Health Insurance

A Health Insurance policy is not a financial priority anymore; it has become a necessity in today’s age due to the continuous rise in healthcare risks and price inflation. Any unplanned hospitalization would lead to numerous expenses such as medical treatment or surgery costs, diagnostics test charges, pharmacy, doctor’s visits, room rents, ambulance transportation charges etc. These costs can easily cripple a family’s financial health in a flash. But with the right health insurance cover, you can protect yourself and your family from these medical expenses without causing many dents in your savings. Do not let the massive costs of treatment become a hindrance in seeking the right care for a loved one. A health emergency will not knock on your door before entering your life. Especially with physical fitness featuring low on our priority list, diseases are becoming more common. Medical treatments, especially in a private hospitals can lead to inflated bills. And if you find yourself in such a situation, it can completely drain your savings if you don’t plan. A health insurance plan will offer you a cushion in times of medical emergencies. It provides you and your family with financial assistance that will cover your family’s urgent medical needs. Apart from this, when you buy a health insurance policy can also offer you tax benefits under Section 80D of the Income Tax Act. 1961. Get health insurance for your family now.

Following are some of the key coverages and benefits you get when you buy a health insurance policy:

1. Cost of hospitalization:All the hospitalization expenses incurred due to illness or accident injuries
2. Pre and post hospitalization expenses: Expenses incurred during a certain number of days before and after hospitalization as long as they are related to the illness/injury
3. Daycare procedures: Surgeries and treatments that do not require 24- hour hospitalisation, due to technological advancements, are also covered
4. Ambulance cover: Transportation of the patient to the hospital
5. Income Tax benefit: Save Rs 25,000 for self and family & additional 50,000 (if senior citizen parents included) under section 80(D) of Income Tax Act
6. Organ donor expense: Medical expenses of an organ donor during an organ transplant.
7. No Claim Bonus: A bonus is given to the insured during renewal in case no claims are filed in the previous policy year. The bonus can be in the form of an increase in the sum insured.
8. Cashless treatment: Can be availed when hospitalised in one of the network hospitals of the insurance company
9. Sum insured recharge: Sum insured gets replenished on exhaustion of entire health cover
10. Alternative treatments (AYUSH Benefit): Alternate therapies like Ayurveda, Unani, Siddha and Homeopathy get covered
11. Free health check-ups: Free health check-up facility is given to the insured members up to the pre-defined limit in the policy.
12. Domiciliary hospitalization (Health homecare): Treatments availed at home on doctor’s recommendation
13. Convalescence Benefit: Lumpsum amount is given to the insured person as a recovery benefit in case of a long duration of hospitalisation

It is important to realize that inclusions will vary from one provider to the next and from plan to plan.

Some of the exclusions under a health insurance policy are as follows:

1. Expenses due to pre-existing disease incurred during the waiting period
2. Expenses incurred during the waiting period for the disease/ailments having a mandatory waiting period
3. Cosmetic and Dental surgery expenses
4. Sexually transmitted diseases
5. Self-inflicted injuries, adventure sports, abuse of drugs and intoxicants
6. Injuries caused due to war

A detailed list of exclusions can be found in the policy wordings of the respective health insurance product.

Choosing the right health insurance plan is the most important step while purchasing a policy. Following are some of the factors that should be kept in mind while looking for health insurance:

1. Sum insured: Determining the right coverage is the first step when opting to buy health insurance. Individuals residing in metro cities may go for a higher sum insured. If looking for family health insurance plans, a sum insured above 10 lacs can be considered so as to cover multiple claims in a year from different members without exhaustion.
2. Sub-limits: Policies that do not have sub-limits on room rents i.e. no higher limit on the rent charges are always recommended.
3. Co-payment: Policies that have co-payment options have lesser annual premiums because the insured individual pays a fraction of the hospital expenses and the rest is borne by the insurance company. Though the premiums are discounted the co-payment amount could be a significant amount in case of high-value claims.
4. Waiting period: Some insurers have shorter waiting periods for pre-existing ailments. Specific covers like maternity benefits are covered after 3 years under policies of a few insurance companies. The shorter the waiting period, the better for the insured person.
5. Cashless hospital network: Insurance companies have tie-ups with hospitals across the country. One should always look for the insurer that has more hospitals under their cashless service.

There are numerous health insurance plans available in the market. Each plan has its own inclusions and exclusions list, benefits and features, cashless hospital network, sub-limits, waiting periods for certain illnesses etc. Hence it becomes imperative to compare these plans first and then choose the one which suits your requirements the most. PayBima helps you choose the right plan by showing a detailed comparison of all the health insurance policies available based on the data provided and hence assists you in making an informed choice.

You can compare and buy health insurance online in a few easy steps. Visit the PayBima website and select health insurance. Then you will be asked to enter a few basic details like age, sum insured amount, area of residence, number of members to be insured etc. Based on the details submitted, health insurance quotes from various health insurance companies will be displayed. You can select multiple plans and compare the benefits and coverages provided along with the premium.

Once you compare health insurance plans and decide on a particular policy that fulfils your requirements, you can select the plan and proceed to the proposal form stage. You have to provide accurate and correct information in the proposal form. After the form is filled, you can review all the details shared till now on the summary page. After reviewing, you can proceed to buy health insurance policy online and make the payment online through various modes like credit/debit cards, internet banking, wallets etc. Post successful payment, a health insurance policy will be generated and emailed to you instantly.

When it comes to buying Health Insurance Plans for Senior Citizens, you need to consider several things to choose the best plan. Below are some of the top health plans available for elderly in India:

• Star Health Red Carpet
• National Insurance Varistha Mediclaim
• Bajaj Allianz Silver Health:
• HDFC Ergo My Health Suraksha Plan
• Oriental Senior Citizens HOPE Insurance Plan
• IFFCO Tokio Individual Medishield Plan
• Kotak Health Care Plan
• New India Assurance Senior Citizen Mediclaim Policy

As per the regulations of the Insurance Regulatory Development Authority of India (IRDAI), any individual up to 65 years of age can procure health insurance. In case of comprehensive Health Insurance Plans for Senior Citizens, individuals between the age of 65 and 80 years can get insurance.

Below are the top health insurance companies in India on the basis of their claim settlement ratio as per FY 2019-2020:

• IFFCO Tokio General Insurance (96.33%)
• Care Health Insurance (95.47%)
• Magma HDI Health Insurance (95.17%)
• The Oriental Insurance Company (93.96%)
• New India General Insurance (92.68%)

Yes, health insurance renewal can be done. Normally a health insurance plan stays valid for one year, and it needs to be renewed upon expiry. If you miss to renew the policy and it expires, you still can renew it within the 30 days grace period offered by insurers. However, after the grace period it cannot be renewed.

Health Insurance Renewal of your lapsed health insurance policy can be done online/offline within the grace period that is allowed by your insurer. You can enjoy the continuity benefits in terms of waiting period and no claim bonus if you renew the policy during the grace period. This can be easily done online through the insurer's website and for offline renewal, you can visit the nearest branch of the insurer.

There are many factors that the Health insurance premium calculator takes into account to calculate the premium of a health insurance policy. The premium calculator considers factors such as age of insured, his/her income, city where the insured is residing, type of coverage etc. to calculate the premium of a policy.

The amount paid every month by the insured towards his/her health insurance every month is the monthly health insurance premium. It is calculated by using a Health insurance premium calculator that takes into account several factors like age, income and other information of the insured.

Below are the three top Coronavirus Health Insurance plans among many others

• Corona Kavach Policy for Covid-19
• Corona Rakshak Insurance Plan
• Coronavirus Group Health Insurance

Yes, but after a certain waiting period as specified in the policy wordings. The waiting period can range from 2 to 4 years depending on the underwriting policy of the insurer. Also, the insured member should declare his medical history accurately in order to claim any expense arising out of the treatment for such diseases, else the claim might get rejected.

• There is a 30-day waiting period that follows the inception of the policy when you buy health insurance online. Any disease, injury or sickness that arises in these 30 days are not covered by the policy.
• Any pre-existing diseases, which are conditions existing in a person before he purchases the policy, are not included in the policy cover.
• Other diseases that health insurance plans do not cover are HIV or AIDS, pregnancy or childbirth complications, aesthetic, cosmetic or obesity treatments, alcohol or substance intoxication, treatment for war, riots, strike, nuclear weapon injuries

You can compare various health insurance plans to know which covers your requirements.

No, there is a waiting period of 30 days from the day of the inception of the policy. Any treatment of illness undergone during this period is not covered in the policy except for injuries from accidents.

Before an individual is hospitalized, there are preliminary expenses which are incurred on doctor’s consultations for diagnosing the illness, medical tests for finding out the reason for illness, medicines, etc. These expenses are called pre-hospitalisation expenses. Similarly, there might be treatment costs incurred after the individual is discharged from the hospital. These are called post hospitalisation expenses. Both pre and post hospitalisation charges up to a certain number of days are covered in most health insurance plans, provided the hospitalisation expenses claim is covered by the insurer.

If the sum insured is exhausted in the treatment of a member, no further claims would be paid by the health insurance policy in that policy year. If another claim occurs within the same policy year, it would be denied. But from the next policy year, the full sum insured would be available for subsequent claims. In case Sum Insured Recharge benefit is opted for while purchasing the policy, then the sum insured will get replenished upon exhaustion in the same policy year however it can only be availed for a different treatment.

A health insurance portability is a provision given by IRDA that allows the insured to switch their health insurance policy to a different insurer while retaining all the accumulated benefits from the old insurer like waiting period, no claim bonus, etc. In order to avail of this facility, the policyholder will have to intimate the new insurer where he/she wishes to port at least 45 days prior to the policy renewal date.

The premium for health insurance is calculated based on a number of factors. Some of them are listed below:

Age: One of the most important factors that decide your health insurance premium. The older you get, the more you have to pay for insurance as the probability of getting ill is high.

Number of members to be covered: Depending on the number of members you want to include in your policy, the premium is calculated. For a family of four including children, the premium will be high whereas for insuring an individual, the premium would be low.

Pre-existing ailments: Premium will be high for individuals who have a history of illness e.g. diabetes, hypertension etc.

Location of residence: Depending on the place you live, the premiums vary. The cost of treatments in metro and tier-1 cities are high, hence the premium is high for individuals residing in such locations. Whereas tier 2 and tier 3 cities will have a lesser premium for the same individual.

BMI: Your body mass index also plays a role in deciding your health insurance premium. Individuals with high BMI will have to pay more for insurance cover as they are assumed to be more prone to serious ailments. If you have a BMI in a healthy range, the premium would be lesser.

You can pay premium online through one of the various modes of payment offered by insurance companies. Once you have shortlisted a health insurance plan and filled the proposal form, you will be redirected to the payment page of the insurance company. You can then choose to pay through credit or debit cards, net banking, wallets or UPI. Some insurance companies also provide EMI facility on select credit cards.

When you buy health insurance, the premium paid up to Rs 25,000 for self, spouse and dependent children are considered tax-free under section 80D of the Income Tax Act. There is an additional benefit of Rs 25,000 for a premium paid towards dependent parents. However, the limit goes up to Rs 50,000 if you/your parents are more than 60 years of age.

Yes, you would be required to pay a premium again. However, you can avail the benefit of the No Claim Bonus if it is being offered by your insurance company. Through this benefit, your sum insured amount may get enhanced further by a fixed amount for every claim-free year.

Yes, you can cancel your health insurance and get your premiums refunded. Every health insurance policy has a free lookup period of a certain number of days. If you are not satisfied with the terms of the health insurance policy purchased, you may apply for cancellation. In such cases, the insurance company will refund your premium amount after some deductions made for processing costs incurred by them. In case of cancellation after the free look period, a prorated amount will be deducted.

Cashless claim settlement is a process where the insurance company takes care of the medical bills itself without you having to pay for the medical cost yourself. A cashless claim is allowed only when you get admitted to a hospital that is tied up with the insurance company. In such cases, the insurance company settles your medical bills directly with the hospital and you don’t have to bear the financial burden of your medical emergency.

In a cashless health insurance policy, your medical costs are handled directly by the insurance company. They are paid by the insurance company to the hospital and you can avail of treatments without having to bear the financial burden. As such, a cashless health insurance policy provides you financial relief in medical emergencies.

Moreover, since your medical bills are met by the insurance company, you don’t have to draw on your savings to pay for hospitalisation. You can also avail quality healthcare when you know that the subsequent costs would be borne by the insurance company and not you.

Claim assistance is the help offered at the time of a health insurance claim. Insurance companies have a dedicated claim assistance team to help their policyholders with their health insurance claims. They guide the policyholders with the required steps to be followed in order to get their claims settled. PayBima also provides claim assistance services to its customers. In case of a claim under your health insurance policy, you can contact PayBima at our toll-free number 1800 267 67 6 or drop us an email at paybima.care@mahindra.com. Our claim experts will help you get your health insurance plan claims settled at the earliest.

There are two procedures for claims:

1. Planned: If a member of the family knows of a forthcoming hospitalization, they need to call on the helpline number mentioned on the Health Identity Card. The next step is to upload the required documents such as doctor’s certificates, medical bills, etc. The service provider of the online health insurance plan or TPA should approve your claim.
2. Urgent: If there is a sudden sickness or injury, the patient needs to be immediately admitted to the hospital where they avail treatment. Friends or family then contact the service provider or TPA to make a claim.

Cashless claim facility can only be availed at network hospitals in the medical insurance plan. For non-network hospitals, claims can be availed in form of reimbursement upon submission of relevant bills.

The essential documents required for filing a Reimbursement Claim are:

• Discharge card issued by the hospital
• Signed/Stamped In-patient hospitalization bills
• Prescriptions and medical store bills
• Duly filled and signed claim form
• All Investigation and Test reports
• Doctor’s consultation bills
• Copies of Insurance policy
• Government authorised Photo ID Card
• Doctor prescribed consumables and disposables
• Any other document asked by the TPA/Insurance company

No, you are not allowed to claim twice for a single payment even though there are two separate service providers offering you a medical policy.

Cashless hospitalization allows a member of the medical health insurance policy to get admitted to a hospital and undergo their treatment without worrying about the payments. The hospital will have a procedure to settle the payment directly with the medical insurance policy provider. However, this facility is only available in any network hospital. For non-network hospitals, standard procedures for insurance claims will apply.

The members of the policy can pay for the expenses incurred in the treatment themselves and then later claim for the reimbursement of those expenses from the policy provider. This is called a Reimbursement Claim.

A Pre-authorization is issued by the insurance company or the service provider of the health insurance policy. It states the value of medical treatment and cover provided by the company that a member can claim under the health insurance policy. A pre-authorization is needed for planned cashless hospitalisation at least 3-5 days prior to hospitalisation.

• Network Hospitals: A hospital that is in association with the insurance company is known as the network hospital. This is done primarily to enable a Cashless Claim process. A Cashless Claim process is where the hospital settles the payment for the treatment of a member directly with the insurance company. The network hospitals list can vary from one company to another. This can be viewed on the website of the service provider or TPA when you buy medical insurance online.
• Non-Network Hospitals: These are the hospitals that do not have an association with the insurance company, hence, they do not offer Cashless Claims. If a member undergoes treatment in these hospitals, they may either file for a reimbursement claim or contact the service provider in case of an emergency.

A network hospital offers you the Cashless Claim feature while a non-network hospital does not. But a member can choose either of them for treatment. A member can file for a Reimbursement claim in such a case. However, the non-network hospital should be compliant with hospital facility definition and geographical limits as defined in policy documents. This information is available when you compare health insurance plans.