Why health insurance is necessary?

The modern day lifestyle has made illnesses very common among individuals, of all age groups. Though the advancement of modern medicine has found cures for the most serious of ailments, the costs involved are another matter altogether. Medical inflation is at an all-time high. Basic hospitalisation costs seem to burn a hole in the pockets of a common man. Add to this the higher probability of ailments and an average middle-class individual faces a heavy financial strain.

A health insurance plan fits in the picture in these cases. The plan pays for the medical expenses incurred and thus takes away the financial burden. As life expectancy rates increase, there are a growing number of senior citizens who will need to meet the growing expenditure of health care. A health plan is the ideal answer.. Increased life expectancy, higher probability of illnesses and the heavy medical costs necessitate a health insurance plan.

Which are the Top 9 health insurance companies in India?

Amidst dozens of general insurance companies offering health insurance products, here is a list of the top 9.

  • ICICI Lombard General Insurance Company Limited – this is a leading name in the general insurance market and the company’s health plans are designed keeping in mind the need of individuals.
  • Royal Sundaram General Insurance – the company offers a range of health insurance plans and allows cashless settlements across more than 3000 hospitals in India.
  • Religare Health Insurance – a standalone health insurance company, Religare is a reputed name in the industry.
  • Future Generali – also offers a range of health insurance plans which suit every requirement.
  • Apollo Munich Health Insurance – has a variety of health insurance plans with unique coverage features and benefits.
  • Max Bupa Health Insurance – a collaboration between Max India Limited and the UK based Bupa, the company offers customer-friendly health insurance products.
  • HDFC Ergo General Insurance Company Limited – a leading general insurance company, HDFC Ergo has tie-ups with hospitals across India for allowing cashless claim settlements.
  • Cigna TTK Health Insurance – the company offers simple health insurance plans at affordable premium rates.
  • Star Health and Allied Insurance Company Limited – a leading name in the health insurance sector which offers a whole gamut of health insurance plans.

How to choose the best health insurance policy in India?

The Indian health insurance market is flooded with various health insurance plans each of which offer something beneficial to the policyholder. Judge the plan on the following parameters to choose the best one –

  • The coverage features – look closely at the coverage features offered by the plan. They should suit your coverage requirements and be as exhaustive as possible.
  • The premium rate – the premium of the plan should be in proportion to the coverage features offered.
  • Waiting period – pre-existing illnesses are not covered in the first few months or years of the plan. If you have any pre-existing illnesses try and look for a plan with the lowest waiting period.
  • Premium discounts – the best health plan should offer premium discounts to reduce your premium.
  • NCB – the No Claim Bonus should be high so that the sum insured increases when you don’t make a claim while the premium remains the same.
  • Networked hospitals – the best plan should have an exhaustive list of networked hospitals wherein you can make a cashless claim.
  • Claim settlement ratio – the higher the claim settlement ratio the better are your claim settlement chances.

Best cashless mediclaim policy for families in India

A cashless mediclaim policy is the best option when availing a family floater cover. Here is a list of the top 10 plans for your consideration –

  • ICICI Lombard Complete Health Insurance – the plan covers inpatient AYUSH treatments without any sub-limits. The wellness program also motivates you to stay healthy.
  • Royal Sundaram Lifeline Plan – a plan offering sum insured levels up to Rs.1.5 crores and no sub-limits on room rent.
  • Religare Care – a plan with a unique super No Claim Bonus which doubles the sum insured within the first two policy years.
  • Future Generali Health Total – a comprehensive family health insurance which increases the sum insured in case of accidents.
  • Apollo Munich Easy Health – the most popular health insurance plan which comes in three different variants at very affordable premium rates.
  • Max Bupa Heartbeat Family Floater Plan – coverage is allowed for up to Rs.1 crore without any room rent sub-limits and it includes childcare benefits too.
  • HDFC Ergo Family Health Insurance – the plan has no entry age restrictions and allows coverage for maternity and new born babies.
  • Cigna TTK Pro Health Insurance Plan – a plan with five different variants offering coverage’s of up to Rs.100 lakhs.
  • Star Comprehensive Insurance Policy – a comprehensive plan for the family which covers bariatric surgeries too.
  • Star Family Health Optima – a plan which allows free annual health check-ups for all family members.

How much health insurance coverage do I need?

Your health insurance coverage needs should depend on the following factors –

  • The members covered – if you are buying a family floater plan the coverage should be sufficient to cover each member. If there are dependent parents in the floater cover, try and opt for a higher sum insured.
  • Your lifestyle expenses – should dictate the coverage requirements. If you seek hospitalizations in single rooms, your health insurance should have a high sum insured.
  • The expected cost of treatments expected expenses in case of a medical contingency is one of the foremost considerations. Understand medical inflation, the possible cost of hospitalisation and then decide the coverage you need.
  • Your employer’s health insurance – if you are employed and are covered under an employed sponsored group health insurance plan, you should weigh the coverage of that plan before choosing the coverage under an independent policy.

How to port a health insurance policy?

Porting is shifting or changing plans or company within a policy year. Under the feature of porting you can change your health insurance plan or your health insurance company. To port an existing plan you must raise a porting request your current insurance company. Keep in mind, the request has to be raised at least 45 days before the renewal of an insurance policy date. The request should be shared with the new company. When you port, you can retain the no claim bonus and avail the waiting period credit.

For example, a policy has a waiting period of 4 years and you have raised a request for porting after two years. In this case, 2 years will be deducted from the waiting period of your new policy – so it means you have to wait for only 2 more years, instead of an additional 4 years.

What are the various riders and benefits available in a health insurance?

A health insurance plan might have optional additional coverage features called riders which enhance the level of coverage at an additional premium. Some common riders found in health plans are as follows –

  • Critical illness rider – a list of specific critical illnesses is covered in case the insured suffers from a covered illness, a lump sum benefit is paid under critical illness plan
  • Hospital cash rider – a daily cash amount is paid in case of hospitalisation during the term of the policy.
  • New born baby rider – available in health insurance plans with a maternity cover wherein health expenses incurred on a new born baby are also covered.
  • Maternity rider – covers the delivery expenses for health plans which do not have an inbuilt maternity cover. Maternity Insurance covers pre-natal and post-natal expenses.
  • Room rent waiver – waives the limit on room-rent when health plans have a sub-limit on room rents.
  • Personal accident rider – pays an additional benefit in case of accidental death and disablements.

What are pre-existing diseases or conditions for health insurance?

In a health insurance policy, pre-existing diseases or conditions represent those ailments or illnesses which the insured is already suffering from when buying a fresh policy. If the insured is suffering from existing ailments and is aware about them, the information is to be shared with the insurance company. If not notified, claims arising out of such pre-existing conditions are rejected by the company on grounds of non-disclosure.

There is a waiting period applicable in all health insurance plans. This waiting period is specifically designed to cover pre-existing illnesses. Complications arising out of pre-existing conditions are covered only after the completion of the waiting period. During the waiting period, if any complications arise, the policyholder will bear the cost of treatments. In case of critical pre-existing conditions, the health insurance plan might also exclude coverage for related complications even after the waiting period. Some common pre-existing illnesses include diabetes, hypertension, etc.

What are the fine prints which I should know before buying health insurance?

Do not overlook the fine details of your plan. These are the following ones to be considered to make a valid claim –

  • Sub-limits on room rents – many health insurance plans have a room rent sub-limit. Expenses beyond these limits are not paid by the policy and should be checked before buying the plan.
  • Waiting period – pre-existing conditions are covered only after the waiting period is over. Be aware of the waiting period before buying a plan.
  • Exclusions – every health plan has a list of exclusions i.e. ailments and diseases not covered by the plan. Know these excluded coverage features to avoid making an invalid claim.
  • Co-pay ratio – if a senior citizen is covered under the plan, there would be a co-pay ratio which represents the portion of claim borne by you. Check this ratio.
  • Limits on specified treatments – treatments like cataract, AYUSH, domiciliary, etc. might have limits. Check for these limits.

What is health card?

When you buy a health insurance policy you get a card along with the policy documents. This card is called a health card. The card contains the name of the insured, the policy number, name of the insurance company and the contact details of the in-house claim settlement department of the company among other details. If the company uses the services of a TPA (Third Party Administrator), the name and number of the TPA is also mentioned on the card.

There are separate health cards for each family member in a family floater plan. The health card lets you avail the cashless claim facility at networked hospitals. It serves as the proof of the policy and provides necessary details to allow for cashless treatments at network hospitals.

What is the right time to buy health insurance policy?

There is no right time to buy a health insurance policy. Buy the policy as early as possible and include even the youngest members of your family in the cover. A health insurance plan should be bought once you become financially independent. A plan at a young age will come with lower premium, and in most cases, minimum or no medical checkup. The plan will help take care of hospital bills, doctors’ fees and related expenditures in case of accidents, other emergencies and even seasonal ailments like coughs and colds. People of all ages should have health insurance to meet with routine and unexpected medical expenditures.

What is sum assured in health insurance?

The sum insured in a health insurance plan is the coverage amount. Claims made up to the sum insured would be paid by the company. Costs exceeding the sum assured are to be borne by you. Thus, sum insured represents the maximum claim liability which the insurance company undertakes to pay in case of any covered medical expenses.

What is the waiting period for health insurance?

Waiting period means the period during which health insurance coverage is not allowed for certain diseases or ailments. Some of the different waiting periods are as follows –

  • Waiting period for pre-existing illnesses – if the insured suffers from a medical ailment when buying a new policy, that ailment and its related complications are not covered for a stipulated time. This waiting period for pre-existing illnesses usually ranges from 1 to 4 years.
  • Initial cooling-off period – there is a waiting period of 30 days to 90 days from the plan inception during which medical contingencies, except those occurring from accidents, are not covered.
  • Waiting period for specific treatments – there is a waiting period of 1 to 4 years for covering specified treatments like hernia, fistula, piles, cataract, joint replacement surgeries, etc.
  • Maternity waiting period – if the plan has a maternity cover, the cover is available only after a specified waiting period. This period ranges from 2 to 6 years.

Does a health insurance plan cover maternity?

Maternity coverage is allowed in selected health insurance plans. Coverage for maternity includes expenses incurred during childbirth (both normal and caesarean deliveries are covered), pre and post-hospitalisation expenses, pre and post-natal care expenses, etc. The new born baby is covered under many health plans providing a cover for maternity. However, even this cover has limits and exclusions.

Is medical check-up necessary before buying a health insurance policy?

The necessity of a medical check-up depends on the health insurance policy, the age of the insured and the sum insured selected. Usually, if the sum insured is up to Rs.5 lakhs and the age is up to 45 years, no medical check-up is necessary. However, for older adults or higher limits, medical check-ups become necessary. If the insured suffers from medical complications, a medical check-up might be required by the insurance company or if the underwriter feels the proposed risk is higher. The cost of the medical check-up is borne by the company either fully or partly. You will be required to undergo medical check-ups at the company’s pre-authorised laboratories or clinics.

What are the minimum and maximum health insurance policy durations?

A health insurance policy is offered for a minimum duration of 12 months. Some companies offer options for a continuous period of up to 3 years which is the maximum duration. You then pay the premiums for all three years at the time of buying the policy. In case of health insurance plans offered by life insurance companies, the duration might extend to 5 years.

Can I buy a health insurance if I am not an Indian citizen?

Yes you can. Non Resident Indians and foreign citizens are allowed to buy a health insurance policy in India. However, before buying a policy you should check for the following details –

  • Geographical coverage limitations – most health insurance policies offer coverage only in India while there are some policies which allow international coverage as well. Check the geographical coverage limitations when buying the policy.
  • Premium rate – a foreign citizen or NRI will be charged a higher premium.
  • Tax benefits – while NRIs can claim tax benefits for their health insurance premium under Section 80D, foreign citizens cannot. If you are foreign citizen get information on tax liabilities and benefits.

Ask questions, get clarifications on what is covered and where, before buying a health insurance policy in India.

Do health insurance policies cover outpatient expenses too?

Yes, there are some health insurance plans which allow coverage for outpatient expenses. This coverage is called OPD coverage and includes expenses incurred on doctor’s consultations, investigative reports, medicines and also dental treatments. OPD treatments, however, are covered upto a specified limit. Moreover, this feature is, usually, available in a health plan with a high sum insured levels of Rs.5 lakhs and above. Some health plans allow an optional coverage for outpatient expenses. You can choose to opt for this cover by paying an additional premium.

Can I purchase health insurance policy for my kid who is 3 years old?

You have two options to buy health insurance for a 3-year-old or for any other child. Buy an individual health insurance plan for your child -premiums would be paid by you while only the kid’s medical expenses will be insured. The second option is insuring the kid under a family health insurance. The plan would cover you, your kid/s and spouse under one policy. The premium would be determined based on your age and your kid/s can enjoy the coverage.

What are the advantages of Family Floater Insurance over an Individual Health Policy?

An individual policy restricts the coverage of the policy to a single person whereas, a Family floater Insurance policy offers flexibility by allowing any member to utilise the full Sum Insured. In addition, the total cost for individual policies is much higher as compared to a family floater insurance plan covering the same set of members.

What is a Health Card and what are its benefits?

A Health Card is a card provided as a part of the policy documents. It enables the policyholder to avail cashless hospitalisation at any of the network hospitals for the particular insurance company. It also includes the contact details of the Third Party Administrator in case you need assistance.

Do I need to purchase a separate Health Insurance Policy even if my employer is covering me in a Group Health Insurance Plan?

Yes. It is highly recommended that one should avail a separate health insurance policy, as the insurance provided by the employer is a shared policy and will be valid only for the period of employment period. In addition, an individual health insurance can also be customized according to your needs. But a group policy would provide better benefits and coverage.

Will my Health Insurance cover diagnostic charges like CT scan, MRI, X-Ray, etc.?

Diagnostic charges are covered when they are carried out during hospitalisation or detect a disease that leads to hospitalisation. In this case, the amount spent can be recovered by producing the receipts as pre-hospitalisation expenses. In case, no disease is diagnosed after the tests or it is a routine check-up, then that would not be included in the cover.

Can I add/ remove family members from my Family Floater Insurance policy after it is issued?

Yes. Based on the terms of the policy, you can add or remove family members to/ from a Family Floater Insurance Policy. In case of policyholder’s demise, the rest of the family continues to receive the benefits covered in the policy.

Is Ayurveda and Naturopathy covered in Health Insurance?

Although, Ayurveda covers several treatments, many insurers do not cover every treatment to avoid misuse. But, some insurers provide coverage for treatments such as Ayurveda, Naturopathy, Unani and Homeopathy during hospitalisation. Reach out to your insurer to ascertain if a specific treatment is covered in your health insurance policy.

Why should I opt for a Critical Illness cover?

‘Critical illnesses’ refer to fatal diseases that are terminal in nature. However, the definition varies from insurer to insurer. Diseases such as cancer, kidney failure, heart attack, and stroke are generally considered as critical illnesses.

A critical illness cover provides a lump-sum amount when the illness is detected. It is a protection over and above your health insurance. The person insured does not necessarily have to undergo treatment using that amount. It can be spent towards palliative care even when there is no hospitalisation or immediate medical expenses.

If I cancel my health insurance do I get a refund?

Cancellation of your health insurance policy is allowed and the premium is also refunded. However, the portion of premium refunded depends on the cancellation date or period. There is a free-look period of 15 days from the policy start date. If the policy is cancelled during this free-look period, the full-premium is refunded after deducting the applicable expenses incurred on pre-entrance medical check-ups (if any), stamp duty and the risk cover allowed until the date the policy is cancelled. Cancellation is also allowed after the free-. In that case, the amount of premium refunded ranges from 75% to 0% depending on the cancellation period. If the policy is cancelled after 6 months from the date of purchase, no premium refund is allowed. Cancel before 6 months of purchase to get a premium refund.

Which factors determine the Health Insurance premium?

While the premium criteria varies from insurer to insurer, the major factors that determine health insurance premium are age, gender, current health, existing diseases, , the family’s medical history, past surgeries and lifestyle choices (like smoking, drinking, etc.). In addition, place of stay and hobbies also influence the premium.

Can I get a No Claim Bonus under my health insurance plan if I do not make a claim?

Most health insurance plans offer a no claim bonus if you do not make a claim in the policy year. This No Claim Bonus increases every subsequent year when no claim is made. Though different plans will offer a variety of benefits, the most common ones under a No Claim Bonus are as follows –

  • Increase in sum assured – under most plans, the sum insured is increased for every claim-free year. There is a limit to the maximum increase which is allowed. The premium, however, remains the same even though the sum insured is increased.
  • Premium discounts – under many health plans, are discounted if the previous policy year was claim-free. This feature saves premium costs when the plan is renewed.
  • Discount vouchers – some health insurance plans also allow gift or discount vouchers after every claim-free year as a No Claim Bonus. The value of the vouchers is expressed as a percentage of the sum insured and the vouchers can be used for availing wellness discounts.

What to Do When Your Insurance Company Won’t Settle Claim?

The insurance company may not settle your claim due to a number of reasons. Here are the steps to follow for claim settlement –

  • Find out the reason of claim rejection. Check whether you have submitted all the relevant bills and documents and whether the claim you made is admissible on not. If the claim is made for an excluded cover, there will be no settlement.
  • Find out if you raised a claim within the specified time period. Emergent claims should be made within 24 hours of hospitalisation while for planned cases the time limit is at least 2 to 3 days in advance.
  • The company might reject your claim on grounds of non-disclosure. Check whether you did or did not disclose all material facts when buying the policy.
  • If everything is in order and you have a valid claim, approach the company’s internal grievance cell and make a complaint.
  • If you are not satisfied with the company’s internal redressal cell, you can approach an insurance ombudsman.
  • You can also approach the consumer forum for settlement of your claim.

When should I make a health insurance claim?

A health insurance claim should be made –for hospitalizations and medical expenses incurred. Ensure the expense is covered by your health insurance plan before making a claim. If you can afford to make the payment of a small medical expenditure from your own pocket, avoid making the claim as it will help accumulate the No Claim Bonus. Avoid the claim if the accumulated bonus is more economical. Make the claim within the prescribed time limits. In case of an emergency hospitalisation, make a claim within 24 hours of hospitalisation. For a planned treatment, the insurance company should be informed at least 48 to 72 hours prior to hospitalization. If you follow the time limits and adhere to the company’s terms, your claim will be settled without hiccups or delays.

What happens to the health insurance policy after the claim is filed?

After you file a claim, your insurance company will co-ordinate with the hospital in which you are admitted. For network hospitals, you get cashless settlement; the money is transferred directly to the hospital. For non-network hospitals, you settle the hospital bills and related reports, and raise them to the health insurance company. The money is reimbursed to your account. Once the claim is settled, the policy would continue for the remaining duration with coverage available for the remainder of the sum insured. If the sum insured has been exhausted, you can opt for a top-up plan or wait for the renewal date. Once renewed, the policy becomes a new policy with the sum insured restored and you can avail coverage as before No claim bonus will not be given. There might be a reduction in the accumulated bonus when a claim is made.

What are the common documents required to file a health insurance claim?

The documents required vary from condition to condition and treatment to treatment. However, the common documents are:

  • Copy of the current policy
  • Investigation report along with bills, details of consumables and disposables used for surgical purposes
  • Prescription of the doctor along with the chemist bills
  • Hospital discharge card

Is there a limit on number of claims that can be filed in a year?

The number of claims is not restricted. However, the total amount available for claim is fixed and is upto the Sum Insured.

How do I file claims for emergency hospitalisation?

In case of emergency hospitalisation, you might not be able to locate a network hospital offering cashless hospitalisation. You might not even have the Health Card. In such a case, you might have to make an out-of-pocket payment during admission. Later on, you can inform the insurer and submit the required documents to get the payment reimbursed.

Alternatively, you may use the mobile app to file a claim

What is the procedure for cashless and reimbursement claims?

In case of cashless claim, the insured/ family member must approach the hospital/ Third Party Administrator desk at the network hospital with the Health Card, medical documents and the policy documents.

The TPA verifies the details and assists the insured/ family member with the documentation. It then sends a pre-authorisation request to the insurance company, which sends an acknowledgement. Some insurance companies approve within a couple of hours!

In case of reimbursement claim, the customer after being admitted in the hospital gets the necessary treatment by making out-of-pocket payment immediately. The insurer later scrutinises the documents and processes the reimbursement.

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