Health Insurance

HeartHealth insurance (popularly known as Medical Insurance or Mediclaim) protects you and your dependents against any financial constraints arising on account of a medical emergency. It sometimes includes disability and long term medical needs. In Mediclaim, you pay a premium and in return the insurer commits to pay a predetermined sum of money to meet the claims. Health insurance is new in Indian context and is slowly catching up with the consumers. Consumers understand the objective of health insurance and it’s offering to cover the ever rising medical expenses.

Health insurance is available to both individual and groups. However, premium for individual policy is costlier than that of the group policy. An individual is the owner of his personal policy. Whereas in group plans, the sponsor is the owner of the policy and the registered members are covered by the policy. You can take advantage of group health insurance to overcome the shortage of your individual insurance. People with no policy or are uninsurable due to one or the other reason can take good advantage of the group plans and be covered.

However, before buying a health insurance policy, plan your requirements carefully. It will save you from buying a policy which might not be appropriate for you and can also be expensive.

What is Health Insurance?

The term health insurance (popularly known as Medical Insurance or Mediclaim) is a type of insurance that covers your medical expenses.The concept of health insurance is new in India but its awareness is growing fast. Health insurance comes in handy in case of severe emergencies. Life is unpredictable, insurance can make it safe and secure from bearing huge financial loss. A health insurance policy is a contract between an insurance company and an individual. Sometimes it is associated with covering disability and custodial needs. The contract is renewable annually.

Health insurance is affordable and carries the assurance and freedom from insecurities that threaten normalcy now and then. The type and amount of health care costs that will be covered by the health plan are specified in advance. Health plans are available in two formats, individual and group plans. In an individual policy you are personally the owner of the policy. While in a group plan, the sponsor owns the policy and the people covered under it are called its members.

Why Health Insurance?

Medical expenses are sky high these days. An appointment with a doctor might churn out big bucks. The elaborate medical treatment expenses could eat into your savings meant for the future. Health insurance policy kicks in to ensure that you get the required treatment and your pocket is still under control. Having health insurance is important because the coverage helps people get timely medical care and improve lives and health. It covers the risk of financial difficulties in the event of long illness. The awareness has been enormous in the last couple of years. This must have been in response to the series of uncertainties people have observed in recent times like the terror attacks.

Benefit depends on the policy you choose and the coverage it provides. Here is a list of basic coverage provided by most of the health policies.

  1. It helps securing a better future by paying a fraction as an expense today called the premium.
  2. It reduces saving huge amount of financial losses, risk of financial breakdown in case of expensive medical and post-illness care.
  3. It definitely induces a sense of security to the insured.
  4. It provides financial security to the family members.
  5. It covers your hospitalization and medical bills.
  6. It also covers disability and custodial bills.
  7. You can avail tax benefits on the premium paid under section 80D of the Income Tax Act.
  8. The best factor, you can also opt for health insurance policies even after the age of 60.
Types of Health Insurance

Health care costs have seen a phenomenal rise in the recent times. This has led the customers to insure not only themselves but their family members also. It will cover future medical expenses and other related requirements if it ever arises. The need to insure has gained more importance amongst older generation who is either retired or will retire in the near future. Let us discuss the types of medical insurances available in the market.

Medical Insurance
This is typically a hospitalization cover and reimbursement of the medical expenses incurred in respect of covered disease or surgery while the insured was admitted in the hospital as a patient. Different types of medical insurances are available in the market like individual medical insurance, group medical insurance and overseas medical insurance. There are health policies that reimburse you the actual hospitalization cost for treatment of any disease and are offered by the non-life insurers only. These policies are popularly called “Mediclaim” policies. Other types of health insurances are provided by both the life and non-life insurers.

Critical Illness Insurance
Critical Illness plan insures you against the risk of serious illnesses in return of a premium you are required to pay. This gives you the same security of knowing that a guaranteed cash sum will be paid if the unexpected happens and you are diagnosed with any one of the critical illness. Sometimes a critical illness can change your lifestyle in addition to help within the home or the family. In this type of health insurance plan, the insured receives a lump sum amount within a few days of diagnosing critical illness. Once this lump sum is paid, the plan ceases to remain in force. Typically, a critical illness plan would provide cover for the illnesses mentioned below.

  1. Aorta graft surgery
  2. Cancer
  3. Coronary artery bypass surgery
  4. First heart attack
  5. Kidney failure
  6. Major organ transplant
  7. Multiple sclerosis
  8. Paralysis
  9. Primary pulmonary arterial hypertension
  10. Stroke
What does your Health Insurance Cover?

Health is an important aspect of our lives. Right from ages we had been cautious and concerned about our health and the risks involved in it. Today the awareness is rising and the response is positive. More people are interested in owning health insurance. Each year new illnesses and disorders are discovered by the researchers. This means our health is at constant risk and is wise to get insured. Health Insurance is a necessity and a measure which helps overcome huge losses. It might be an expense today, for a safe and insured tomorrow. These are the coverage we can broadly define:

Basic Coverage - A health insurance plan should provide cover for hospital rooms, doctor or surgeon fees, medical tests, medicines and related expenses. It provides you with essential protection plus a range of optional extensions that can be selected to suit your specific insurance requirements.

Specific Health Plans - It provides covers for critical illnesses or diseases such as heart attack, kidney failure, etc; most insurers offer critical illness plans. Another set of specific insurance plans target ailments such as diabetes and cancer. These plans offer cash on hospitalization, reimbursement for expenses incurred on surgical treatments, and such like.

Critical Illness Plan - Critica illness insurance is designed to provide financial assistance in the form of a lump sum, tax-free payout to help you overcome the financial stress and difficulties associated with diagnosis of a serious illness. Critical illness insurance plans supplements mediclaim, which reimburses the hospitalization and medical expenses. Critical illness insurance plans are benefit plans that pay the amount equal to sum assured, if the critical illness strikes, irrespective of expenses incurred on treatment.

Factors affecting premium of Health Insurance

Like any other insurance, the premium for Health insurance also depends on some factors which determine the amount we pay out. At times we generalize paying out the premium as an expense, but remember it is only a precaution for a secure future! It can save us huge loss if the coverage is planned carefully.

  1. Age is a major factor that determines the premium, the older you are the premium cost will be higher because you are more prone to illnesses.
  2. Previous medical history is another major factor that determines the premium. If no prior medical history exists, premium will automatically be lower. However, if you had suffered from specific illness the premium may turn out to be expensive.
  3. The premium cost also depends on the work environment of the insurance buyer. Supposedly the premium of a pilot will be more expensive than that of a teacher, or premium of a miner will be expensive. This is because the job of a pilot and a miner are more hazardous, thus they are more prone to disorders and risks than a teacher.
  4. Term of the policy helps in determining the premium, the longer the term the cheaper is the premium and vice versa.
  5. Claim free years can also be a factor in determining the cost of the premium as it might benefit you with certain percentage of discount. This will automatically help you reduce your premium.

Coinsurance is the portion of the health plan that requires you to pay a percentage of the coverage meaning that you will essentially be splitting the cost of your healthcare with your insurance provider. For instance, if your health plan has an 80/20 co-insurance rate, your insurance plan pays for 80% of your eligible medical expenses and you are responsible to cover the remaining 20% of the expenses.

Copay is available on many individual health insurance plans. This is the amount you pay for a visit to the doctor or for a prescription. Insurance companies use copayments to share health care costs.

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How to file a health insurance claim?

Taking health insurance and paying premium is one story and filing for claim is another. Claiming benefits can be quiet tricky at times so you have to be smart and careful while filing for the claim. To file a Health Insurance claim with your Insurance company one has to keep the following things in mind.

  1. Claim form duly filled and signed by the claimant.
  2. Discharge Certificate from the hospital
  3. All documents pertaining to the illness starting from the date it was first detected i.e. Doctor’s consultation reports/history
  4. Bills, Receipts, Cash Memos from hospital supported by proper prescription.
  5. Receipt and diagnostic test report supported by a note from the attending medical practitioner/surgeon justifying such diagnostics.
  6. Attending doctor’s certificate stating the nature of the operation performed, bill and receipt. Attending consultant’s / specialist’s / anesthetist’s bill and receipt, and certificate regarding diagnosis.
  7. Certificate from the attending medical practitioner / surgeon that the patient is fully cured.
  8. Details of previous policies if the details are not already with TPA except in the case of accidents