Clarify All Doubts Related To Health Insurance
A health insurance policy is an agreement between an insurance company and a policyholder. In this agreement, the policy provider offers financial assistance for medical expenses to the policyholder in return for a premium. The policyholder can get reimbursement for medical treatments, hospital bills, surgical bills, etc. or choose the cashless claim feature. The cashless claim feature allows the policyholder to avail treatment on a network hospital without worrying about the payments. The insurance company and the network hospital have an association through which they settle the bills of the policyholders.
You can compare multiple health insurance plans online. Buying medical insurance online helps you to choose the one which best fits your requirements.
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 hospitalisationIt is important to realize that inclusions will vary from one provider to the next and from plan to plan.
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 warA detailed list of exclusions can be found in the policy wordings of the respective health insurance product.
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.
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.
- 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.
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.
There are two procedures for claims:
- 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.
- 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
- 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.