Health Insurance

What is Health Insurance

Health insurance is a type of insurance that helps you pay for your medical expenses when you get sick or injured. It is like an agreement between you and an insurance company, where you pay a certain amount of money called premiums, and in return, the insurance company agrees to cover some or all of your medical costs. This can include expenses for doctor visits, hospital stays, surgeries, medications, and more. Having health insurance can help you save money on healthcare and provide peace of mind knowing that you are protected financially if you get sick or injured.

Importance of Health Insurance

Health insurance plans are of great importance in India for several reasons:

Rising Medical Costs:

The cost of medical treatment in India has been rising steadily over the years. Health insurance plans can help individuals and families cope with these costs and avoid the financial burden of medical expenses.

Protection Against Uncertainty:

Health issues can arise unexpectedly, and the expenses associated with medical treatment can be high. Health insurance provides protection against such uncertainties and ensures that individuals and families are financially secure in the event of a medical emergency.

Access to Quality Healthcare:

With health insurance, individuals can access quality healthcare without worrying about the cost. They can choose hospitals and doctors based on their preference, rather than affordability.

Tax Benefits:

Health insurance premiums are eligible for tax benefits under Section 80D of the Income Tax Act, which can help reduce the tax liability of the policyholder.

Customizable Coverage:

Health insurance plans can be customized to suit the specific healthcare needs of individuals and families. Policyholders can choose the type of coverage they require, such as coverage for critical illnesses, maternity benefits, and more.

Cashless Hospitalization:

Many health insurance plans offer cashless hospitalization, which means that the policyholder can avail medical treatment without paying anything upfront. The insurance company settles the bills directly with the hospital.

In summary, health insurance plans are important in India because they provide financial protection against rising medical costs, uncertainty, and access to quality healthcare. They also offer tax benefits, customizable coverage, and cashless hospitalization, making them an essential part of one's financial planning.

What are the benefits of purchasing health insurance online?

Looking to buy health insurance? Consider purchasing it online for added convenience and a wide variety of plan options. Here are some reasons to buy health insurance online:

Buy Health Insurance Online

Here are three steps to buying a health insurance plan online:

Step 1

Research and compare: Start by researching and comparing different health insurance plans offered by various insurance companies. Use online resources to access plan details, coverage benefits, premiums, and customer reviews.

Step 2

out the application: Once you have shortlisted a few plans that meet your requirements, fill out the application form online. You will need to provide personal information such as your name, age, occupation, and medical history. Be sure to read the terms and conditions carefully and understand the coverage benefits, exclusions, and limitations of the plan.

Step 3

Make payment and receive policy: After submitting the application, make payment through a secure payment gateway using your preferred mode of payment. Once the payment is confirmed, you will receive an email confirmation and a copy of your policy documents. Make sure to keep the policy documents in a safe place and read them carefully to understand the coverage benefits and the claims process.

Health Insurance Key Features

Let's explore the main features of health insurance plans that you should keep in mind while comparing different options:

Factors to Consider Before Buying Health Insurance Policy

Health insurance plans can be a vital investment for your well-being and financial security. Before buying a health insurance plan, here are some key factors you should consider:

Health Insurance Inclusions

Health insurance plans typically cover a range of medical expenses in India. Here are some of the key benefits that you can expect from a health insurance policy:

In-patient Hospitalization Expenses - If you require hospitalization for more than 24 hours due to an illness or injury, the medical expenses incurred during your stay will be covered by the insurance company.

and Post Hospitalization Expenses - The cost of medical tests required before hospitalization and the expenses incurred on medication and check-ups after being discharged from the hospital are usually covered.

Charges - Many health insurance policies cover emergency ambulance charges. Maternity Cover - Medical expenses incurred during pregnancy and delivery, including newborn baby expenses, are usually covered.

Health Check-ups - Some health insurance plans offer regular health check-up facilities.

Procedures - Medical treatments that do not require hospitalization for more than 24 hours, such as eye surgery, dialysis, and other common procedures, are typically covered.

Treatment Cover - Some policies also cover the expenses incurred on getting medical treatment at home on the advice of a medical practitioner.

Benefit - Many health insurance plans reimburse the medical costs incurred on Ayurveda, Unani, Siddha, or Homeopathy treatment up to a specified limit.

Healthcare Cover - All health plans are required to cover mental illnesses as per the Mental Healthcare Act, 2017. This includes conditions such as acute depression, bipolar affective disorder, and schizophrenia, among others.

Health Insurance Exclusions

The following is a list of medical expenses and situations generally not covered by a health insurance plan:

• Claims arising within the initial 30 days of buying the policy, unless it's an accidental emergency
• Pre-existing diseases coverage is subject to a waiting period of 2 to 4 years
• Critical illnesses coverage usually comes with a 90-day waiting period
• Injuries caused by war/terrorism/nuclear activity
• Self-inflicted injuries or suicide attempts
• Terminal illnesses, AIDS, and other diseases of similar nature
• Cosmetic/plastic surgery, replacement of hormones surgery, etc.
• Dental or eye surgery expenses, unless specified under the policy
• Bed rest/hospitalization and rehabilitation for common illnesses
• Treatment/diagnostic tests and post-care procedures, unless specified under the policy
• Claims arising out of adventure sports injuries or hazardous activities

Note: It is recommended to check your policy wordings to get a detailed and accurate list of exclusions for your health insurance plan.

Riders in Health Insurance

Additional coverage that you can purchase to enhance your health insurance policy are called riders. The cost of these riders depends on various factors such as age, sum insured, and type of coverage. Below are some of the most common riders that you can consider purchasing along with your health insurance policy:

How to File a Claim in Health Insurance?

Filing a claim for health insurance is an essential aspect of the policy. There are two ways to file a claim: health reimbursement claims and cashless claims.

Health Reimbursement Claims

For treatments received in non-network hospitals, the policyholder can claim reimbursement of the treatment expenses. After completing the treatment, the insured must settle the bill, gather all necessary documents, and submit a claim to the insurer or TPA for reimbursement.

Cashless Claims

For treatments received in network hospitals or cashless hospitals, the policyholder can avail cashless treatment services. After completing the treatment, the insurance company settles the bill directly with the hospital.

The process for filing claims for planned and emergency hospitalization may vary as given below:

For Planned Hospitalization:

• Inform the insurer at least 48 hours before the treatment.
• After getting approval from the TPA, file for reimbursement and cashless claims by submitting the claim form.
• Submit other related documents such as medical bills, reports, discharge summary, etc.
• The insurer pays the claim amount directly to the policyholder for reimbursement claims.
• For cashless claims, the hospital bill is directly settled by the insurer.

For Emergency Hospitalization:

• Inform the insurer within 24 hours of getting hospitalized.
• Show your health card at the hospital and submit the pre-authorization form to get TPA approval for emergency hospitalization for cashless claims.
• If approved, the insurer will settle the claim amount directly with the network hospital.
• If TPA approval is not obtained, file for reimbursement later.
• Submit all the necessary documents such as hospital bills, discharge bills, etc.
• The claim amount will be paid to the policyholder.

Frequently Asked Question