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Health Insurance

Health Insurance is a segment of insurance that basically takes care of your medical expenses in the event of medical emergencies. Health insurance plans, safeguards you and your family against the health adversities. With the rising cost of treating medical emergencies, it has become imperative to take a health insurance policy for yourself and your family. A health insurance policy like other policies is a contract between an insurance company and an individual / group in which the company agrees to furnish definite health insurance cover at a specified premium related to the health policy.

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Terminologies used in the Health Insurance Parlance
The legal document which behaves as a contract between the insurer and insured specifying all the terms &conditions including health coverage, benefits, exclusions, etc. is termed as “ Health Policy”.
The payout amount that the insurer is liable to pay to the insured in case of an eventuality covered in the health plan is termed as “Sum Insured “ which follows the principle of indemnity.
The predefined fixed percentage of the claim amount which is to be paid by the policyholder and the remaining amount will be settled by the insurance Co. is termed as “Co-Payment” .
The disease or medical condition which the person has before taking the health plan is termed as “Pre-existing disease”.
The fixed timeline or the time range for which the insured has to wait to get certain health benefits under the health policy is termed as “ Waiting Period”.
There are certain events or conditions which are not covered under the policy coverage are termed as “ Policy Exclusions”.
The list of hospitals and medical centers where the insured can avail cashless services or discounted services under his health plan is termed as “ Network hospitals”.
An organization which acts as a separate entity in processing the claims or provides cashless facilities as termed as “ Third Party Administrator (TPA)”.
Illnesses which are so severe that, even after treating the disease alters the lifestyle of a person drastically is termed as “Critical Illness”.
Spouse, unmarried kids, parents for whom the policy holder is responsible for are termed as “ Dependents”.
Types of Health Insurance Plans

Individual Health Insurance Plans

The individual health insurance covers only one individual who will reap the benefits provided in the health insurance plan. Under such plan, the insurer guarantees to take care of the medical costs of the insured in return for a premium. Such plans may cover hospitalization charges, along with pre and post hospitalization expenses, subject to the policy conditions.

Family Floater Health Insurance Plans

A family floater plan covers several members of a single family under one plan. The entire family, including spouse, parents, children can be covered for a specific sum assured by paying a lump sum premium amount for the entire family. In the event of multiple illnesses in the family, the sum assured can be shared between family members and multiple claims will be paid in a policy year basis the maximum limit.

Senior Citizen Health Insurance Plans

As the age advances more is the risk of getting sick and surrounded by various diseases. Health insurance plans have become the need of an hour. Senior citizens have to pay the hospital bills from their savings which will make a big hole in their pocket. Under one plan umbrella both senior citizen husband and wife can be covered or the plan can be taken on an individual basis as well. Health plans catering to the needs of the senior citizens offer policies within the age bracket of 65 to 80 years.

Critical Illness Plans

Critical illness insurance protects you financially in the event you are diagnosed with any of the critical illnesses such as cancer, stroke, kidney failure, etc. covered by the health plan. Upon diagnosis and a survival period of 30 days, you get a compensation equivalent to the sum assured opted in the plan.

Personal Accident Plans

Personal Accident plan safeguards you against personal accidents resulting in death or permanent total/partial disablement. Severe injuries caused by a personal accident can undesirably affect the earnings of the person affected and can significantly influence his/her life in multiple ways. This plan can be taken individually or can be taken for your entire family against unforeseen accidental events.The sum assured of the policy is paid to the policyholder or beneficiary as the case may be. Such plans may also cover hospital daily cash, subject to the terms & conditions.
Need for Health Insurance Plan
Health Plans provide financial security to encounter the health pertaining emergencies. In this changing era of hectic lifestyles, health concerns have aggravated and have become more complex. In such changing times, it is vital and essential to have a health insurance plan in hand, to shield you from the financial turmoil in the case of medical emergencies. Health insurance covers you from the risk of expenditure caused due to medical contingencies. In the present scenario where high medical inflation rates are touching the sky, not having a health insurance plan or inadequate amount of health insurance cover can prove to be a major personal financial catastrophe. So it is imperative to take a health insurance plan of the adequate amount to safeguard yourself and your family.
Benefits under the Health Insurance Plan
The basic benefits under the Health Insurance Plan are mentioned below. But it is imperative to understand that the benefits of the health insurance plan may vary from Insurer to Insurer.

Covers Medical Expenses During Hospitalization

Health Insurance policy covers the medical expenses, which are the rational charges that the policyholder has essentially incurred on the advice of a certified medical practitioner. It covers the inpatient hospitalization expenses like room rent, nursing charges, Surgeons, Anesthetists, Dieticians and other Doctors fees, ICU charges, etc. The scope of coverage of such expenses may vary from insurer to insurer.

Provides Pre and Post Hospitalization Benefits

Most of the health insurance plans cover pre and post hospitalization expenses for treating a specified medical condition. The coverage is stipulated to cover few days like 30 days preceding the date of admission and 60 days from the date of discharge. The number of days specified varies from insurer to insurer.

Provides Cashless Treatment

Almost all insurance companies provide the benefit of cashless benefits during your hospital stay if you opt from the network of hospital lists of the insurer. The intent is to provide the policyholder hassle free, tension free stay in case of medical emergency.

Tax Benefits

The health insurance premium that the policyholder pays for himself, his/her dependents (spouse and children) and his/her parents, are all considered for tax benefit under Section 80D of the Income Tax Act 1961, for a maximum value of Rs.25000 for Non senior citizens and Rs.30000 for senior citizens.

No Claim Bonus

NCB or No Claim Bonus is a benefit provided if the insured does not make any claim in the preceding policy year. No claim bonus may result in either added as an increment in the sum assured or a fixed percentage discount in the premium amount. It’s essential to compare the cost of the treatment and compare it with the amount of bonus to analyze the decision of making a claim or not. If the bonus amount exceeds the actual expense, it’s wise to pay from your own pocket.

Provides Emergency Ambulance Benefit

Many insurers cover the cost for transferring you / your family members who are part of the policy to or between Hospitals in the hospital's ambulance or in an ambulance hired by any ambulance service provider. The benefits amount is specified as per the policy terms and conditions. This benefit is provided only in case the claim is accepted.

Hospital Cash Benefit

A regular daily hospital cash benefit is payable in the event the insured is hospitalized due to either accidental bodily injury or sickness. This benefit is paid on a day to day basis, depending upon the level of cover opted for under your health policy.

Free Medical Check-up

Free medical check-ups are provided by the insurance companies in case you have a good claims history or at the end of claim free year. It varies from insurer to insurer as well.

Factors Determining Health Insurance Sum Assured
Your age is the imperative deciding factor in defining the Sum Assured. At an early age, you don’t require a very high health insurance Sum Assured as the susceptibility towards illness or hospitalization is lower as compared to higher aged people.
You want health insurance on an individual basis or for the entire family including your spouse, parents and children. Accordingly, only the Sum Assured will be decided basis the number of insured’s in the health policy.
You need to consider the growing inflation in mind, which is making the health services expensive day by day. So, basis the inflation factor, an adequate health insurance Sum Assured needs to be determined.
You need to check on the room rents and other expenses payable under your health insurance policy. Such factors are increasingly being linked to the sum insured opted for, it is always prudent to take suitable cover from an early age, as it may be stressful to ask for an increase in the sum insured post occurrence of a claim.
You need to analyze the location where you are residing. Is it metro or a non metro city. As the cost of medical health services varies with place to place.
What additional add on covers you need like Personal Accident cover, Critical Illness cover. That also defines the sum assured range for your health insurance policy.
Factors Determining Health Insurance Premium


Age is the most imperative factor that determines your health insurance premium. As your age advances ,the premium will be higher because it is assumed the older you get, the more prone you are towards the illness.

Sum Assured

Higher the sum assured opted by the policyholder under health plan more will be the premium the insurance company will charge to indemnify the amount in the event of a claim.

Previous Medical History

It is another key factor in deciding the premium amount. The clear medical history attracts less premium whereas if you have suffered some major illnesses or pre existing diseases then your insurer might ask for higher premium.

Number of Insured’s

The premium amount depends on the number of insured’s covered in the policy. Health insurance provides a family floater policy where you can cover your spouse, kids and parents as well. So more the number of insured’s more will the premium as compared to the individual health policy.

Claim Free Years

Claim free years are also a determining factor for the health insurance premium. With the claim free year you get a no claim bonus which might give you a certain percentage of discount on your renewal premium. So it may reduce your premium.
Add on Covers/Riders
Add on covers will make your health plan comprehensive. With the purchase of additional covers your health premium will elevate depending upon the add on cover opted for.

Critical Illness Cover

Critical illness means any disease or illness which is terminal in nature, such as cancer, massive heart attack, stroke, etc. Critical illness cover provides an immediate fixed specified amount, apart from the expenses incurred during the actual medical process. Usually a basic health plans covers 10-15 ailments on account of critical illness on average, but taking it as an add on the cover can cover up to 38 ailments in a case taken as an add on cover.

Maternity Cover

Maternity benefits are usually not included in the basic health plan. Add on maternity cover provides coverage against maternity expenses incurred during child birth after a waiting period. This could be two years or more, depending on the insurer and the plan. Apart from this, insurers also furnish an option to cover newborn babies, from birth till the end of policy term.

Personal Accident Cover

A personal accident add-on benefit covers the risks that erupt due to the death or total/partial disablement in the event of accidents. Personal accident cover is basically available, as separate insurance covers on additional premium amount. Such rider is supportive in the cases of medical emergencies occurring due to accidents. You need to decide the coverage of personal accident cover prudently to get saved from the gigantic hospital bills.

Room Rent Waiver Cover

A room rent waiver add-on benefit allows you to have an elevated room rent limits in case of hospitalization. Usually, most of the health plans have a fixed and specific predefined sub-limit on the room rent or room type. With this add-on rider you can go for either an improved or expensive room and still it wouldn't bother into your existing sum insured.
Before Buying Check on these Key Determinants

Co-Payment Clause

Co-payment clause specifies predefined fixed percentage of the claim amount to be paid by the policyholder and the remaining amount will be settled by the respective insurer. Basically, this option is offered in the group health plans, but now some companies have extended this clause in the individual policyholders as well. The intent is to keep a restricted cap on the claims out go. So check on the co-payment clause before buying your health insurance.

Waiting Period

The pre-existing disease is a disease or medical condition which the person has before taking the health plan. All pre-existing diseases may or may not be covered by the health plans. Even if it is covered, it will not be included from day first of buying the policy. There is a waiting period in the health plans for such inclusions. So check on the waiting period span before opting for the health insurance plan

Network hospitals

It is imperative to check on the list of network hospitals included in the insurer’s list. Check the inclusion of the facilities that you often visit in the network hospital list. It is all the more imperative factor to be taken into account if you are a frequent traveler or move cities.

Renewability Clause

Health insurance plans need to be renewed after the policy term ends. Check on the renewability clause before buying the health insurance plan. Go for the plans which offer lifelong renewability rather than limited renewability.

Pre/Post Hospitalization Expenses

Medical expenses paid before hospitalization are called Pre Hospitalization expenses and after discharge from the hospital are called as Post hospitalization expenses. During the hospitalization stay some portion of the treatment spread beyond the hospitalization stay like follow-up visits to the doctor, medicines, follow-up investigations, etc. So check on this aspect of coverage as well before applying for a health insurance plan.

Claims Efficiency

It is imperative to study the claim settlement ratio and claim settlement time of the insurance company before buying the policy. As in the case of medical emergencies, the need of the hour is the quick financial assistance from the insurance company. The insurer should have a higher claim settlement ratio and fastest claim settlement turnaround time.

Payout Options in Case of the Health Insurance Claim

1. Direct Payment or Cashless option

Under this scenario, the policyholder does not need to pay the network hospital and the treatment will be cashless. This means that the insurer pays directly to the hospital. Under the cashless scheme, the policyholder and other family members who are mentioned in the policy can undertake treatment from such hospitals, which are included in the list of network hospitals of the insurer.

2. Reimbursement of the Claim amount

Under this payout approach the policyholder pays the hospital bills for the duration of the treatment he/she (or other people covered under the policy) stays in the hospital. Later the policyholder can take a reimbursement of the claim amount from the insurer for the treatment that is covered under the policy undertaken by furnishing the hospital bills and other related documents.
Policy Exclusions
Following is the general policy exclusions:
All pre - existing diseases (the pre - existing disease exclusion is consistently defined by all insurance companies offering health insurance plans.
Under first year policy, any claim during the first 30 days from date of cover, for sickness / disease. Accidental injury claims may be entertained and does not require waiting period.
During the first year of cover – cataract, Benign prostatic hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital Internal diseases, Fistula in anus, piles, sinusitis and related disorders are under the exclusions.
Cost of specs, contact lenses, hearing aids
Dental treatment / surgery if requires hospitalization
Convalescence, general debility, congenital external defects, V.D., intentional self-injury, the use of intoxicating drugs / alcohol, AIDS, Expenses for Diagnosis, X-ray or lab tests not related to the disease for which the insured has been hospitalized.
Treatment related to pregnancy or childbirth, including cesarean section.
Naturopathy treatment.
The exclusions may vary from plan to plan and insurer to insurer.
Health Insurance Companies
Oriental Health Insurance
Agriculture Health Insurance
Apollo Munich Health Insurance
Bajaj Allianz Health Insurance
Bharti AXA Health Insurance
Cholamandalam MS Health Insurance
Cigna TTK Health Insurance
ECGC Health Insurance
Future i Health Insurance
HDFC ERGO Health Insurance
ICICI Lombard Health Insurance
IFFCO Tokio Health Insurance
L&T Health Insurance
Liberty Videocon Health Insurance
Magma HDI Health Insurance
Max Bupa Health Insurance
National Health Insurance
Raheja QBE Health Insurance
Reliance Health Insurance
Religare Health Insurance
Royal Sundaram Health Insurance
SBI Health Insurance
Shriram Health Insurance
Star Health Insurance
Tata AIG Health Insurance
The New India Assurance Health Insurance
United India Health Insurance
Universal Sompo Health Insurance
Benefits of buying Online Health Insurance
As Internet dispersion grows manifold in India and people becoming increasingly comfortable with transacting online, we are witnessing a huge online buying and selling of products and services in the country. Online Buying of insurance has propelled the customer to make informed buying decisions. Listed are the various benefits associated with buying online Insurance.

1. Cost Effective

Online buying allows insurance companies to save their operational cost by 20-25% by cutting on intermediary commission, cost of an agency, physical cost of branches and the cost of paper proposal forms. That is why insurance companies offer cheaper premium rates, because this saved cost is passed on to the customer buying online. Insurance policies purchased online are generally less expensive as compared with the basic traditional sales model .So the customer gets higher coverage at a lower premium cost.

2. Time Saving

In today’s time the only shortage we have is about time. We don’t have ample time to do things. When it comes to buying online insurance, it saves a lot of time of an individual. At a click of a button you are eligible to buy insurance online. The online buying process is a time saving process as compared to buying offline.

3. Convenience

Convenience of access is a major differentiator; all you need is an Internet connection to purchase a policy online. We all are ready to pay for things, but the prime factor is of convenience in today’s hectic life scenarios. The advantages of online buying insurance include instant issuances of policies and customization, toll-free numbers for assistance or live chat facility to the customer for resolving doubts and making the buying decision easy.

4. Option to Compare

One of the huge advantages of buying online insurance is that it allows you to make an informed buying decision in a simple and appropriate manner. You can choose, compare and buy the right insurance product for the right purpose. Comparing allows you to differentiate between the cost and features of various plans offered by top insurance companies. Online buying also facilitates the correct understanding of the product features and thus allows you to make a decision as per your objective and need.

5. Option to check the track record of the Insurance Company

With an advancement of social media, various customer platforms and websites, you can extract enormous information and feedback about the insurance company and their plans by the views of industry experts, regulator, existing customers and extract a fair idea about the track record of a company financially by knowing their solvency ratio, claim settlement ratio, customer service performance and various other parameters .All these information helps the customer to make an informed buying decision.

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