As we know, health-related problems are rising nowadays, and the treatment costs are also increasing simultaneously. Thankfully, Health Insurance can provide financial assistance against such expenses. But what is health insurance? It is basically a contract between an insurance company and the policyholder, where the former offers complete coverage to the latter maximum up to the limit of the sum insured. It also offers medical coverage for medical expenses that are incurred during an emergency or planned hospitalisation. The insurance company reimburses the costs and expenses incurred due to illness or injury, etc. This plan includes the surgical and medical expenses of an insured, which are paid to
the insurer afterwards.
How Does Health Insurance Work?
A health insurance plan is designed to provide financial coverage against eligible hospitalisation and medical costs, subject to applicable terms and conditions of the plan. The policyholder is required to make premium payments for a specified tenure, where the policy specifies certain details, such as sum insured, waiting period, and other applicable terms and conditions.
In case of hospitalisation or medical treatment, a policyholder can opt for reimbursement or cashless treatment at a network hospital, depending on the policy terms and conditions. Under the reimbursement option, the policyholder is required to pay eligible expenses and then submit the necessary documents to the insurance company to get the claim settled. Under the cashless option, the insurance company settles the claim directly at the network hospital, subject to applicable terms and conditions.
The insurance company evaluates the claim depending on the applicable terms and conditions of the plan to settle the claim amount eligible as per the limit prescribed under the policy. Hence, it becomes necessary to understand the policy coverage, waiting period, exclusions, and claim process before buying a health plan.
Different Types of Health Insurance
The different Types of Health Insurance cater to different healthcare needs, providing coverage depending on factors such as family needs, age, and level of financial protection needed.
- Individual Health Insurance
This type of plan provides health coverage to an individual against eligible medical and hospitalisation expenses eligible subject to policy terms and conditions. The coverage may include surgery, hospitalisation, pre-and post-hospitalisation expenses depending on the plan.
Family Floater Health Insurance
This plan covers multiple family members under a single plan with a shared sum assured. The premium depends on certain factors, such as sum insured, members’ age, features of the plan, etc.
Critical Illness Insurance
This plan offers a lump sum amount of money on diagnosis, subject to applicable terms and conditions. The benefit amount is to be paid according to the amount mentioned in the plan, which may be used to meet medical and financial expenses. This plan may not require hospitalisation to raise the claim.
- Senior Citizen Health Insurance
This plan offers coverage to cater for the healthcare requirements of senior citizens, including hospitalisation and other eligible medical costs, subject to applicable terms and conditions. The premium amount also varies depending on certain factors, such as coverage, age, and other applicable factors.
Top Up Health Insurance
This plan offers additional health coverage whenever the eligible claim amount exceeds the applicable deductible, subject to applicable terms and conditions.
Group Health Insurance
This type of health insurance plan offers coverage to a group of individuals, such as employees of an organisation, under a single plan. The organisation buys the plan for the employee, subject to applicable terms and conditions.
Benefits of a Health Insurance Plan
Health insurance offers financial assistance against eligible healthcare expenses, thus reducing medical treatment costs. Some of the benefits are:
Financial Protection
This plan covers eligible hospitalisation and medical costs, subject to applicable terms and conditions.
Cashless Treatment
This plan allows policyholders to avail cashless treatment at network hospitals, subject to applicable terms and conditions.
Coverage for Hospitalisation Expenses
This plan covers surgery, hospitalisation, pre- and post-hospitalisation costs, depending on the plan.
Choice of Coverage
There are different plans available that best suit your choice, age, and family needs.
Taxation Benefits
The premium paid towards the plan is eligible for tax deduction under applicable provisions of the Income Tax Act, subject to prevailing tax laws.
Factors to be considered before buying a Health Insurance Plan
An individual should consider the below-mentioned factors before buying a health insurance plan:
Sum Insured
An individual should choose an appropriate amount of sum insured depending on the healthcare requirements and number of individuals to be covered.
Premium
Compare the premium cost against the features and coverage offered with the plan.
Waiting Period
Review the waiting period applicable to the specific treatments and pre-existing diseases.
Network Hospitals
Evaluate whether the plan offers access to the network hospitals near your location.
Inclusions and Exclusions
Understand the inclusions and exclusions of the plan, along with limits and conditions.
Claim process
Evaluate the claim process and the details required for cashless and reimbursement claims.
Conclusions
A health insurance plan lets the policyholders manage the financial uncertainties arising due to medical issues. It is therefore essential to understand the type of plans available, coverage, inclusions, exclusions, benefits, and applicable terms and conditions of the plan to choose an appropriate insurance plan. An individual should compare the premium amount and coverage offered, network hospitals, waiting period, and claim process to make an informed decision.
FAQs
Is there a waiting period in the health insurance?
Yes, there is a waiting period in case of certain treatments, specified conditions, and pre-existing conditions. Its applicability and duration depend on the plan.
Can I buy a health insurance plan for my family?
Yes, a health insurance plan can be purchased for the family, covering eligible family members under one single plan, subject to applicable terms and conditions.
Can I change my health insurance plan later?
Yes, a policyholder may port from an existing plan to another insurer depending on the insurance company, subject to applicable terms and conditions.
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