HEALTH INSURANCE

What is Health Insurance ?

In a country like India, where healthcare costs are on a persistent rise, protecting your health and finances should be a top priority. Health insurance is an agreement between you and the insurer (the insurance company), wherein the latter promises to partially or fully pay for your healthcare costs against a sum paid to them (premium) to them.
According to a World Bank report, out-of-pocket medical expenses were highest in India in 2021, amounting to almost 50% of total healthcare. This illustrates that half of the Indian population usually faces sudden healthcare expenses. So Health Insurance is policy as important as primary need of family.

Who can buy a Health Insurance Plan ?

Anyone who is over 18 years can purchase a healthcare policy. For children, it starts from 1 day or 90 days, depending on the insurance provider.

How Does Health Insurance Work?

When you buy health insurance, the insurer provides financial protection up to a specified sum. The sum insured is the maximum amount you can claim from an insurer against the covered medical expenses within a year. For this, you have to pay the insurance company a premium amount, which is set according to your age, health condition, income, and the insured limit. This amount is paid at agreed periodic intervals, which can be monthly, quarterly, half-yearly, or yearly.

When you incur medical expenses covered under your health policy, the insurer pays or reimburses this amount, subject to the terms and conditions of the policy.

Healthcare policies in India cover a wide ambit of medical expenses, such as surgery costs, room rent, hospitalization charges, day-care procedures, doctor consultations, etc. It is to be noted that not all medical expenses are covered under health insurance. Hence, you must thoroughly read the coverage details when buying a policy.

Different Types of Health Insurance

Below are the most common types of health insurance policies offered by insurers in India.

Individual Health Insurance - An individual health insurance plan is a policy that provides medical coverage for a single person. If you want your family to be covered, you must purchase an individual health insurance policy separately for each family member, as its premium and benefits cannot be shared.

Family Health Insurance - As the name suggests, family health insurance provides coverage to your entire family under a single policy. The policy is offered on a floater basis, implying the sum insured is shared among the family members. By paying the single premium, the benefits can be availed by any one or more members of the family in case of medical treatments and emergencies.

Senior Citizen Health Insurance - It is an insurance explicitly designed to cover the medical expenses of people over 60. Senior citizens may require frequent medical aid, thus needing more financial protection. Regular health policies may not be sufficient to cover such hefty expenses. Hence, having separate health insurance for senior citizens is a good idea.

Critical Illness Insurance - Treatments for critical illnesses, such as cancer, stroke, paralysis, renal failure, etc., are often long-term and exorbitant, requiring more finances than regular ailments. A basic healthcare plan may not provide adequate coverage for such huge costs. A critical illness insurance cover allows you to pay for your medical bills and take care of other financial responsibilities in an unfortunate case of such serious, life-threatening diseases.

Maternity Health Insurance - Maternity health insurance offers financial assistance for all pregnancy-related costs. This includes expenses incurred for normal or C-section delivery, hospitalization, pre and post-natal care, medical tests, etc. It also covers newborn baby expenses.

Personal Accidental Insurance - A Personal Accident Insurance Policy provides financial protection to the insured and their family in the event of an accident resulting in death, disability, or injury. It covers the financial impact of accidents, offering lump-sum payments and potential benefits like medical expenses, hospitalization and even loss of income.

Benefits of Health Insurance

Here is why having health insurance is essential:
• Fights Rising Medical Costs
• Covers Hospitalisation Charges
• Covers Pre & Post-Hospitalisation Charges
• Day Care Surgeries
• Accidental Hospitalization
• Organ Donor Expenses
• Ambulance Charges
• Air Ambulance Charges
• Home Health care Expenses
• AYUSH Treatment
• Robotic & Modern Treatment Coverage
• Critical Illness
• Lasik Treatment
• Bariatric Surgery
• NO Claim Bonus
• Restoration Benefit
• OPD Cover
• Free Medical Check-up
• Maternity Benefit
• Pre & Post Natal Cover
• New Born Baby Cover
• IVF Treatment

1. Peace of Mind During Emergencies -
Mediclaim insurance ensures peace of mind by covering hospitalization expenses, especially during emergencies. Whether you met with an accident, underwent surgery, or are diagnosed with a sudden illness, your health insurance company will handle your hospital bills, allowing you to focus completely on recovery.

2. Cashless Claim -
With a cashless claim, you can undergo the required medical treatment without having to make upfront payments. The insurer pays the medical expenses directly to the hospital while you can priorities your treatment.

3. Incentive for Maintaining a Healthy Lifestyle -
Many health insurance companies in India offer wellness benefits as incentives for maintaining a healthy lifestyle. These benefits may include discounts on renewal premiums, rewards for achieving fitness goals, or additional services like free health check-ups. With health insurance discounts, insurers encourage policyholders to save money and, in turn adopt a healthy lifestyle.

4. Tax Benefits -
Health insurance allows you to receive tax benefits under Section 80D. The amount of tax benefits is calculated on the premium amount you pay and depends upon the age group of the beneficiaries (self & family and parents).

Now that you are aware of the various benefits of health insurance, know how to choose the right health insurance policy for you and your family.

How to Choose the Right Health Insurance Plan ?

Check out the key factors to consider while choosing the right health insurance plan:

Assess your Health Needs - Start by assessing your medical needs and those of your family. Consider whether you need a critical illness cover, maternity benefit, or any other specific coverage. Choose a health plan that meets your health needs without adding unnecessary features that could increase your premiums.

Claim Settlement Ratio - The Claim Settlement Ratio (CSR) indicates how likely a health insurance company is to settle your claim. A higher CSR means the insurer is more likely to settle claims and is reliable. Checking the claim settlement ratios beforehand and opting for an insurer with a higher CSR gives you the confidence that your medical expenses will be covered without fail during emergencies.

Compare Multiple Health Insurance Plans - With plenty of options in the market, it is essential to explore and compare health insurance plans before making a decision. You must compare their premiums, sum insured limits, inclusions, exclusions, and additional benefits before picking a plan that fits your budget.

Coverage for Pre-Existing Diseases - If you have any pre-existing disease, check whether your desired health insurance plan covers it. Many mediclaim policies have a PED waiting period of 2 to 3 years before they cover the treatment cost of pre-existing diseases. However, several plans today also come with PED coverage from day 1. So, make sure to choose a plan with a shorter waiting period for pre-existing diseases so that these conditions are covered as soon as possible.

Check Sub-Limits - Some health insurance policies have sub-limits, which put a cap on specific expenses like room rent, ambulance charges, or treatment costs for certain illnesses. Make sure to review these sub-limits carefully to ensure they align with your out-of-pocket limit so that you do not face unexpected costs later.

Check the Co-Payment Clause - Co-payment in health insurance requires you to pay a fixed percentage of your medical expenses out of pocket before raising a claim. The insurer only pays the remaining amount during claim settlement. Make sure to review the co-payment clause carefully before choosing a policy. Also, opt for a plan with no co-payment or a co-payment that you can afford to pay without creating any financial burden.