Clarify All Doubts Related To Health Insurance
A health insurance policy is an agreement between an insurance company and a policy holder. In this agreement, the policy provider offers financial assistance for medical expenses to the policy holder in return of a premium. The policy holder can get reimbursement for medical treatments, hospital bills, surgical bills, etc or choose the cashless claim feature. The cashless claim feature allows the policy holder 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.
Why is Health Insurance Important?
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 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 ahead. 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 you and your family’s urgent medical needs. Apart from this, buying a health insurance policy can also offer you tax benefits under Section 80D of the Income Tax Act. 1961.
Different Types of Health Insurance Plans in India
The several types of offline and online health insurance plans in India are:
- Individual Health Insurance Plans
- Family Health Insurance Plans
- Senior Citizen Health Insurance Plans
- Personal Accident Insurance Cover
- Group Health Insurance Plan
- Maternity Health Insurance Plan
Two types of health insurance policies that have been introduced recently are
- Coronavirus Health Insurance Plans
- Unit Linked Health Insurances
Individual Health Insurance Plans
Individual health insurance plans offer financial cover against medical expenses for an individual. The insured alone gets all the benefits of the plan. It is best for individuals whose family members are already insured or who is at a higher health risk. An Individual health insurance is for a single person and cannot float within the family. This type of medical insurance plan covers hospitalisations, surgeries, room rent, physician’s fee and tests. However, the insured has to pay a certain amount as co-payment for some healthcare services. There are no restrictions on the maximum age for the renewal of the policy.
Family Health Insurance Plans
A Family Health Insurance Plan or a Family Floater health Insurance plan is a single sum of money offered to the entire family as coverage. The sum is divided amongst the family members equally in case multiple members fall sick. A single premium is to be paid in a year to avail this insurance. A single claim or multiple claims can be made within a year under this plan. It is more cost-effective than taking individual health insurance plans for each member of the family. However, addition of senior citizen members into this plan may increase the yearly premium.
Key Benefits of Health Insurance Policy in India
When the medical bills pile up, your savings drain quickly out of your pocket. A regular health check-up may also cost you more than you can afford. This doesn’t mean that you cannot have access to the best treatments available for you and your family. A health insurance policy comes to your aid is such a scenario. It covers your medical expenses so that you can lead a long and healthy life. Here are some key benefits of an online health insurance:
- Medical Check-Up Facility
- Ambulance Fee
- Coverage of Pre and Post-Hospitalization Expenses
- Cashless Medical Treatment
- Tax Benefits of Health Insurance Plans
- Third Party Administrators
- Pre-Existing Disease Cover
- Room Rent Sub-limits in Your Health Insurance Plan
You should get a full health check-up once a year to nip any oncoming diseases in a month. Most of us ignore this fact because we don’t have the resources. A health insurance plan offers you the facility of regular health check-ups. These check-ups can be inclusive or you can have it as an add-on with your medical insurance plan.
The transportation fee for the patient from their home to the hospital can be costly. Most health insurance plans offer coverage of the ambulance fee up to a certain amount. This way, the patient and the family can only focus on the treatment and forget about the frill charges.
If the insurance covers the disease or illness, they will provide the pre and post-hospitalization expenses. This means that if there are any medical bills that arise prior to hospitalization, they will be covered. If you need medical care at home after your stay at the hospital, the health insurance will cover that too.
If you get treatment from one of the network hospitals of the insurance company you can avail the Cashless Claim facility. This facility allows you do get treatment without paying for it. The network hospital and the insurance company will settle your bills amongst themselves. The list of network hospitals is available on the website of company.
Health insurance plans offer you tax benefits under the Section 80D of the Income Tax Act. You get a tax rebate, the amount depending upon the premium and certain factors. If you are below 60 years, you can get a rebate of up to Rs.25000 in a year. If over 60 years, this amount can go up to Rs. 50000. If you are paying insurance premium for your parents, you get rebate up to Rs. 55000.
*tax benefits are subject to changes in tax laws
Third Party Administrators or TPAs assist both the insurer and the insured. They help the insurers against fake claims or overhead costs. TPAs help the insured to avail secure and swift services. These TPAs handle claims, reimbursements, premium collection, etc. on behalf of the insurance company.
After an incubation period (generally 2-4 years) insurance plans begin to cover pre-existing diseases. Pre-existing diseases are illnesses that the policyholder had before buying the policy. These may include diabetes, hypertension, etc. You can claim for these illnesses once the incubation period is over. But these diseases should be mentioned in the policy.
Most insurance policies reduce their liability by putting sub-limits on certain services. One of which is room rent sub limit. The health insurance policy will offer you a maximum coverage up to the sum assured, but they may limit their expenses. For example, there may be a cap of Rs 6000 on room rent, or they may not offer to cover a suite. If your hospital room charges are 10,000, the insurance will give you 6000 and the rest 4000 will be borne by you. The charges mostly depend upon the type of room you require, for example, a private room, semi-private room, suite, etc.
Does a Health Insurance Policy Cover Coronavirus (COVID-19)?
If you have an existing health insurance policy, a coronavirus claim will be handled by the insurance company expeditiously. It will go through a thorough review by the claim review committee and decided if it will be accepted. If you want to buy a health insurance policy online, most of them now offer insurance against coronavirus. Certain insurance companies have also rolled out medical policies centred around COVID-19. The IRDAI has also launched two new policies for Coronavirus – Corona Kavach Policy and Corona Rakshak Policy.
Health Insurance Plan Inclusions & Exclusions
Most insurance policies are customizable and you can choose which one suits your requirements. However, there are certain common inclusions and exclusions which you can choose from. They are:
- Hospitalization expenses
- In case of organ transplant, donor expenses up to a certain amount
- Overnight hospitalizations in cases of serious injuries
- Pre-existing diseases after a set incubation period
- Pre and post hospitalization expenses
- Ambulances charges up to a certain amount
- Room rent up to a sub limit
- Free health check-ups
- Maternity and new-born expenses
- Day care treatments
- Treatment from home or domiciliary hospitalization
- No expenses incurred during the waiting period (30 days), unless it is an accidental emergency
- Pre-existing diseases are not covered in the incubation period. (Usually 2-4 years)
- Illness and injuries caused by war or nuclear activities
- Suicide attempt
- Cosmetic/Obesity/Aesthetic surgeries
- Replacement of hormones or sex-change operations
- Dental or Eye Surgeries
- Non-allopathic treatment
- Certain treatments or diagnostic tests
- Treatment abroad by under-qualified professionals
It is best to compare health insurance plans online to choose the one which offers maximum coverage.
How to Compare Health Insurance Plans at Paybima?
You need to fill up a form which asks for your basic details depending upon the insurance type you’re looking for.
- The form will lead you to a host of policy options customised according to your needs. The list quotes the premium and the basic details of every policy.
- You can click on each policy to view their detailed information.
- On the page with the list, you can select the policies you want to compare by checking the ‘Compare Product’ box. You can select up to 4 products at a time and click compare.
This will lead you to a comprehensive table which lists all the benefits of your shortlisted policies. You can take your time and choose the best one for you and your family.
Benefits of Comparing Health Insurance Plans Online
It is crucial to compare medical insurance plans online before finalising one. It helps narrow down the best plan which offers the maximum coverage. There are several plans that offer more services on a low premium. So, you can choose the one that suits your requirements and is also affordable. You don’t have to simply accept amongst the couple of choices handed to you by an agent. Comparing health insurance policies gives you the power to choose according to your needs.
- Access to Accurate Information
- Time Efficient and Convenient
- Availability of Provider/Plan Reviews
When you compare health insurance plans, get access to all the information you need to purchase a policy. You don’t have to rely on agents and middle-men who offer their (mostly) biased opinions. You can easily log on to a website and read all the services, terms and conditions.
You don’t have to meet agents or set up calls with insurance companies to buy a policy. You can get a comprehensive table which lists all the benefits and shortcomings of every policy when you check online. Post-buy tasks such as paying premiums or renewing policies are also now available at the click of a button.
Many insurance companies offer a variety of services and coverage on a low premium. You can view them online and choose the one which fits your needs. Comparing health insurance plans online also reduces the cost of purchasing a plan since it eliminates the middle-men. You are not required to pay any sort of commission.
Not only can you compare health insurance plans, you can also read reviews about the Insurance company or the plan online. If you have shortlisted a few policies, read their reviews before making a final decision. These reviews enable you to make an informed decision.
Factors to Consider before Buying Health Insurance Policy
If you don’t have the experience of buying a health insurance policy, all the information available can be a little confusing. There are several factors that you need to consider before buying a health insurance plan. Such as, the premium, if you want an individual plan or a family floater plan, sum assured, etc. You need to know how to choose a robust plan which covers all your requirements. Here are a few factors which you should keep in mind:
- Caps and Sub-limits
- Claim settlement Record
- Scope of Coverage
- Cashless Hospital Network
- Internal Claim Settlement Team
- Health Insurance Portability
- Top up Health Insurance Plans
All insurance companies want to reduce their liability. To do so, they apply caps and sub-limits on certain services. For example, a room rent sub-limit can be of Rs 5000 per day or ambulance fee can be up to Rs 2000. Any expenses incurred above this limit on either of the services will be borne by you.
Always choose a company with a good claim settlement record. This ensures that your future claims will not be wrongfully rejected. Always look for the insurance company’s claim settlement ratio before making a choice. This saves you from unnecessary harassment in times of need.
Always look for a health insurance policy that offers you the maximum coverage. Don’t simply compare premiums with sum assured. A low premium plan might not cover all your needs. So, when comparing health insurance plans, always shortlist the ones offering you more services with higher sub-limits.
When you buy medical insurance online, always check their renewability. The usual plans have a yearly contract which gets renewed when you pay the premium. Many Insurance companies offer a discount on premiums if you pay for two- or three-years’ premium in advance. If there is a break in renewal, you might lose all the accumulated benefit.
Every medical Insurance company has a list of network hospitals that offer you cashless claims. Check if the hospitals around you or in your city feature on such list of the insurance company you are planning to choose. This helps you to get treatment without worrying about the payments and reimbursement claims.
Ensure that the insurance company offering you a medical insurance plan has a claim settlement team. This helps your claim to move swiftly in the process and eliminates any room for mistakes. Most companies hire TPAs to do this work, but that might slow down the process. An internal claims settlement team expedites the claims process.
Choose a health insurance policy and an insurance company which offers the health insurance portability feature. This means that you can switch from one company to another without losing the benefits accumulated. This feature eliminates the waiting period and is offered by most companies for free.
A top-up health insurance policy reduces the cost of your deductibles. A deductible is the cost that you bear willingly. For example, your hospital bill is of 5 lacs and you need to pay a deductible of 2 lac. You can use a top-up health insurance plan to further reduce your deductible. This method is proven to be cost-effective for policy holders.
Health Insurance Eligibility Criteria
A health insurance policy is extremely beneficial for individuals as well as families. These policies secure you against high medical bills across a network of hospitals. There are two basic types of insurance policies
- Individual Health Insurance Plan
- Family Floater Health Medical Insurance Plan
The essential eligibility criteria for both the plans are:
- Adults should be between 18 to 65 years of age (There are separate plans for 70 and above)
- Children should be between 90 days to 18 years of age
- The policy can be renewed for your entire lifespan and is subject to medical clearance.
Health Insurance Claim Procedures
You can file for a claim if the illness, injury or accident is covered by your health insurance policy. Here are the two ways to make claims:
- Reimbursement claim: If you incur any medical expenses, you can pay the amount to the hospital or the clinic. Once done, you can submit all the documents including medical bills and prescriptions to the insurance company. The company will review your claim and release the reimbursement amount if approved.
- Cashless Claim: You can avail this facility if you get a treatment in a network hospital of the insurance company. Network hospitals have an association with the insurance company where they settle your bills amongst themselves.
Documents Required for Health Insurance Claim Reimbursement
If you make a reimbursement health insurance claim for your medical expenses, you need to submit the following documents:
- Discharge card issued by the hospital
- Signed/Stamped In-patient hospitalization bills
- Prescriptions and medical store bills
- Duly filled and signed claim form
- Investigation report
- Doctor’s consultation bills
- Copies of Insurance policies and copy of an ID proof
- Doctor prescribed consumables and disposables
- Any other document asked by the TPA/Insurance company
1. Cost of hospitalization:All the hospitalization expenses incurred due to illness oraccident injuries
2. Pre and posthospitalization expenses: Expenses incurred during a certain number of days before and after hospitalization as long as they are related to the illness/injury
3. Day care 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 hospital
5. Income Tax benefit: Save upto Rs 75,000 on tax (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 organ donor during an organ transplant.
7. No Claim Bonus: Bonus given to the insured during renewal in case of 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 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, Unaani, Siddha and Homeopathyget covered
11. Free health check-ups: Free health check-up facility given to the insured members upto pre -defined limit in policy.
12. Domiciliary hospitalization (Health homecare): Treatments availed at home on doctor’s recommendation
13. Convalescence Benefit: Lumpsum amount 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 waiting period
2. Expenses occurred during the waiting period for the disease/ailments having mandatory waiting period
3. Cosmetic and Dental surgery expenses
4. Sexually transmitted diseases
5. Self-inflicted injuriesor adventure sports
6. Injuries caused due to warDetailed list of exclusions can be found in the policy wordings of the respective health insurance product.
1. Individual health insurance plan: This type of plan suits for individuals who chose to buy a policy for covering one individual.
2. Family health insurance plan: This type of plan provides coverage for the entire family which can include spouse, parents and children. The sum insured can be shared among all the family members or each family member can have an individual sum insured.
1. Sum insured: Determining the right coverage is the first step when opting to buy a health insurance. Individuals residing in metro cities may go for higher sum insured. If looking for family health insurance plans, 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 option 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 but 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 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 who has more number of hospitals under their cashless service.
- 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 plansdo 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.
There are two procedures for claims:
- Planned: If a member of the family covered 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:
- A filled-out claim form
- Original bills and receipts of the hospital
- Discharge certificate from the hospital
- Pharmacy bills with prescriptions
- Investigation reports from the pathological laboratories including a note from the surgeon prescribing the tests
- Surgeon’s bills along with a report on the nature of the treatment
- 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 buying 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.