About Health Insurance

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About Health Insurance

The surfacing of lifestyle ailments and rising communicable and vector-borne diseases have brought genuine health concerns. Despite staying healthy, falling prey to diseases is highly possible.

A tryst with hospitalization is not uncommon. Acute and constant medical attention seems to be the new normal.

While healthcare and medical facilities advance by leaps and bounds, costs of treatments and medical care skyrocket.

The unfortunate fallout of medical inflation: financial burden, monetary stress, depleting personal savings, and at times, debts.

In these times of uncertainty, if there’s one key solution to securing healthcare needs – it’s health insurance plans.

Types of Best Health Insurance Plans in India

Individual health insurance
Family floater plans
Group health insurance
Critical illness health insurance
Senior citizen health insurance
Specific illness health insurance

Top health plans in India

Insurance Companies

Aditya Birla Health Insurance

Bajaj Allianz Health Insurance

Bharti AXA Health Insurance

Health Insurance Plans

Active Assure Diamond Plan

Health Gaurd Plan

Smart Health Assure Plan

Sum Insured (Rs.)

Min- 2 Lakh

Max- 2 Crore

Min- 1.5 Lakh

Max- 50 Lakh

Min- 3 Lakh

Max- 5 Lakh

Incurred Claim Ratio

59%

85%

89%

Network Hospitals

6000+

6500+

4300+

Key Features of Health Insurance Policy

Cashless Medical Treatment
Coverage of Pre and Post-Hospitalization Expenses
Ambulance Fee
No Claim Bonus
Medical Check-Up Facility
Room Rent Sub-limits in Your Health Insurance Plan

Inclusions & Exclusions of Health Insurance Policy

Inclusions

  • Hospital expense cover
  • Other medical expenses
  • Day care treatments
  • Pre & post hospitalization

Exclusions

  • Injuries caused by war/nuclear attack/suicide
  • Dental or eye surgery
  • Cosmectic/Plastic surgery & more

Does Health Insurance Policy Cover Coronavirus COVID-19 Treatment?

Claim settlement process for Health Insurance

The claim process is nothing but the request from a policyholder to the insurance company to compensate/make payment for the medical treatment costs incurred by the health insurance policyholder. There are two types of claims:

  • Cashless claim
  • Reimbursement claim


For both types of claims, health insurers follow a set of processes which have to be completed within a few days to a few weeks of the hospitalisation. Typically, the process involves informing the insurance company about the medical procedure/emergency within a specified time frame, submitting a claims form and the required documents. The insurance company then investigates the documents to release the payment.

Health Insurance Cashless Claim Process

Cashless claim is an agreement between the insurer and the network hospitals to allow policyholders treatments without any payments from the policyholder. In this type of claim, the insurer pays directly to the hospital. The policyholder does not have to make the payment and then receive it back as reimbursement from the insurance company.

This process, typically, follows these steps:

Get treatment at a hospital part of the network of the insurance policy
Submit a health insurance policy claim form at the hospital
The insurance company sends an approval to the hospital or raises a query in case of missing information

Health Insurance Reimbursement Claim Procedure

In this type of claim, the health insurance policyholder has to make the payment to the hospital, which is then reimbursed by the insurer upon following the reimbursement process, as follows:

The policyholder is required to fill a claims form and submit to the insurer along with the medical and hospital bills
The insurer then investigates the documents
If the claim is approved, the insurance company sends an approval letter. In case of rejection, a rejection letter along with the reasons is shared with the health insurance policyholder.

Reasons to buy a Health Insurance Policy Online

  • Customized Policy
  • Convenience of Comparing Policies
  • Hassle-free Transactions
  • Secure, Faster and Time Saving
  • Easy claim settlement
  • Tax Advantages
  • Policy Renewal

Why do you need to compare Health Insurance Plans?

Once you have a clear picture of your requirements, select a few plans from different health insurance companies. Compare different plans. Look for these differences and identify benefits:

  • Premium
  • Add-on offered
  • Pre and post hospitalization coverage range
  • Illnesses and diseases covered
  • Flexibility – portability option, possibility of adding a new member, increasing or decreasing sum insured, etc.
  • Claim settlement ratio of the company
  • Network hospitals
  • Cashless claim facility
  • Waiting period for pre-existing diseases
  • Exclusions
  • Co-payment and sub-limit clauses

How to compare insurance plans?

Select the appropriate sum assured

Select the appropriate sum assured

Select the appropriate sum assured


Benefits of comparing Health Insurance Plans Online

  • Access to accurate information
  • Time efficitent & convenient
  • Pocket Friendly
  • Availibity of the Provider
  • Plan Reviews

How to calculate health insurance premiuim?

  • Comaprision of health plans
  • How does the calculator work
  • Instant calculation
  • Pre-existing ailment
  • Health covergae

FAQ

Q. What is the benefit of health insurance?

A. Health insurance is financial security against medical problems and treatments. It ensures the policyholder/s receive the best medical care without any financial burden. Not only does health insurance provide protection against high medical costs such as hospitalization, daycare procedures, ambulance, room rent and more, it even provides return on investment in some cases, in the form of bonus and additional sum insured.

Q. How do I purchase health insurance?

A. Purchasing health insurance is easy – apply for a plan online or get in touch with a health insurance agent. What is difficult, is selecting the right kind of insurance and good policy. Your insurance agent or the insurance company would be able to help you with the selection.

Q. How does health insurance work?

A. Health insurance works on the simple principle where an insurance company bears the financial risk associated with a health-related event in return for an annual premium for its policyholders.

Q. What are the different types of health insurance plans available?

A. Individual health insurance: individual health insurance plans are single-person plans that provide coverage to individuals only. The premium for individual plans is determined by the age, the medical history, claims history, pre-existing diseases, and sum insured. Family floater plans: family floater plans provide coverage for the entire family – self, spouse, children and parents. Certain family plans include extended families such as grandparents and other family members. The premium for family plans is determined by the age and medical conditions of the oldest members. Group health insurance: group health insurance plans are often offered to employees by employers. Here, the premium is paid by the employer, but the coverage supports the employee. Such plans are preferred by businesses and organizations. Critical illness health insurance: critical illness plans are dedicated to covering illnesses such as cancer, cardiac ailments, and kidney failure, among other specified health conditions. Senior citizen health insurance: these plans are designed especially for senior citizens (age 65 years and more). The premium of senior citizen health insurance is generally higher than others as it is determined by age, health conditions, and medical history. Specific illness health insurance: these insurance plans are designed to provide coverage for specific illnesses only, such as diabetes, and cardiac issues, among others.

Q. Why do I need Health Insurance policy?

A. Health insurance plan is a financial security, a financial cushion that helps to safeguard a person from health-related expenses, whether planned or sudden. Health insurance policy is a must to meet the rising medical care expenses.

Q. Can I cancel my Health Insurance? If yes, will I get my premium back?

A. Yes, a health insurance policyholder can cancel the policy at any time. However, typically, the insurer does not return the premium already paid. In some cases, the insurance company might return the premium.

Q. What do you mean by waiting period in Health Insurance plan?

A. When a person buys a health insurance plan, insurance companies have a waiting period clause in the health insurance policy. The waiting period can range from a few days to a few years. This means that the policyholder cannot make any claims before the waiting period is over.

Q. Do health insurance plans cover outpatient expenses also?

A. Yes, health insurance plans offer coverage for outpatient expenses. These are expenses that are incurred by the policyholder who is not hospitalized but requires medical treatment. Depending on the clauses in the health insurance policy, the plan might cover outpatient expenses.

Q. When should I make a health insurance claim?

A. A health insurance policyholder can make a claim when they are hospitalized due to an illness. Critical illness plans do not require the policyholder to be hospitalized to make a claim. The policyholder can make a claim upon the diagnosis of the critical illness.

Q. How much does a Health Insurance cost?

A. The cost of the health insurance plan premium depends on many factors such as the sum insured, the age of the policyholder, the clauses, the coverage and other factors. It is best to check the cost of different health insurance plans individually.

Q. What is the sum insured in Health Insurance plans?

A. Sum insured is the total amount of coverage that a health insurance policy would provide to the policyholder. Typically, the sum insured for health insurance plans range from anywhere between Rs 50,000 to 2 to 3 crores.

Q. What are the various riders & benefits of a Health Insurance plan?

A. Different health insurance plans might offer different riders and benefits. Some of the most common ones are no-claim bonus benefit, add-on insurance benefit, critical illness rider, and more.

Q. What is the right time to buy a Health Insurance Policy?

A. The earlier one buys health insurance plans, the better the benefits. Ideally, everyone - adults, children, and senior citizens should have a health insurance plan at all times. The moment one starts earning a salary, one must buy a health insurance plan.

Q. What is personal accident insurance?

A. Personal accident insurance plans are designed to offer coverage to individuals in case of accidents and hospitalization. PErsonal accident insurance policies cover the expenses of treatments.

Q. Why should I buy a critical illness cover?

A. Critical illnesses are mostly expensive ailments. The cost and the incidence of critical illnesses is rising in India and hence it is wise to buy a critical illness plan in order to meet the high expenses and to avail the best treatments.

Q. How to select best health insurance plan in India?

A. The insurance marketplace offers many health insurance plan options. In order to buy a plan, one must first assess their medical care needs, budget, and other lifestyle factors and then choose a plan from online insurance marketplaces.

Q. Are individual health plans better than family floater plans?

A. Whether an individual health plan is better than having a family floater plan depends on the individuals needs and conditions. If an individual has a family - spouse and children, it is advisable to go for a family floater plan.

Q. Is medical check up necessary before buying a policy?

A. A pre-policy medical check-up depends on the insurance company. Many insurers require a medical check up while many don't.

Q. What is the minimum & maximum policy duration?

A. Typically, the minimum duration of a health insurance policy is at least one year. The maximum duration of a health plan is typically two to three years after which it can be renewed and continued.

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