Act, 1961.
✚ OPD Expense Coverage: Cover for outpatient department (OPD) is a recent feature offered as part of health insurance policies by some insurance companies. Health insurance plans with OPD coverage will take care of doctor’s consultation fees, pharmacy bills, health check-ups, dental treatment, diagnostic tests, etc. The extra premium paid for availing the OPD cover is eligible for tax deduction under Section 80D of the Income Tax Act under the prescribed limit.
✚ Alternate Treatment Coverage: A health insurance policy will cover expenses related to medical treatments in hospitals. However, sometimes there are situations where alternate treatment, such as Ayurveda, homeopathy, etc. may seem more relevant for treating certain ailments or diseases. Some of the best health insurance policies in the market provide coverage for such treatments. This gives the insured more flexibility with regards to the kind of medical treatment the individual would like to undergo.
✚ Health Insurance Portability: Health insurance policies are portable, which means the policyholder can change their policy from one insurance company to another. In the past, when a policyholder opted for this option, it resulted in them losing certain benefits, such as the waiting period for covering pre-existing ailments. However, now the insurance regulator protects the policyholder by giving the individual the right to port his or her health insurance policy to another insurer, keeping the benefits intact. The regulator has stated that the new insurer “shall allow for credit gained by the insured for pre-existing condition(s) in terms of waiting period”.
✚ Lump sum pay out: The insurer pays the insured a fixed and guaranteed sum insured amount in lump sum irrelevant of the actual expenses incurred for getting the critical illness treated. It solely depends on the insured how to utilize the sum insured.
✚ Zero sub-limits: Unlike an indemnity health insurance plan, the fixed benefit health insurance plans don’t have any sub-limits on mandatory co-payment, room rent capping etc. So, the insured has the leverage to manage the funds as per his requirement.
✚ Pocket-friendly plan: Fixed benefit health insurance plans are pocket-friendly premium wise. You do not have to shell out a huge amount in terms of the annual premium. The competitive pricing makes these plans the most essential plans to buy that cover critical illnesses.
This is applicable both when the policyholder moves from one insurer to another and also from one plan to another with the same company.
An essential point to be noted in case of health insurance portability is that 45 days before renewal, the policyholder needs to i) write to the old insurer requesting a shift, ii) mention the company to which the shift is being made and iii) renew the policy without a break (a 30-day grace period is applicable if porting is under process).
In recent years, advancements in medical technology has made it possible to cure ailments and diseases that were once considered incurable. However, the costs associated with them is quite high, making it difficult for middle class families to afford them.
According to various studies, medical inflation is expected to rise in the coming years which in turn would mean health care costs will also see an increase. In order to provide a solution to this, insurance companies have designed different kinds of health insurance plans, available at affordable premium rates. This makes availing healthcare facilities accessible and affordable for all.
Below are some factors that make the purchase of an effective health insurance policy essential for everyone:
While investing in heath insurance is a good idea, it usually is a cumbersome process. The traditional method of buying health insurance was to contact an agent, decipher those complex clauses and not really understand the true meaning of most of them. Also the entire process was time consuming and would involve a lot of paperwork. But with online methods of getting your health insured, one need not worry about any of this. Hence, buying insurance online has become a preferred method of protecting one’s health for millennials. Benefits of buying health insurance online are:
| NAME OF HEALTH INSURANCE COMPANY | BEST HEALTH INSURANCE PLANS | INCURRED CLAIM RATIO (2017 - 2018) | NETWORK HOSPITALS |
|---|---|---|---|
| HDFC ERGO Health Insurance (previously Apollo Munich Health Insurance) | 62.47% | 10000+ | |
| Bajaj Allianz Health Insurance | 77.61% | 5700+ | |
| Aditya Birla Health Insurance | 89.05% | 5700+ | |
| Star Health Insurance | 60.51% | 6000+ | |
| National Health Insurance | 115.55% | 6000+ | |
| ManipalCigna Health Insurance | 46.29% | 4000+ | |
| New India Health Insurance | 97% | 1200+ | |
| ICICI Lombard Health Insurance | 68.26% | 5025+ | |
| Religare Health Insurance | 51.97% | 4500+ | |
| United India Health Insurance | 110.95% | 7000+ | |
| HDFC ERGO Health Insurance | 52.58% | 10000+ | |
| SBI Health Insurance | 52.93% | 24000+ | |
| LIC Health Insurance | 98.33% | NA | |
| Reliance Health insurance | 106.54% | 4000+ | |
| Raheja QBE Health Insurance | 18.19% | 2000+ | |
| Oriental Health Insurance | 113.86% | 4300+ | |
| TATA AIG Health Insurance | 60.68% | 3000+ | |
| Cholamandalam Health Insurance | 39.96% | 2600+ | |
| IFFCO TOKIO Health Insurance | 90.69% | 3000+ | |
| Royal Sundaram Health Insurance | 61.41% | 3000+ | |
| Bharti AXA Health Insurance | 98.50% | 4500+ | |
| Max Bupa Health Insurance | 50.19% | 3500+ |
Health Insurance in India can be broadly classified into the following types:
★ Family Floater plans: cover the entire family in one health insurance plan. It works under the assumption that not all members of a family will suffer from illness at one time. These plans cover hospital-related expenses which can be pre and post hospitalization. Most health insurance companies in India offering family insurance have a wide network of hospitals that help the insured people in times of an emergency.
★ Senior Citizen Health Insurance Plans: As the name suggests, senior citizen health insurance plans are for the older people of the family. These plans cover health issues arising during old age. As per IRDAI guidelines, each insurer must provide cover up to age of 65 years.
★ Maternity Insurance Plans: Maternity health insurance plans provide coverage for maternity and other additional expenses. These policies take care of both pre and post-natal care, and delivery of baby i.e. normal or caesarean deliveries. Just like other health insurance plans, the maternity insurance providers usually have a wide range of network hospitals and also takes care of ambulance expenses. As you progress and you reach 60 years of age, your body needs special attention. Hence, it is only wise to invest in a health insurance plan that takes care of your specific needs. Various insurance providers have customized plans that are designed for senior citizens and cater to the needs of older people of the society. Some of the best health insurance plans are provided by Star Health Insurance, Bajaj Allianz, Max Bupa, HDFC Ergo Health Insurance (Apollo Munich), ICICI Lombard and Religare Health Insurance,
★ Hospital Daily Cash Benefit Plans: Hospital Daily cash benefits is a defined benefit policy that provides a certain sum of money for every day of hospitalization.
★ Critical Illness Plans: These plans are benefit-based policies, where a lump sum benefit amount is paid on diagnosis of covered critical illness. These diseases are usually specific, with high severity and low frequency in nature. Hence, the treatment cost is high when compared to day to day medical / treatment need. Some of these illnesses include heart attack, cancer, stroke etc. Women are subjected to a number of health hazards and medical conditions that the other gender does not have to suffer from. This is basically because of the difference in their biological make and the fact that there are several risks associated with pregnancy, childbirth and menstruation. Many insurance providers understand a woman’s plight and have introduced various health insurance plans that combat critical illnesses associated with the fairer sex of the society. Critical illness plan which covers a number of medical conditions such as breast cancer, cervical cancer, burns, paralysis, fallopian tube cancer, uterine or endometrial cancer, vaginal cancer and ovarian cancer.
★ Health Insurance For Parents: As a child, your parents always invested in raising you well and giving you the best. Hence, now it is important that their needs are catered to so that they stay in the pink of their health in their later years. Therefore, various insurance providers have rolled out special health insurance plans that cater to the medical needs of your parents. These plans cover pre and post hospitalization charges, ambulance charges and a few of them are also inclusive of pre-existing diseases.
| Top Health Insurance Plans | Sum Insured Range | Entry Age | Coverage | Policy Periods |
|---|---|---|---|---|
| Star Senior Citizen Red Carpet Plan | 1 Lakh to 10 Lakh | Adults: 60 years to 75 years | 1, 2 years | |
| Religare Joy Plan | 3 Lakh to 5 lakh | For children : 1 day - 90 days, Adults: 18 years to 65 years | 3 years | |
| Star Family Health Optima Plan | 2/3/4/5/10/15 lakhs | For children : 16 days old, Adults: 18 years to 65 years | 1 year | |
| Religare Care Plan | 2/3/4/5/7/10/15/20/25/50/60 Lakh | 18 Years to No Limit | 1, 2 & 3 years | |
| Oriental Happy Family Floater Mediclaim Plan | Up to Rs.10 Lakhs | For children : 91 days, Adults: 18 years to 65 years | 1 year | |
| Star Comprehensive Insurance Policy | 5/7.5/10/15/20/25 Lakhs | For children : 16 days old, Adults: 18 years to 65 years | 1 year | |
| Aditya Birla Activ Assure Diamond Plan | Up to Rs.50 Lakhs | 5 years to 65 years | 2 to 3 year | |
| SBI Arogya Premier Policy | INR 10,00,000 up to INR 30,00,000 | For children : 91 days, Adults: 18 years to 65 years | 1, 2 & 3 years | |
| SBI General Arogya Plus Policy | Rs. 1,00,000, Rs. 2,00,000 and Rs. 3,00,000 | For children : 91 days, Adults: 18 years to 65 years | 1, 2 & 3 years | |
| Bajaj Allianz Health Guard Family Floater Plan | 2 Lakh - 10 Lakh | For children : 91 days, Adults: 18 years to 65 years | 1 year | |
| Oriental Bank Mediclaim Policy | 1 Lakh - 10 Lakh | 3 months to 79 years | 1 year | |
| National Insurance Parivar Mediclaim | 2 Lakh to 5 lakh | 18 years to 65 years | 1 year |
Health Insurance Schemes by Government of India and Various States
Pradhan Matri Suraksha Bima Yojana – This government-backed scheme extends its benefits to economically underprivileged sections of the Indian society, financially securing them with a sum assured of up to Rs. 2 lakhs. This scheme is designed to financially protect individuals and families against death, and partial and total disability.
Ayushman Bharat by Government of India / Pradhan Mantri Jan Arogya Abhiyaan – Launched by the Government of India, Ayushman Bharat is an ambitious scheme aimed at offering health insurance benefits of up to Rs. 5 lakhs to 50 crore people who belong to underprivileged families throughout India. Covering even pre-existing diseases, the health insurance benefits can be availed at government as well as private hospitals.
Rashtriya Swasthya Bima Yojana – This scheme is especially designed by the Government of India for financially protecting unorganized workers from health concerns arising from disability, maternity, old age, etc. this scheme has been launched by the Ministry of Labour and Employment under the Central Government, backed by the Unorganized Workers Social Security Act (2008). Universal Health Insurance Scheme – An initiative of the Government of India that was introduced in 2003, serves the objective of providing quality healthcare to Indian families below as well as above the poverty line, especially BPL families.
Bhamashah Swasthya Bima Yojana by Government of Rajasthan – Initiated by the Government of Rajasthan, it was introduced to offer IPD patients the benefit of cashless medical treatment. It serves the objective of ensuring financial protection for the treatment of illnesses. It also helps in creating a health database, streamlining processes for any changes in data that may be required in the future. Families covered under the National Food Security Act, and Rashtriya Swasthya Bima Yojana are eligible for this scheme.
Yeshasvini Health Insurance Scheme by Government of Karnataka – Introduced by the former chief minister of Karnataka in the year 2013, the scheme is aimed at ensuring inexpensive medical treatments to farmers throughout the state. It is specifically tailor-made for farmers of the cooperative society and belonging to the lower middle income and middle income groups. It financially covers them against illnesses like orthopaedic surgeries, paediatric surgeries, neurosurgery, surgical oncology, angioplasty, neurosurgery, neonatal intensive care, among others.
Mukhyamantri Amrutum Yojana by Government of Gujarat – Initiated by the Government of Gujarat, this health coverage scheme offers financial benefits on medical treatments, surgeries and hospitalization. Financed entirely by the government, this can be availed by all families with an annual income of less than Rs.1.5 lakh. This scheme offers a cover of Rs.2 lakh per family of 5 members. West Bengal Cashless Medical Treatment Scheme – Launched in 2014 by the Government of West Bengal, as evident from the name, it is aimed at offering cashless medical benefits of a maximum of Rs. 1 lakh to employees as well as pensioners of the state government. These benefits can be availed by all their family members and at all network hospitals under this scheme.
Mahatma Jyotiba Phule Jan Arogya Yojana – This scheme, renamed from Rajiv Gandhi Jeevandayee Arogya Yojana scheme in 2017 by the Government of Maharashtra, is an effort to extend free and quality healthcare services to inhabitants of below poverty line in the state. It plans to introduce the scheme to underprivileged section of the society, that is, those who are holders of a Yellow or Orange Ration Card.
Chief Minister’s Comprehensive Health Insurance Scheme – Introduced by the Government of Tamil Nadu, it is specifically customized to offer the benefits of comprehensive health insurance to economically underprivileged sections of the society. Offered in collaboration with United India Insurance Company Ltd., one of the pioneers in health insurance in India, this scheme reaches out to more than 1 crore households in the state. It offers medical treatments, follow-up check-ups, and cashless benefits at public and private sector hospitals.
Rajiv Aarogyasri by Government of Andhra Pradesh – Tailor-made for inhabitants of the state who are below the poverty line, it offers claims of up to Rs. 1.5 lakh on individual and family health insurance plans available on a family floater basis. An additional amount of up to Rs. 50,000 can be availed in case the medical treatments and surgeries exceed Rs. 1.5 lakh. It offers the special benefit of offering coverage on pre-existing diseases as well, a feature that health insurance plans usually do not cover.
Biju Swasthya Kalyan Yojana by Government of Odisha – This scheme has been introduced by the Government of Odisha and named after a former Chief Minister of the state, Shri Biju Patnaik. It covers medical treatments worth up to Rs. 5 lakh per family and Rs. 7 lakh for women. It is aimed at 70 lakh families.
Difference Between Health Insurance and Critical Illness Insurance
| Health Insurance | Critical Illness Insurance |
|---|---|
| Health insurance is a base policy that provides insurance coverage against medical expenses incurred by the policyholder during the policy period. | Critical illness insurance is a defined benefit policy where the insurer pays out a lump sum benefit if and when the insured individual is diagnosed with a pre-specified critical ailment. |
| A health insurance policy remains active even when a claim has been made, until the sum insured limit is exhausted. | Once the lump sum benefit is paid, the policy ends |
| There is generally an initial waiting period of 1 month for illnesses and 1-3 years for pre-existing ailments. | There is generally an initial waiting period of 3 months. |
Difference Between Health Insurance and Term Insurance
| Health Insurance | Term Insurance |
|---|---|
| Health insurance provides medical cover against hospitalization and surgical expenses during the policy period. | Term insurance is a pure risk life insurance product that pays out the sum assured upon the demise of the life insured. |
| The sum insured can only be used to cover medical expenses. | The sum assured can be used in any manner the nominee wants - to cover expenses related to children’s education, wedding, etc. |
| Tax deduction can be claimed on premiums paid under Section 80D of the Income Tax Act, 1961. | Tax deduction can be claimed on premiums paid under Section 80C of the Income Tax Act, 1961. |
Difference Between Health Insurance and Mediclaim Policy
| Health Insurance | Health Insurance |
|---|---|
| Health insurance provides a comprehensive health cover. Besides covering hospitalization expenses, it reimburses pre and post-hospitalization expenses, ambulance fees and pharmacy bills. | Mediclaim policy covers only expenses related to hospitalisation and treatments. |
| Health insurance provides a comprehensive health cover. Besides covering hospitalization expenses, it reimburses pre and post-hospitalization expenses, ambulance fees and pharmacy bills. | Mediclaim policy covers only expenses related to hospitalisation and treatments. |
Difference Between Individual Health Insurance and Family Health Insurance
| Individual Health Insurance | Family Health Insurance |
|---|---|
| Individual health insurance, as its name would suggest, covers a single person. | Family health insurance, also referred to family floater policy, covers the whole family under a single policy. |
| Individual health insurance, as its name would suggest, covers a single person. | The sum insured under a family floater policy is shared by all the covered family members. When one member files a claim, the cover reduces for the others by that much. |
| Premiums of a family floater policy are determined by the age of the eldest member insured. |
Difference Between Government Health Insurance and Private Health Insurance
| Government Health Insurance Schemes | Private Health Insurance Plans |
|---|---|
| These schemes are initiated by the government mainly for the welfare of low-income groups. | They are offered by private companies, with varying sum insured and premiums to suit different client needs. |
| Government schemes are normally offered for free. | Insurance premiums are determined on the basis of a number of factors, like age of the policyholder, sum insured, etc. |
Health Insurance Claim Process
Health Insurance claims can be made in two ways- the cashless claim process and the reimbursement claim process.
Cashless claim process- In order to avail the benefits of a cashless claim policy, the insured has to be treated in one of the hospitals that falls under the network of hospitals that the insurance provider has an affiliation with. Upon presentation of the e-card, details of the health insurance policy or any other physical proof of insurance, the insured can avail the benefit of cashless treatment and hospitalization. This facility can be availed only if the injury or illness is covered in the health insurance policy. On discharge of the patient, the medical bills are sent to the insurance provider by the hospital. The company then evaluates the expenses and settles the payment.
Reimbursement claim process- Health insurance companies also reimburse up to the sum insured, the amount initially paid by the insured in times of illness or accidents. This usually happens in case the patient is hospitalized or gets treated from a hospital that does not fall under the insurer’s network of hospitals. The insured then has to initially pay the cost of treatment entirely from his own pocket and then submit the bills of treatment to the insurance provider for claim settlement. The company then evaluates the cost and then, according to the scope of the policy coverage, reimburses the amount up to the sum insured. In case the treatment is not covered in the policy, the claim is rejected. The following documents need to be submitted during the reimbursement claim process:
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Q. Who is Eligible for Medical Insurance?
Policyholder: The minimum entry age varies between 18 years and 21 years, depending on the insurance company. The maximum entry age varies between 60 years and 100 years, with the flexibility of renewal being extended to whole life.
Dependents: Spouse, children and parents are referred to as dependents of the policyholder. The entry age for children starts from 90 days till 18 years or 25 years, depending on insurers.
Renewability: Health insurance policies can generally be renewed for the entire life, but this again varies from one insurance company to the other. After a certain age, medical tests maybe recommended and companies may ask for higher premium rates.</p>
Q. What are overseas health insurance policies?
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.
Q. Are children covered in health insurance plans?
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.
Q. What is co-pay?
Co-pay is a clause in the health insurance policy that underlines that the insured will have to share the claim burden and co-pay a pre-determined amount.
Q. Is maternity covered under health insurance plans?
Yes, maternity is covered under health insurance plans. In fact there are special health insurance plans by many insurers that take care of medical expenses related to maternity.
Q. What is top-up in health insurance?
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.
Q. Can Health Insurance Policies Be Ported?
Yes, health insurance plans can be ported to another insurer.
Q. Which Type of Health Insurance Policy in India will be the Best-fit for you?
There are many types of health insurance policies in India that offer you the best of coverages and features. If you are a single individual, it is best to opt for an individual health insurance plan in India. But, if you wish to cover all the family members, it is better you opt for a family floater health insurance plan since the sum insured would be higher and that too at a lower premium.
If you wish to cover your senior citizen parents in India, it is best you opt for a senior citizen health insurance plan for your parents and a family floater for the other members of the family.
Q. What is a health insurance (Medical Insurance) in India?
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.
Q. Is health care and Health insurance the same thing?
Yes. Mostly, health care and health insurance is referred to as the same thing.
Q. What are some of the important exclusions under a mediclaim policy?
There are four important types of exclusions in a Mediclaim policy. These are:
Q. Without compromising on the renewal benefits, can the existing health insurance Plan be transferred to another insurer?
Yes. In simple terms, the process of transferring the prevailing health insurance plan from existing insurer to a new insurer is termed as portability. According to the circular issued by The Insurance Regulatory and Development Authority (IRDA), from 1st October, 2011, the insurance companies are directed to permit portability from one insurance company to another and from one plan to another, without the insured having to lose the renewal benefits for pre-existing illnesses, enjoyed in the preceding policy. The entire process for the portability has to be kick started at least 45 days prior to the actual renewal date. For the terms and conditions related to the subject, it is best to refer the policy documents.
Q. What is the average health insurance cost?
Health insurance premiums are determined after taking into consideration factors like age, family medical history, pre-existing medical conditions, Body Mass Index and smoking habits, among others. Additionally, the type of coverage, sum insured and members covered under a policy have an impact of the premiums payable. The annual premium for a 35-year old male (non-smoker) for a Rs. 20-lakh health cover can go anywhere from Rs. 11,000 to Rs. 17,000. The premiums payable for a 45-year old male (non-smoker) for a similar health cover can be around Rs. 14,000 to Rs. 25,000. Individuals are advised to use the health insurance premium calculators available online to get an estimate of the premiums they will need to pay for a health plan.
Q. What are fixed benefit health insurance plans?
To encounter such financial hardships to treat critical illnesses, it is essential to introduce something called as ‘fixed benefit health insurance plans’. These plans take care of two major expenses such as hospital room charges as well as the entire cost of the surgery. But, remember these plans do not pay the expenses that include pathology, radiology and medical consultation.
Q. How does it work benefits of health insurance plans?
An amount equal to the sum insured is paid off by the insurance company to the insured in case he suffers from an illness which forms a part of the policy wordings. This amount however is fixed and guaranteed. Here, a lump sum amount is offered irrespective of the actual expenses to the policy holder in case of a claim. In short, fixed benefit health insurance plans don’t include ‘indemnity’. The pre-existing ailments are covered only after the waiting clause comes to an end.
The survival period clause mentions that it is necessary for the policyholder to survive for certain period post diagnosis of the critical illness to make a legitimate claim.
Standalone Heart/ Cancer Insurance Plans, Critical Illness Insurance Plans etc. are few products that form a part of the fixed benefit health insurance plan.
Q. Should you Opt for Fixed Benefit Health Insurance Plans?
With the change in lifestyle and environment and many other hereditary factors, there has been a drastic rise in people falling prey to critical illnesses. Though medical technology and science has improved tremendously, the cost of medical treatments too has reached sky high! So much so, that a middle class sole earner finds it difficult to save his hard-earned money during medical emergencies in absence of a health insurance policy. Unfortunately, opting for personal loans from banks and at times from friends and relatives has created much distress among many families.
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