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Health Insurance Plans

What is a Health Insurance Plan?

A health insurance plan is a service product that provides comprehensive risk coverage for medical expenses as per the terms of the insured person’s policy. Policyholders are required to pay a regular premium to either avail cashless treatment or get medical expenses reimbursed. In other words, an insurance policy is nothing but a contract between the individual party and the insurance provider to provide a certain benefit for a particular price during a said period.

As per directions of the Insurance Regulatory and Development Authority (IRDA), those holding a health insurance policy can claim tax exemption in India. Apart from this benefit, purchasing an insurance policy has a number of advantages.

Why do you need to take a Health Insurance Plan?

  • Inflation in medical expenses-It can lead to a big personal financial crisis at the time of a medical emergency because the cost of medical treatment is highly inflated in today’s times and prices will only increase over time. Hence, it is important to have in place at least a basic health insurance plan that can cover emergency hospitalization expenses.
  • Tax benefit-All personal health insurance policies provide the policyholder a tax benefit under section 80D of the Income Tax Act. Senior citizens can avail a tax deduction towards their health insurance premium and even their family members are eligible for this benefit.
  • You pay less- With a health insurance policy, you essentially pay a lesser price when compared to the actual market price of the expense incurred. Paying monthly premiums are much more cost effective than paying for the actual cost of medical care.
  • Free preventive health care- Those with a health insurance plan are eligible to obtain regular preventive health care check-ups for free. These include annual check-ups, screenings, vaccines, blood tests etc, as per the terms and conditions of the policy chosen.
  • Increase in lifestyle diseases-Health reports and recent research has revealed that the number of people suffering from health ailments are on the rise due to lifestyle changes. In this scenario, it becomes important to have in place a good health insurance policy.
  • Good quality medical treatment-A good policy provides policyholders high-quality medical treatment at the empanelled network of hospitals. This assures speedy, good quality medical care for those insured.
  • Restore benefit- Also referred to as recovery benefit, this entitles the policyholder a lump sum amount after hospitalization for day-to-day expenses. This benefit is given so that the patient can take care of domestic expenses till he gets fit.

Pros and Cons of Health Insurance Policies:

Individual Family Senior citizen
Tax benefit Tax benefit Tax benefit
Less expensive Comparatively more expensive Expensive due to age
Lesser claim amount Greater claim amount Medium claim amount
Caters to just 1 person Caters to all family needs Only senior citizen
Not many discounts Many offers and discounts No discounts
No continuous family cover Continuous family cover No continuous family cover
Easy to buy policy Easy to buy policy Difficult to buy policy

Coverage of Health Insurance Policy:

  • Cashless treatment- All medical insurance policyholders will be eligible for cashless medical treatment that can be availed from the listed or empanelled network hospital. Therefore, if the patient is hospitalized all expenses will be taken care of by the insurance provider and the policyholder need not pay anything from his own pocket. However, if the expenses exceed the coverage limit of the policy, the insurance policyholder must pay.
  • Pre and post hospitalization care-Depending on the insurance policy purchased, this feature takes care of medical expenses incurred before a person is hospitalized and also after being discharged from the hospital.
  • Ambulance fee-This covers transportation expenses that may be incurred by the policyholder. This is usually an optional add-on that comes with an additional fee.
  • No claim bonus-Many insurance policies offer the no claim bonus option which makes the policyholder eligible for a certain discount if he or she has not made any claims during the policy year. This benefit can usually be availed during the policy renewal process.
  • Regular screenings- Policyholders will be eligible for regular medical check-ups, health camps, and screenings. All these measures are taken as a preventive health care mechanism.
  • Room rent- At the time of hospitalization, the policy will cover expenses related to the room rent. However, the type of room eligible for this option might vary as per the terms and conditions of the policy and the premium amount.

Exclusion of Medical Insurance:

Hospitalization due to war, nuclear risks, radiation, chemical or biological weapons
Policyholders who have committed or attempted to commit suicide
Policyholders who have attempted or have committed an illegal or criminal act
If the insured party is injured as part of naval, military, air force, scuba diving, parachuting, adventure sports
If the policyholder is ill due to substance abuse or intoxication
Any expenses due to sexually transmitted diseases like AIDs etc
Non-allopathy treatment
Congenital diseases
Mental disorders
Pre-existing ailments
Alternative therapies
Lifestyle related conditions
Cosmetic treatments
Diagnostic expenses
Dental treatments
Cost of spectacles, contact lenses, eye or ear examinations
Treatment for sleep disorders
Sex change or gender reassignment surgeries
Treatment received outside India
Out-patient treatment

Types of Medical Insurance Plans:

  • Individual health insurance policy- Under this plan, a single individual is covered against all kind of illnesses as mandated in the terms and conditions of the policy.
  • Family floater plan-All family members will be included in this plan and protection will be given to all against a single family floater plan. This plan offers a certain fixed sum for family members. This can be given to one person or all those who are insured. More than one claim for more than one person can be made during the policy year. However, this plan will cost you a comparatively higher premium.
  • Surgical & critical insurance plan-This kind of insurance policy covers critical health problems such as heart attacks, cancer, kidney failure, paralysis etc. The premium for such plans is usually very high because the cost of medical treatment for serious illnesses tends to be very expensive.
  • Senior citizen health insurance plan-Chalked out specifically for senior citizens, this particular plan can be opted by anyone who is 60 years of age or above. Depending on the type of insurance provider, there may be a requirement to take a pre-insurance medical test. The plan usually covers pre-existing diseases and offers lifetime renewal.
  • Maternity health insurance -This type of health insurance plan provides comprehensive coverage for the mother-to-be and baby. Cost of pre and postnatal care are covered, including delivery costs for both normal and caesarean. The newborn baby may also be eligible for benefits under this type of policy. This may also cover transportation charges for the mother’s travel from any point to the nearest hospital.

Top Companies offering Medical Insurance Plans:

Company Name Coverage Copay Renewability Cashless hospitalization
HDFC ERGO General Insurance Individual or family floater No copay Lifetime 4800+
Max Bupa health insurance Individual or family floater 20% if insured is above 65 years Lifetime 3500+
National insurance Individual or 6 family members Zonal copay Lifetime 6000+
Reliance General Insurance Individual or up to 6 family members 20% if insured is above 61 years Lifetime 4000+
L & T general insurance Individual or up to 4 family members 10% if insured is above 81 years of age Lifetime 2800+
New India Assurance Individual or up to 6 family members 10% on pre-existing medical conditions Lifetime 1200+
Cigna TTK health insurance Individual or up to 4 family members 20% if insured is over 65 years old Lifetime 4000+
Religare health insurance Individual or up to 6 family members 20% on the first claim for those above 61 years Lifetime 4500+

Who are Eligible to take Medical Insurance?

If you want to buy a health insurance policy there are certain prerequisite conditions that you have to meet. Some insurance providers may ask you to undergo a medical check-up, after which they will assess the risk factor and accordingly determine the premium amount. However, for those who are below 45, health check-ups are usually not a prerequisite.

Procedure to take a Health Insurance Plan:

Contact the insurance provider through a toll-free number or email
Obtain an insurance quote
Compare different policies online and choose the best one that suits your personal needs
Undergo medical tests if required by the insurance provider
Make payment with relevant details and documentation
Receive the insurance policy and medical card

Documents Required for Health Insurance Policy:

ID proof
Proof of income
Medical test results

Cashless Hospitalization:

Cashless hospitalization is an option provided by all insurance companies. IRDA has made this possible through a network of empanelled hospitals that provide these services through third-party administration. Cashless services can be availed only from the list of network hospitals that are made available to the policyholder and this list may vary from policy to policy. Before purchasing a policy, it is advisable for the prospective buyer to take a look at the list of network hospitals and choose accordingly as per personal convenience, needs, and location. It is very simple for the policyholder to take this route. All you have to do is to go to the nearest network hospital and provide necessary details. The hospital will directly contact the insurance provider and process the payment.

How Cashless Hospitalization Helps?

Cashless hospitalization has come as a boon for many as one does not have to go through the stress of arranging for finance during an unforeseen emergency. All you have to do is go to the nearest empanelled hospital, submit your insurance policy details and then avail treatment immediately. This cuts down the hassle of payment as it will be taken care of by the insurance provider. Below are the advantages of cashless hospitalization:

  • Hassle-free
  • High-quality service

Procedure for Cashless Hospitalization:

  • Ideally, if it is a planned hospitalization, one must contact the respective customer service representative of the insurer or the third party representative in the selected network hospital to inform them about the hospitalization. This needs to be pre-authorised by the insurance provider.
  • Once the pre-authorisation process is complete, which usually does not take more than 4 to 5 hours, the patient is eligible to get admitted for treatment.
  • However, in case of an emergency, the policyholder needs to only give the network hospital the cashless treatment card number.

Reimbursement Claims:

Policyholders are eligible to get their medical bill reimbursed after the completion of the medical treatment procedure. In this case, expenses will only be reimbursed for those health ailments that are listed under the terms of the policy.

Documents Required for Reimbursement Claims:

Claim form
Discharge documents
Hospitalization bills
Medical store & doctor’s prescriptions
Investigation report
Other bills
Copy of insurance policy-both current & previous year
Copy of ID card of third-party administrator

How to File Reimbursement Claims?

Keep bills ready
Fill in the claim form
Submit the claim form after completing the paperwork
Notify the insurance provider
The claim should be processed within 7 working days

Health Insurance Premium Calculator:

Firstly, let’s understand what premium is. In health insurance, the premium is the sum of money that the policyholder agrees to pay the insurance company at regular intervals in exchange for health services. There are many factors based on which the premium for your health insurance policy is calculated. Some of the factors include pre-existing health conditions, body weight, lifestyle, family medical history, smoking or drinking pattern, age, gender, marital status etc. Based on these factors the amount of premium may usually vary for the same type of insurance plan.

Compare & Buy Medical Insurance Online at BankBazaar:

Comparing different health insurance policies just got easier. You can obtain all the information that you need at the click of a button online. Just log on to bankbazaar.com and go to the health insurance main page. Here you can compare different health insurance policies in the market and get the best quote.

Key Terminologies - Health Insurance Glossary:

  • Allowable charge- This refers to the maximum amount in rupees that the health insurance provider will allot to the policyholder based on the type of medical service, location, and hospital.
  • Benefit- The amount that the policyholder is entitled to receive from the insurance company towards medical expenses.
  • Benefit-level- This refers to the maximum sum of rupees that the policyholder will be eligible to receive for a certain medical treatment.
  • Benefit-year-A benefit year is the policy year that extends for a duration of 12 months from the date on which the policy has been availed.
  • Co-payment- The insurance policyholder pays a certain sum and the insurance company pays a certain sum for medical treatment.
  • Claim-This refers to the request made by the policyholder to avail the benefit provided by the insurance provider.
  • Coinsurance-This refers to the sum of money in the percentage that the policyholder is eligible to pay post deductibles to share the cost of treatment.
  • Deductible-This is the sum of money in rupees that the policyholder has to pay each year to obtain cover before the insurance policy pays medical expenses.
  • Dependent-The individual, usually a family member such as the child, spouse or parents who are covered by the primary policyholder under the scheme.
  • Effective date-This refers to the date of commencement of the health insurance policy.
  • Exclusion or limitation- This may refer to a certain type of ailment that is not paid for under the terms of the insurance policy.
  • Group health insurance-A group insurance policy is one that is provided to an individual and his/her dependents by the concerned employer or particular organisation.
  • In-network provider-An in-network provider may refer to one who is a medical professional, hospital or pharmacy assigned to take care of health insurance plans in the concerned network hospital. These hospitals may be empanelled under the cashless network of hospitals.
  • Pre-existing condition- Any health ailment that the policyholder is suffering from or is diagnosed with before the purchase of an insurance policy.
  • Premium- This refers to the sum of money that the policyholder pays towards the insurance policy.
  • Rider- Any additional benefit offered by the insurance provider that comes with a certain additional fee.

News About Health Insurance

  • Cigna TTK Health Insurance Raises Rs.114 crore to expand its Business

    Cigna TTK Health Insurance is a joint venture between Cigna Corporations and the TTK Group. Since Cigna Corporations has hiked its stake in the insurance firm from 26% to 49%, the company is all set to expand its business, upgrade its technology, and increase its distribution network, all to the tune of Rs.114 crore. The insurer is also planning to increase the number of branches from 16 to 21 by the end of 2019, in order to reach customers in Tier II and Tier III towns.

    This business expansion will also see the number of agents increasing from 19,000 to 25,000-30,000, in the future. The firm currently has a 900-employee workforce, and will soon be increasing this number by hiring 300 new employees. The insurance firm is currently focusing on a multiple network distribution model. The insurer will also be launching a new insurance product called the ProHealth Select Plan, which will include a host of beneficial features, such as healthy rewards, an inflation shield, reassurance benefits, and more.

    28th Aug 2017

  • Cancer-Specific Insurance Plan to be launched by Star Health Insurance

    Star Health Insurance is in the process of launching an insurance product specifically catered to people already suffering from cancer. It is reported that the product will be launched as soon as the company has fixed a price for it. The insurer is also planning to introduce insurance products for children suffering from autism, and is currently awaiting regulatory approval for the same.

    In order to escalate their growth and meet targets, the company is in talks to raise Rs.200 crore, within the next few months. The company has also re-launched and increased the purchase price of its Family Health Optima policy. The insurer, who collected gross written premiums worth Rs.2,962 crore last year, is targeting a premium collection of Rs.4,000 crore for the current year. The insurer is also looking to open around 20-25 branches shortly, in order to scale its operations.

    18th Aug 2017