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Health Insurance

Health problems or medical emergencies are unanticipated events in our lives. With the skyrocketing cost of medical services in India, the only way to tackle them is by keeping ourselves prepared. A health insurance is an excellent way to keep yourself and your family members financially protected from unplanned illnesses and accidents.

Health insurance can be defined as a type of insurance coverage which covers surgical and medical expenses of the insured individuals. Based on the kind of health insurance you choose, you will have to either pay the medical costs yourself and then the insurance company will reimburse you for the same or the insurance company will directly pay for your medical expenses.

Types of Health Insurance

Health insurances in India are majorly divided into four different categories. Depending on your budget and requirement, you can choose one that suits you the best.

  • Individual Health Insurance- This type of health insurance policy covers the medical expenses of a single individual. For instance, if you buy an individual health insurance policy with a coverage of up to Rs. 3 lakh, you are eligible to claim the entire amount if your illness is covered by the policy.

  • Family Floater Health Insurance- This health insurance is designed to cover the medical expenses of all the family members. For instance, if you have a family of 3 and buy a family floater health insurance with coverage of up to 3 lakhs, the amount can be used by all the family members until it completely exhausts. If you are suffering from some medical problem and claim Rs. 1 lakh from the coverage of Rs. 3 lakh, other two family members can still make a claim for up to Rs. 2 lakh if they get hospitalised.

  • Critical Illness Policy- This type of health insurance is exclusively designed to cover the expenses of critical ailments, like heart attacks, cancer, etc. Generally, the policyholder is provided with a lump sum amount once when they are diagnosed with the problem. These policies are available as standalone policies, or you can also buy them as a top up on a standard health insurance policy.

  • Senior Citizen Health Insurance Policy- As the name suggests, this type of health insurance policy covers the medical expenses of senior citizens. While this type of plan was not available in the past, increasing number of insurance companies are now offering them to protect the ageing policyholders from rising medical costs.

Health Insurance Criteria

Health insurance plans can now be easily purchased online. However, companies avoid selling these policies to individuals who are considered medically risky. Moreover, there are also age limits for buying and renewing a health insurance policy.

Entry Age-

Generally, children are also covered in the health insurance policies purchased by their parents after 91 days or 3 months from their birth. Until the age of 25, children in India are considered dependents.

Maximum Age for Renewing Health Insurance-

Many of the health insurance companies in India offer policy renewal option throughout the lifetime of the policyholder. But after a particular age, they will ask the policyholder to go through medical tests for renewing the health policy.

Coverage of Health Insurance

The coverage offered by health insurance policies varies among companies. Thus, it is imperative to first compare multiple policies to choose one that provides you with most advantages. Generally, a health insurance policy covers-

  • Expenses of the donor if the policyholder goes through an organ transplant

  • Hospitalization expenses

  • Daycare procedures

  • Ambulance charges

  • Costs of medical check-ups

  • Expenses before and after hospitalisation

  • Maternity and newborn expenses

  • Costs for treating pre-existing medical problems (conditions applicable)

For the purpose of widening the coverage offered by your existing health insurance policy, you can always buy top-up or add-on health insurance plans. These policies will require you to pay additional premiums on your policy.

What is Not Covered in Health Insurance Policies?

No health insurance policy covers everything. The insurance companies fix some exclusion, and these exclusions vary between companies. Following are some of the most common exclusions-

  • Coverage only turns effective after 30 days from purchasing the policy

  • Cost of newborn babies and maternity

  • There is generally a waiting period of 2-4 years for the conditions and diseases that are pre-existing

  • Injuries and ailments that are caused due to nuclear risks, war, suicide attempts, civil unrest, etc.

  • Health problems, like STDs, HIV, and other related problems

  • Non-allopathic and unconventional treatments

  • Hormonal replacement or sex change procedures

  • Plastic or cosmetic surgeries

  • Treatments done by unqualified doctors

  • Treatments done outside India

How to Make a Health Insurance Claim?

With a health insurance policy, you can register claim during a medical emergency (if the medical emergency is covered by the policy). Depending on the type of policy you buy, claims can either be Cashless or Reimbursement.

Cashless Claims

As the name suggests, this type of claim doesn’t require you to pay any expenses for the medical treatment of illnesses or emergencies covered in the health insurance plan.

However, you can only get this facility in hospitals that are a part of the network of your health insurance provider.

Cashless claims are further divided into two different types of hospitalisations- Planned and Emergency.

Planned Hospitalisation- When the hospitalisation is planned, all you need to do is to inform TPA (Third-Party Administrator) about your policy for getting the claim approved prior to admission. You will be required to fill some forms for the same.

Emergency Hospitalisation- If the hospitalisation is done on an emergency basis, you will be required to produce the health insurance policy card provided by your insurer and fill some forms for getting the coverage. There is also a possibility that the hospital might reject your cashless claim. However, the insurer will still reimburse the medical costs at a later stage.

Reimbursement Claims

Apart from the cashless claim, you can also pay the medical fees from your pockets and then make a claim for reimbursement. If your health insurance policy covers the illness, the insurer will reimburse the entire hospitalisation costs.

No matter if you go for a cashless claim or reimbursement claim, you will be required to provide all the required proofs and documents that are relevant to medical treatment. Also, the insurance company will only pay for the expenses that your policy covers. All the other charges will go out of your pockets.