Health Insurance

Health insurance is a type of cover that is provided to the individuals (who provide insurance to individual) in fulfilling their medical requirements. The insurance also covers the surgical expenses of the policyholder and the family members. The coverage criterion differs from policy to policy. The expenses can be paid directly to the insured or the hospital.

If the person rarely gets sick, he/she may think that there is no need to invest in any health insurance. It will be an excess burden and an extra expense that will carry no practical value. This is a very big misconception. Nobody knows the future and it’s better to stay ready rather than going bankrupt if any serious illness strikes. The need of any of the health insurance plans can only be felt in case of an emergency.

Importance Of Health Insurance Today

The expenses of medical requirements are getting higher day by day. When there is an option of getting some help to cover the expenses, an individual must take it. A health insurance will not only cover the policyholder, but the family as well. There will be no stress of saving a huge amount in case there is any need.

The importance of health insurance in modern times is increasing at a very rapid pace. The importance of health insurance in a person’s life is vast and some important points are:

Sufficient Medicare

If a person hasn’t invested in any health insurance plan, it will be very hard for him/her to manage the funds when life hits with any emergency medical demand. A health insurance plan provides the financial cover for that and gives the opportunity to live a stress-free life to the policyholder. The best health insurance plan will cover almost all of the medical demands one can make.

One thing to also note that these insurance plans don’t only work with government hospitals but an array of good private hospitals are also in the contract with the insurance company.

Economic Importance

Medical services are getting costlier on an hourly basis. If a person somehow gets admitted to a hospital, there will be many expenses that will be incurred. The numerous tests, medicines, doctor’s fees, bed charges, etc. are just some of those expenses..

No one is able to make assumptions that when he/she is going to be ill/sick and how much money will be needed? Many people don’t take these expenses into account while saving and that causes a huge loss and all the savings will get drained very fast. Health insurance plans provide the cover by taking a little amount as premium, monthly or annually as per the plan specifications.

Taking Care of Pre-Existing Diseases

Pre-Existing diseases are the diseases that are already present in one’s body at the time of purchasing the insurance policy and it’s a huge liability for the insurance companies to cover the policyholder for those diseases as well, otherwise, there’s no point in getting an insurance plan.

Not only the policyholder but the family members are also getting the cover for the diseases. One must fill all the details very accurately while getting an insurance policy and must not hide any kind of detail, minor or major. The best health insurance plan will not give any hurdle while claiming for the insurance.

Tax Exemption

It’s a surplus benefit that a policyholder will get. If a person has purchased a health insurance policy, he/she is liable to get a rebate of up to ₹25,000 annually. The tax rebate is allowed under Section 80D of the Income Tax Act. This rebate will be provided if the policy covers only the family of the holder.

If he/she also included parents in the policy, an extra rebate of ₹15,000-₹20,000 is provided on the income tax.

Benefits of Having A Health Insurance

Along with the importance, there are also many benefits that an individual has no idea that the policy he opted for also provides these. These benefits are the hidden ones and a policyholder, most of the time, is not aware of these benefits and therefore not able to extract the true potential of the policy.

Renewal Can Be Done Lifelong

Almost all the health insurance plans come with an age limit of 70-80 years. However, the renewal time provided by the companies is extended to 10-20 years more. But the limit set by a majority of them is 90 years.

If a policy comes with a lifelong renewal feature, one must go for that one only. If an individual is not able to get the cover in his/her old age when the medical needs are needed most, that’s a huge drawback of investing so much for so long.

Recovery Benefit

This feature of a health insurance policy is much underrated. It provides the holder an approximate amount when he/she gets discharged from the hospital. This amount is provided to the individuals to sustain until he/she joins work after the illness.

The only condition that this feature comes with is that the owner is hospitalized him/herself and the hospitalization period must not be less than 10 days. This feature is also called as convalescence benefit by some companies. A majority of people remain unaware of this and don’t make the claim.

Timely Care

Health insurance plans will provide timely care to the ill person. When there is no health insurance plan, this happens many times that the treatment gets delayed due to absence of funds that are needed. In many cases, it is seen that the delayed treatment actually worsens the condition of the patient. Health insurance will take care of all the expenses.

There are not many policies that are operational in India having this feature, but it’s happening.

Refill of The Cover Amount

The insurance companies generally leave the policyholder on their own if the total assured amount got used. This also kills the purpose of having an insurance policy. The part where this feature comes into play is when a person is hospitalized and the amount got exhausted, the insurance company refills the amount and doesn’t leave the policyholder hanging in time when that person needs the company most. This is one of the most important benefits of health insurance.

This feature comes with an extra premium amount but it’s totally value for money and if the company has this feature in the policy, one must opt for it as it basically provides extra cover than the actual insured amount.

Cashless

The insurance companies are now providing many cashless options and it awards the insured person with the option to stay away from the stress of cash. The insurance company will take all the responsibility and the policyholder will not have to deal with any payments.

Maintaining sufficient cash is a very difficult thing to do. At these times, the insurance companies come as the biggest helping hand. They deal with the hospitals and try to indulge in as less cash as possible. As the insurance company will deal all by itself with the hospital listed in its network, the cost will also be much lesser.

Top Up

The best health insurance plans come with this feature. It may occur that an individual got promoted or the business is finally on track or any opportunity came where the income of the policyholder increased, in that case, the holder has the option to get bigger coverage as he/she can now afford it.

It would be very tiring to get all the procedures done again to get a new bigger policy. The feature comes in very handy as it allows the individual to top-up the existing plan and it increases the cover amount by much. The premium is now set accordingly.

Room Rent

The health insurance will also cover the daily room rent. The hospital rooms are very much costly and have the potential to take a whole lot of savings. Insurance companies providing the cover for the same turns out to be of very much help. The only part that a person should worry about is reaching the hospital as soon as possible.

However, there is a cap on room rent coverage and the policyholder must take note of that before finalizing a purchase. Room rents can be very exhausting and a huge burden if the policies were not there to provide the cover.

Alternate Treatments

The insurance policies don’t cover the treatments taken from ayurvedic, homeopathic, or naturopathic routes. The companies put these treatments in their exclusion clause. However, the trend is changing rapidly. National Insurance is the first insurance company that came up with one such benefits of health insurance.

The regulatory authority, IRDA, is expected to take some reformative decisions in this step where the insurance companies will have to set a percentage in the cover amount towards the treatments that an individual is taking from these alternative methods.

Domiciliary Hospitalization

There are many cases that require the patient to stay at home, as he/she is not capable of moving to a hospital. As all the insurance policies only cover the expenses that are incurred in a listed hospital, they refuse to cover any amount if the patient is getting the treatment from home. There is a time limit for the in-home hospitalization. The cover amount will only be reimbursed if the hospitalization is of less than 72 hours.

This trend is also changing rapidly. If the doctor’s approval to get the treatment from home is attached, there are some insurance companies that cover the whole amount. This feature is known as domiciliary hospitalization. Before finalizing the purchase, one must check the brochure again if the company is providing this service or not.

Exclusions In Health Insurance Policy

There is a whole range of points that almost all health insurance plans cover. From any critical illness to a pre-existing disease and covering the policyholder’s family in case of his/her death, all are covered under almost all the plans that these insurance companies offer.

But, there are also certain areas that these policies do not cover and if the individual that is going to get a policy for him/her is not aware of those points, the person is going to feel like getting trapped as soon as the time of claim arrives.

Pre-existing Diseases

Some of the most common exclusions that most of the insurance companies do not cover are pre-existing diseases and alternative treatments (mentioned these as covered upside). However, these things are started to getting covered by some companies now and more companies are adopting it.

Still, there is much exclusion that is listed by the insurance companies and are not covered by any company whatsoever.

Lifestyle Conditions

The diseases and illnesses that are caused by the lifestyle choices of the individual are not covered by any insurance company. The diseases related to the lungs caused due to smoking or any other disease caused by alcohol consumption or any other drug are not covered.

Corrective Treatments

As the trend of getting cosmetic operations is becoming more and more common, the policyholders should not assume that these expenses are also covered under any insurance policy.

However, some companies provide the clause of covering those expenses if it is medically recommended and the necessity of the treatment process after an accident.

Pregnancy/Childbirth

If an individual thinks that the benefits of health insurance also include pregnancy expenses or even the hospitalization expenses at the time of childbirth, it’s not the area that insurance companies cover. The cover for these expenses are provided by some of the insurance companies after a fixed waiting period is over.

The same case also applies to the treatments of infertility or the expenses in case of an abortion. These are some points that everyone must keep in mind while purchasing any insurance policy.

Expenses Before Diagnosis

There are many tests that need to be done to reach the final diagnostic. These tests, however, are not cheap at all. But the insurance companies don’t provide the cover for that.

If the tests confirm that a person is a carrier of a certain disease, the company will definitely cover the costs from now on. This is the feature an individual must note about all the health insurance plans.

Suicide Attempts

The insurance company will not provide the cover in the case of someone harming him/herself or has attempted suicide. Any deliberate self-harm is not covered under any policy of any insurance company.

Waiting Period

The insurance policy doesn’t work as if a person purchased a policy today, he/she will start getting the cover from the next day. There is a clause in each and every policy that states all the waiting periods that the insurance company has preset to start providing cover amount to the policyholder.

The standard waiting periods are:

  • For existing diseases, it’s 2-4 years.
  • For conditions like hernia and related to ENT, it’s 1-2 years.
  • In case of treatment for newborn babies/infants, it’s 90 days.
  • For any spinal disorder, tumor, joint replacement, cataract, etc., the waiting duration is 2 years.

Miscellaneous

There are some exclusions that are permanent and carry no chance of ever getting a place in the coverage. The medical conditions that are caused due to war, self-harm, along with HIV and congenital diseases are some of the permanent exclusions.

It is very important for an individual to go through all the clauses along with terms & conditions before making the final purchase. In case of any confusion, ask the insurance company directly and never make any assumptions.

Top 5 Health Insurance Plans That You Can Consider

When it comes to getting a policy that covers the person along with his/her family, most of the people get very much confused and find themselves in the confusion. That causes the delay in getting a policy which eventually increases the premium amount.

Top 5 Health Insurance plans that a person can consider in 2019 are:

PlanSum InsuredAge Limit
Religare Care Health Insurance PlanUp to ₹50,00,00065 years
Aditya Birla Active Assure Diamond PlanUp to ₹50,00,000

Up to ₹2 crores for a comprehensive plan

80 years
Star Family Health OptimaUp to ₹15,00,00065 years
Max Bupa Health CompanionUp to ₹1 crore for a comprehensive plan65 years
HDFC ERGO Health SurakshaUp to ₹7.5 lakhs (best for low-income people)Up to 65 years for medical check-ups.

Religare Care Health Insurance Pan

The prime features of this plan are:

  • The policy comes with 65 years of age limit to enter the policy. Basically, it also applies to a person having the age of 100 years.
  • To the holders above 18 years of age, Religare Care offers a complimentary health check-up, it doesn’t matter if the individual made any claim or not.
  • There is also the provision of no claim bonus.

Aditya Birla Active Assure Diamond Health Insurance Plan

The prime features of this plan are:

  • The premium amount of this policy makes it very affordable and economic.
  • The top up provision is also provided that allows the policyholder to keep getting benefits even if the limit is exhausted.
  • A limit is also offered on this plan to cover the expenses if the policyholder is getting any alternative treatment such as Ayurved, Unani, Homeopathy, etc.
  • The plan offers the cover amount for expenses incurred from 60 days prior to the date of hospitalization and 180 days post the discharge date.

Star Family Health Optima

The prime features of this plan are:

  • The policy provides coverage for the whole family that too on a very affordable premium.
  • A sum of ₹5,000 is offered for the health check-ups every year without any additional cost.
  • Star Family Health Optima also covers the newborn babies from the 16th day of their birth date.
  • This policy has a list and network of over 6000 hospitals and also offers domiciliary hospitalization.

Max Bupa Health Companion

The prime features of this plan are:

  • The plan comes in 3 variants, individual, family floater, and family first.
  • Max Bupa Health Companion covers all the daycare expenses and provides a huge cover of over ₹1 crore.
  • The policy also covers all organ transplants and in-home treatments.
  • A discount of 12.5% is provided under this policy if an individual opts for a policy tenure of 2 years.

HDFC ERGO Health Suraksha

The prime features of this plan are:

  • Anyone from any age can get enrolled under this scheme. There is an entry age limit of 65 years.
  • Children under 5 years are covered under the policy with a condition, both parents should be insured under this policy..
  • The pre-existing diseases are also covered under the scheme, however, the waiting period is 4 years.
  • A 5% discount is offered as a no claim bonus every year if the policyholder doesn’t make any claim.

Why Health Insurance In Needed?

Most people haven’t yet understood the need and importance of getting health insurance. Though, it’s not any new thing that’s introduced in our country. There are a lot of people who are still not convinced that health insurance policy do any good to them. It is very important to understand the need of a health insurance and the benefit that the policy provides to the policyholder as well as the family.

The unexpected expense is just one of the many reasons for which the policy is needed. An individual can also remain stress-free that he/she has got a security that there will be no problem of funds to get treatment when there is a need.

There are many families that are unable to meet the medical expenses because the cost is going upward by every passing hour. Getting treatment when it’s needed is becoming a luxury and not everyone has the capability to afford it. Any disease related to cardinal or cancer will easily eat up around ₹5 lakhs to ₹50 lakhs in very easily. In case, a person hasn’t opted for any health insurance plans may not be able to bear such expense.

Some of the reasons to buy a suitable policy are:

Higher Cost

The higher medical costs are the first and foremost reason for anyone to buy a plan for him/herself as soon as possible. Health insurance plans are very important for elderly parents as they have extra medical expenses.

In case someone is getting hospitalized, there are many expenses that started to add up in the final billing. The expenses like doctor’s fees, bed charges, prescription costs, tests, check-ups, etc. are just a few of the many. As many people are moving to private hospitals in the hope of getting better treatment, these policies cover the expenses for those hospitals as well.

Quality Treatment

Another reason is getting quality treatment for everyone in the family. A health insurance policy can be a very effective tool to help in achieving that. Instead of getting all worried about the cost, an individual can actually focus more on the treatment quality and opt for a good hospital along with no stress on how the expenses will be met.

It is a need that most people don’t understand. In case a person is ill and hospitalized, he/she needs to stay relaxed as much as possible. Getting all worried about the expense will slow the recovery process and sometimes even decrease the health more than recovery.

Changing Lifestyle

There is a significant improvement in the lifestyle of a person when he/she remains stress-free from a certain area that carries utmost importance in human life. A health insurance policy takes away the full responsibility just by taking some little amount from a person as premium. Stress can take away a lot from a person and that situation start causing the fall in the set lifestyle.

Tax Redemption

The least important of all the reasons, but a salaried, as well as business person, can get some help in the tax rebate. Section 80D of the Income Tax Act allows the benefits up to ₹50,000. Especially for the salaried people who fall in the category of taxpayers, a health insurance policy can be a very good option to save some money along with getting health benefits.

Just like the list of getting all of the favorite things, adding health insurance will also yield some very good results at the time of the need. Getting a policy is not any difficult task anymore, the younger generation or the tech-savvy people can easily get a policy for themselves through the online route and there will be absolutely no need for any broker or commission expenses.

Frequently Asked Questions

No one wants to invest their hard-earned money somewhere where they remain unsure about the benefits they are liable to get. Before investing, there are a lot of questions that come up in everyone’s mind and to clear the confusions, it’s very necessary to address them and consult them to an expert. Some of the very general questions that are asked by the customers are:

What will happen to the policy if the policyholder who had opted for a family plan dies?

If the person was hospitalized and died in the hospital, all the expenses will be covered under the plan and the family will get full reimbursement. If the policyholder was also the eldest in the family and more than two persons are enrolled in the policy, the premium will be set again according to the age of the next person who is oldest of all.

Also, if the policy only accommodates two people, the plan will get converted into an individual plan.

What are the important factors I look at before making the purchase?

The things you must look at before making a purchase for any health insurance policy are:

  • The number of people the policy is willing to provide the insurance for.
  • The type of insurance cover, individual, family, or both.
  • The total sum insured, an individual should consider a policy good if it’s providing at least 8-10 times of his/her annual earnings as the cover amount.
  • Before making the final purchase, the factor that’s a must to look after is if the policy is coming with a cap amount.
  • The list of hospitals that are enrolled in the network of the insurance company also plays an important role in judging a policy.
  • Always clarify any point in the terms and conditions if it’s creating any confusion. Never make any assumptions.

What if I need to increase the total sum insured of an ongoing policy?

There are many insurance companies who provide the top-up facility where the individual has the option of getting the policy amount risen up by filling up a form at the time of renewal. This is the factor that the person should look after at the time of the purchase, if the policy will allow him/her in the future to do so.

Am I eligible to get reimbursements for maternity expenses?

No. The insurance policies don’t consider maternity expenses in the list of their inclusion criteria. As a health insurance policy generally only covers the expenses that were unexpected. However, there are some insurance companies that are now providing the service of covering maternity expenses on a bit higher premium. The trend is yet to be adopted by a whole lot of insurers.

Can I have the option to cancel the policy and get a refund?

The insurance companies provide a time duration of 15-20 days to understand all the clauses and decide if an individual wants to go further with the policy or not. If a person encountered any clause that he/she thinks is not good or suitable, the objection can be made within the specified time and the full refund will be made to you. Ask the company about the allowed cancellation period and then finalize the purchase.

Can I have more than one health insurance policy?

Yes, a person can have as many policies as he/she wants. If that person is capable of paying that many premiums, he/she can get as many policies.

Is the policy that I enrolled for is valid all over the country?

Nobody knows the time and place when he/she will need a medical requirement. Most of the policies cover this clause and provide the coverage anywhere a person gets hospitalized, only condition is that the hospital must be on the network of the insurance company.

The clause is generally covered by most of the insurance companies. An individual must make sure that the cover is not limited by any geographical condition. Check if any states/regions that are excluded. Some insurance companies also provide the benefit of covering health expenses in some foreign countries as well.

What are the provisions of discount on renewal?

Some companies offer a discount on the premium for the next year if you have not made any claim in the year. The discount is also known as a no-claim bonus which is given by a lot of companies and it came in trend only a couple of years ago.

Some companies also offer some complimentary benefits such as free check-ups, etc. once a year. The companies offer these complimentary check-ups to every policyholder, no matter if he/she made any claim in the previous year or not.

Will I get the reimbursement if the hospitalization duration is not even a full day?

Yes, the claim will be fully entertained. This service is known as Day Care Treatment. There are many technological inventions that can easily provide a person the benefit of getting treated in less than 4 hours, which earlier used to take 2-3 days along with intensive care.

However, a person must not assume that this is a service that is given by all the insurance companies. There are a lot of insurers that only provide OPD coverage which requires hospitalization for more than one day.

What will happen if the policy exhausted during hospitalization?

In such cases, if you informed about the situation to the insurance company, the company will be liable to pay all the benefits according to the plan you chose and its terms and conditions.

There can be two cases regarding the exhaustion, first is the policy got expired, and second, the expenses exceeded the sum insured. In both cases, the insurance company will provide that person all the benefits of health insurance.