Health Insurance

Health Insurance

YOUR HEALTH, OUR PROMISE

Definition

Health insurance, also called mediclaim policy, refers to the financial agreement which provides coverage for all medical expenses of the insured, including hospitalisation costs, expenses of surgery, medicines, etc. depending on the policy purchased.


Benefits:

Having a health insurance policy safeguarding the health and well being of you and your family has a huge number of benefits, including:

  • Coverage of all basic medical expenses, which commonly includes:
    • Ambulatory patient services, which are the outpatient medical services that do not require hospitalisation
    • Emergency services
    • Hospitalization
    • Prescription drugs
    • Maternity services
    • Rehabilitative care and devices
    • Pathological testing
    • Preventive services and chronic disease management
    • Pediatric services
  • Reduced amount to be paid before meeting deductibles.
  • Free preventive care including vaccinations, routine screenings, regular checkups, etc.
  • Health insurance policy premiums are eligible for tax exemption under the Income Tax Act, Section 80D.

Types of Health insurance:

Insurance providers in India commonly provide the following basic health insurance policies:

  • Individual Health Insurance Plan: Provides coverage of medical expenses to individuals against certain pre specified diseases, hospitalization, emergency services, etc. Sum assured is available to a single individual only.
  • Family Health Insurance Plan: The family health plan is an extension of the individual health plan over all your family members, providing the same coverage. Sum assured can similarly be accessed by the entire family.
  • Senior Citizen Health Insurance: Specifically designed to provide coverage to senior citizens (aged 60 years and above) against health conditions commonly borne of advancing age.
  • Critical Illness Insurance: Critical illnesses are serious and often terminal conditions. Critical illness insurance plans provide coverage for treatment of certain pre specified critical conditions such as cancer, heart failure, strokes, etc.
  • Maternity Health Insurance: Maternity health insurance policies cover charges of maternity healthcare, including prenatal care, delivery, and postnatal care, and may even include vaccination. These plans usually cover the baby till policy period expires.
  • Personal Accident Insurance Cover: These plans cover hospitalization and medical expenses in case the insured meets an accident resulting in disability or death. These policies are often fixed benefit plans.
  • Preventive Healthcare: Healthcare is expensive, and much of these expenses can be prevented by keeping healthy and early detection of issues. Preventive healthcare policies thus cover the charges of routine checkups, laboratory tests, consultation, etc.
  • Unit Linked Health Plan: Unit Linked Health Plan or UHLP is a recent addition to the roster of health insurance policies. These plans are a combination of insurance and investment, allowing you to save and invest while you pay insurance premiums.

Add-ons:

Common add-ons available along with basic health insurance plans include:

  • Critical Illness benefits
  • Personal accident benefits
  • Senior citizen plans
  • Indemnity covers
  • Room rent waiver plans
  • Hospital non-medical expense plans
  • Top-up plans

Inclusion & exclusions:

INCLUSIONS EXCLUSIONS
In patient treatment during hospitalization Pre-existing diseases or conditions
Emergency treatments including ambulance charges Lifestyle related conditions and substance abuse
Domiciliary treatment Alternative treatments
Neonatal care including vaccination Cosmetic surgeries
Preventive health check-ups Permanent exclusions such as war, AIDS, self-inflicted injuries, congenital diseases, etc.

Claim process

The process for claiming health insurance are as follows:

  • Cashless Claim:
    • Visit a registered medical practitioner, who will examine you and suggest further treatment, hospitalization, or laboratory procedures.
    • Intimate your insurance provider about the suggestion and the course of action you intend to take.
    • Visit the nearest hospital or nursing home or diagnostic center as required, which is registered with your insurance provider as a network hospital and inform them of your cashless health insurance.
    • After repairs are done, submit the bills and documents to the surveyor, which will be forwarded to your provider.
    • The hospital contacts your insurance company regarding the cashless claim and is directly paid upto the assured amount.
  • Reimbursement claim:
    • Visit a registered medical practitioner, who will examine you and suggest further treatment, hospitalization, or laboratory procedures.
    • Intimate your insurance provider about the suggestion and the course of action you intend to take.
    • Visit the nearest hospital or nursing home or diagnostic center as required, and complete the procedure including payment normally.
    • After the procedures are completed and you are discharged, submit all relevant documents along with the hospital bill to your insurance company within 15 days.
    • The company will go through your claim request and if approved, they will reimburse you for the sum assured.
Health Insurance - FAQs

Let’s Clear Your Doubts

Health insurance plans are usually long term plans that come to your assistance in cases of emergency. Thus, there are certain things in the health plan you are going to purchase that you must consider for complete protection:

  • Max renewal age of the plan
  • First and second year exclusions.
  • Coverage of daycare treatment/procedures.
  • Cover for preexisting conditions.
  • Sublimits if any.
  • Single illness limit if any.
  • 30 days exclusion.
  • Premium for policy renewal.
  • Cashless facilities.
  • Portability of your policy.
  • Add-ons.
  • Top up plans if any.

Health Insurance policies come with added tax deduction incentives. Under Section 80D of the Income Tax Act, you will be eligible for a maximum deduction of Rs. 15,000 per year on your premiums, and Rs. 20,000 for senior citizens. This is cumulative if you are paying premiums on behalf of your parents, so you can claim an additional deduction of Rs. 15,000 per year if you pay premiums on their behalf, or an additional Rs. 20,000 if they are senior citizens.

Health insurance for hospitalization can be claimed if the patient is admitted for a minimum of 24 hours in a hospital with some exceptions. These exceptions include:

  • If the treatment or procedure is such that it necessitates hospitalization, or the infrastructure for it is only available at a hospital.
  • If the treatment normally requires more than 24 hours hospitalization, but technologically advanced hospital infrastructure lets this be completed in under 24 hours.

Insurance providers have a specific list of procedures where this is applicable. Additionally, different insurance providers have different sets of conditions for the clause to be inapplicable.

Yes, you certainly can change the hospital in favour of one where better treatment is available. However, these cases undergo strict evaluation by a Third Party Administrator (TPA), and admitted on case to case merit basis.

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To increase insurance penetration in India, government recently has allowed a new type of distribution system to market the most basic insurance policies called as point of sale or POS. Now you can become a POSP (point of sale person) of Eureka Insurance Broking Pvt. Ltd.

 

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