Health Insurance

A health insurance plan is a protection cover to protect your finances if you fall sick in the future due to illness or accident. It is financial protection that helps you when you need it the most due to hospitalization. This is an agreement between the insurance company and the customer where the former agrees to guarantee payment/compensation for medical costs in case the latter is injured/ill in the future, leading to hospitalization.

Health insurance plans reimburse insured customers for their medical expenses, including treatments, surgeries, hospitalization, and the like which arise from injuries/illnesses or directly pay out a certain pre-determined sum to the customer. In case of sudden hospitalization, illness, or accident, health insurance takes care of the expenses on medicines, oxygen, ambulance, blood, hospital room, various medical tests, and almost all other costs involved. It’s like that one friend who you know will always soothe your pain with some soup.

Generally, health insurance cover offers coverage for the following expenses – hospital room and boarding expenses, fees of the surgeon, physician, specialist, anesthetist, consultant, nurses, costs of blood, oxygen, surgical appliances, anesthesia, x-ray, dialysis, drugs, medicines, operation theatre charges, radiotherapy, chemotherapy, pacemaker, transplant organs, artificial limbs and many more. Be it a planned surgery/treatment or an unfortunate accident, our medical insurance policies are meant to cater to your medical needs. We recommend you buy a health insurance policy so that in future if the need arises you don’t have to shell out your hard-earned savings; instead, our medical insurance plans will act as a savior. In a nutshell, buying a mediclaim policy means having a safety jacket so as to be prepared to face any medical-related expenses that may arise in the future.

TYPES OF INSURANCE PLANS

• Individual plans–These are basic health insurance plans, covering the hospitalization costs of the person insured.
• Family plans–These are health insurance plans where all family members can be included in a single coverage model. In this case, a fixed sum assured is provided for any family member who falls ill.
• Senior citizen plans-These are special insurance policies designed to meet the needs of senior citizens who are above 60 years of age.
• Critical illness insurance plans–These plans cover specific critical illnesses such as kidney ailments, heart attacks, and so on. Cancer insurance and other plans are included in this section as well.
• Personal accident insurance–These plans offer coverage for hospitalization in case of any motor accident.
• Maternity plans- These policies offer coverage for pre and postnatal medical care and delivery expenditure. They also offer coverage for the new-born for a certain duration along with ambulance costs.
• Unit-linked health insurance plans– These plans offer health insurance coverage while also helping build savings to meet those costs which do not have coverage under the policy. These are insurance-cum-investment plans that help you accumulate corpus.
• Preventive Health Insurance Plans– The term preventive healthcare refers to regular health checkups and other diagnostics. Annual health checkups are an efficient way to catch any early symptoms and take the right measures to prevent diseases before they reach critical stages.
• Overseas Mediclaim Policies–Also known as travel insurance, and overseas the Mediclaim policy takes care of your health insurance needs while traveling abroad. The policy provides you hospitalization, medical treatments in case you meet with an accident overseas or fall sick all of a sudden while on a trip.
• Top-up health insurance plans–Top-up health insurance plans which provide supplemental coverage at minimal rates of premiums. If individuals feel that their coverage is low, they can buy top-up plans to increase the coverage. There is a deductible limit under these plans. Any claim which is in excess of the deductible limit is paid.

What are the kinds of health insurance plans available?

There are several kinds of health insurance plans. Here are the main ones:

• Individual plans-These are basic health insurance plans, covering the hospitalization costs of the person insured.
• Family plans-These are health insurance plans where all family members can be included in a single coverage model. In this case, a fixed sum assured is provided for any family member who falls ill.
• Senior citizen plans-These are special insurance policies designed to meet the needs of senior citizens who are above 60 years of age.
• Critical illness insurance plans-These plans cover specific critical illnesses such as kidney ailments, heart attacks, and so on. Cancer insurance and other plans included in this section as well.
• Personal accident insurance-These plans offer coverage for hospitalization in case of any motor accident.
• Maternity plans– These policies offer coverage for pre and postnatal medical care and delivery expenditure. They also offer coverage for the new-born for a certain duration along with ambulance costs.
• Unit-linked health insurance plans– These plans offer health insurance coverage while also helping build savings to meet those costs which do not have coverage under the policy. These are insurance-cum-investment plans that help you accumulate corpus.

How to choose the best health insurance company?

There are more than two dozens health insurance providers in India. Finding the best health insurance provider who meets your specific requirements is a huge task. To simplify the selection process, here we list out the key features you have to consider while comparing and evaluating health insurance providers.

• Claim Settlement Ratio

This is one of the biggest factors you have to consider. You invest in a health insurance plan, with the hope that the plan will provide you financial assistance at times of medical emergencies. Remember, that the insurance provider does not accept all claims. You need to choose a health insurance company that has a high claim settlement ratio (CSR). The higher the CSR, the higher are the chances of your claims getting approved. Most insurance companies publish their CSR numbers on their site. Make sure to consider this factor while evaluating health insurance providers.

• Solvency Ratio

This is another number that you have to consider. A higher solvency ratio denotes that the insurer has a higher proportion of asset holdings. This is good news for customers as the company has strong financials that it can dip into for resolving customer claims.

• Claim Settlement Procedures

Apart from the numbers discussed above, this is another essential factor. During medical emergencies, there isn’t much time to spend with the insurer. Look for health insurance companies that offer quick and hassle-free claim settlement procedures. The company must have a dedicated claim settlement team that can be reached easily via call, online chat, or mail. It’s better if the company has a smoother claim settlement formality as you don’t have to spend much time filing and getting your claims approved.

• Claim Settlement Turnaround Time

Apart from the ease of claims submission, the insurance provider must settle claims quickly, especially in the case of medical emergencies. If the company takes a long time to approve your claims, you have to bear the financial burden – hospital bills, doctor charges, and other medical fees, which can run to lakhs of rupees out of your pocket. Look for health insurance providers who have low claim settlement time.

• Number of Network Hospitals and Location

This is another huge deciding factor. Earlier, policyholders had to foot the medical bills out of their pocket and then submit reimbursement claims from the insurance provider. However, most health insurance providers offer cashless treatment facilities at hospitals. With cashless treatment, you can get treated at any network hospital (up to the sum insured) without paying any fee out of your pocket. The hospital has tie-ups with the insurance provider, and they get the bills settled directly with the insurance provider. Today, almost all health insurance providers have tie-ups with several hospitals that are part of their Preferred Provider Network.

While choosing health insurance providers, look for network hospitals in your area that have tie-ups with your preferred insurance provider. Additionally, take a look at the overall number of network hospitals offered by the provider to get an idea of their extensive coverage

Desclaimer :

• Hospitalization Expenses

A health plan covers in-patient hospitalization costs that occur due to an accident, illness, or a medical/ surgical procedure. Typically, your health insurer will pay for room rent, nursing, medical practitioner, anesthesia, blood, oxygen, surgical appliances, operation theater charges, medicines, drugs, consumables, and other devices required during a surgical procedure. This benefit is covered in most of the Indemnity based best medical insurance in India.

• Pre-Hospitalization Expenses

It covers medical expenses that occur due to illness for 30 days before the insured person was hospitalized. The days of pre-hospitalization included under the plan may vary from one insurer to another.

• Post-Hospitalization Expenses

It covers medical expenses that occur due to illness for 60 days after the insured person was discharged. The days of post-hospitalization included under the plan may vary from one insurer to another.

• Cashless Treatment

Best Health Insurance in India offers Cashless Treatment under its Health Insurance Policy. Most of the insurers offer the facility of cashless treatment, provided you are hospitalized in one of the listed network hospitals of your insurance company. In the case of cashless hospitalization, your insurer will pay your hospital bills. If you go to non-network hospitals, you can claim for reimbursement of medical expenses that are covered under the plan.

• Day Care Procedures

Some medical surgeries require hospitalization for less than 24 hours. Several insurers also pay for such events where you are not hospitalized for 24 hours rather admitted for few hours bases the treatment or surgery.

• No Claim Bonus

No Claim Bonus (NCB) is a benefit under your health plan if the insured person has a claim-free policy year. The advantage of NCB transfers to the insured is either through an increase in the sum assured or specified discount on the premium charges for the succeeding year. Being a healthy individual, you can enjoy a claim-free year and take benefits of NCB under your health plan.

• Hospital Cash Benefit

A hospital cash allowance is payable on a day to day basis. The hospital cash benefit depends on the terms of the policy. A specified minimum stay in the hospital is required to avail of this facility.

• Free Health Check-up

You can avail of the benefit of free health check-ups under your health. It includes a comprehensive health check-up for members covered under the plan. Some insurers offer health check-ups on renewal, and some provide this benefit of free health check-up upon claim-free year/s.

• Emergency Ambulance Benefit

Some insurers cover the ambulance charges for transferring the insured from home to hospital. The coverage amount of ambulance charges depends on the policy terms.

• Tax Benefits

The premium amount you pay for your own health policy or your family’s health plan is considered for tax benefit under section 80D of the Income Tax Act 1961. These benefits are subject to change in tax laws.

REASONS TO BUY HEALTH INSURANCE

• Growing inflation:In India inflation is growing every year, which means the medical treatment which sounds affordable today may burn a hole in your pocket tomorrow. The only way to tackle these issues is by getting a health insurance plan.
• Quality healthcare:You can give your family quality healthcare facilities in case of hospitalization.
• Lifestyle Diseases: Stress, pollution, unhealthy eating habits, gadget addiction, and undisciplined lives have made lifestyle diseases widespread. It’s important to buy a health insurance plan to tackle medical expenses rising due to rising lifestyle diseases.
• Inadequate Employee Health Insurance:Do you think you are securely covered under one health insurance policy against all threats? Be informed that your employee health insurance may prove insufficient. These days medical science has advanced hence it’s important to get the higher sum insured health insurance plans.
• Beat medical inflation: The cost of medical treatment in India is always on the rise. Funding medical expenses on your own will lead to financial loss hence it’s important to buy a health insurance plan to beat the medical inflation.
• Quality Healthcare: You certainly cannot compromise on healthcare quality. Best medical treatment has become a basic necessity, however having a health insurance plan promises quality healthcare as you don’t have to worry about the finances.
• Tax Savings: Health Insurance is a tax saving instrument. Enjoy up to *Rs.75, 000 Tax savings annually under section 80D with health insurance plans. Isn’t it amazing? You can save tax and secure your health too.
• Safeguards your savings:With a health insurance plan you can invest your savings for buying your dream house or taking the much-awaited trip. You don’t have to save for paying your future medical bills.
• Effective Financial Planning: Anybody may fall ill, and several medical treatments, especially a critical illness can obstruct you in achieving your financial goals.
• Peace of Mind Guaranteed: By buying a health insurance policy, you will get coverage against hospitalization expenses for you & your family. With the health cover, you don’t need to worry about medical expenses. It ensures peace of mind at the time of medical emergencies.

● Helps you Make Smart Investments

Health insurance is not only a smart move for people to protect their health but, also helps one maximize their tax benefits and, make use of special benefits such as a Cumulativ

Eligibility Criteria for Health Insurance in India:

When you wish to purchase health insurance, the insurance company could ask you to take certain medical examinations. Currently, majority of the health insurance companies in India provide coverage to individuals under 45 years of age without the need for medical exams..

Medical examinations usually comprise mainly of physical, urine, and blood tests. Although these tests seem simple, they have the ability to disclose a lot regarding human health. They can detect abnormalities in kidney and liver functions as well as an increase or decrease in blood sugar levels. They can also reveal whether you consume tobacco or alcohol. Those who seek health insurance and are above 55 years of age are generally required to take additional medical exams.

Documents required

The following are the documents you will require to purchase health insurance in India:

• Age proof:When purchasing a health insurance policy, you will be required to submit the age proof of all individuals who are going to be covered by the plan. The following documents are acceptable as proof of age:
  1. Birth certificate
  2. Passport
  3. 10th or 12th class marks card
  4. Voter’s ID
  5. PAN card
  6. Aadhaar card
  7. Driving license
• Proof of identity:The following documents can be submitted as ID proof when applying for a health insurance plan:

1. Aadhaar card
2. PAN card
3. Voter’s ID
4. Passport
5. Driving license

• Proof of residence:A permanent address proof must also be submitted when applying for health insurance. The following documents can be used for this purpose:

1. Telephone bill
2. Passport
3. Electricity bill
4. Driving license
5. Ration card
6. Voter’s ID
7. Aadhaar card

• Passport-sized photographs

Certain health insurance companies will require applicants to undergo medical examinations in order to qualify for coverage. Also, insurers can also request other documents apart from the ones mentioned above.

Health insurance covered :

• Sum Insured rebound

This acts like a magical back-up, which recharges your exhausted health cover to treat the next hospitalization of a new illness or injury.

• Installment Benefit

Do you like the idea of paying your health insurance premium in installments? If yes, then get your health cover with us and make the most of our installment benefit.

• No Medical Test Up to 45 Years

If you are young, hale, and hearty then get yourself a health insurance plan by HDFC ERGO without any medical check-ups.

• Cashless Home Health care

If your Doctor recommends you can get yourself treated at home and avail cashless medical facilities then this feature would be of utmost help.

• Hospitalization expenses

Just like every other health insurance plan, we cover you for your medical hospitalization due to illnesses and injuries seamlessly.

• Pre & Post Hospitalisation

It means all your pre-hospitalization expenses up to 60 days of admission and post-discharge expenses till 180 days get covered, like the costs for diagnostics, investigation, etc.

• Daycare procedures

Medical advancements help in wrapping up important surgeries and treatments in less than 24 hours, and guess what? We cover you for that as well.

• AYUSH Benefits

Let your belief in alternate therapies like Ayurveda, Unani, Siddha, and Homeopathy stay intact as we cover hospitalization expenses for AYUSH treatment as well.

• Organ Donor Expenses

Organ donation is a noble cause and we cover the medical and surgical expenses of the organ donor when harvesting a major organ transplant.

• Recovery benefit

If you stay in a hospital for more than 10 days at a stretch then we pay for other financial losses that might have happened due to your absence at home. It helps to take care of other expenses during your hospitalization. (Amount specified in the policy wording)

• Mental healthcare

We believe mental healthcare is just as important as hospitalization due to physical illness or injury; hence we cover hospitalization expenses incurred for treating mental illnesses.

• Free Renewal Health Check-up

Get a free health check-up within 60 days after policy renewal done by HDFC ERGO at the time of renewing your policy with us.

• Save Tax up to ₹75,000

Did you know that a health insurance plan is not just meant to safeguard your savings but also help you save tax? Yes, you can save up to ₹ 75,000 with HDFC ERGO Health Insurance plans.

• Lifetime Renewability

Once you get yourself secured with our health insurance plan there’s no looking back, this health insurance plan continues for your entire lifetime on break free renewals, you don’t have to exit from it.

• No entry age restriction

If you are 18 years old and above you can buy our health insurance plan without any hesitation. We secure people of all age groups.

What is not covered?

• Adventure Sport injuries

Adventures can give you an adrenaline rush, but when coupled with accidents, it can be hazardous. Our health insurance plan does not cover accidents encountered while participating in adventure sports.

• Self-inflicted injuries

You might think of causing injury to your precious self, but we don’t want you to hurt yourself. Our health insurance plan does not cover self-imposed injuries.

• War

War can be disastrous and unfortunate. However, our health insurance plan does not cover any claim that is caused due to wars.

• Participation in defense operations

Our health insurance plan does not cover accidents while you are participating in defense (Army/Navy/Air Force) operations.

• Venereal or Sexually transmitted diseases

We do understand the criticality of your disease. However, our health insurance plan does not cover venereal or sexually transmitted diseases.

• Treatment of Obesity or Cosmetic Surgery

Treatment of obesity or cosmetic surgery is not eligible for coverage under your health insurance plan.

Health insurance claim settlement process

You can make a claim under a Health insurance policy in two ways:

1. Cashless basis and
2. Reimbursement basis

On a Cashless basis: For a claim on cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) who is servicing your policy. You have to seek authorization for availing the treatment on a cashless basis as per procedures laid down and in the prescribed form. Please read the policy document as soon as you receive it to familiarize yourself with the process rather than wait for a claim to arise.

Claims on reimbursement basis: Read the clause relating to claims in your policy document as soon as you receive it to ensure that you understand the procedure and the documents required for making a claim on reimbursement basis. When a claim arises you should inform the insurance company as per procedures required. After hospitalization, you have to ensure that you obtain and keep ready documents such as claim form, discharge summary, prescriptions and bills that you should submit for a claim.

Step-by-step method to file a Mediclaim in India

First,

• Put all receipts, bills and medical reports in order.

• Arrange them in chronological order.

• Check that all the documents contain required information like the patient name, document number, serial number, cost price, signature of the authorized person and so on.

Second,

Ask your insurance company for the claim form.

Usually the claim form can be downloaded from the insurance company’s website. Read the instructions given in the claim form carefully. Fill in the claim form with all the required details. Make sure the information is correct.

Next,

Get the claim form signed by the policy holder as well as the treating consultant. It must also be stamped with the official hospital seal.

Finally,

Attach all the relevant medical and policy documents to the claim form

Medical documents include:

• The discharge summary
• All documents relating to the patient’s illness
• All reports with details of the treatments and procedures conducted
• A certificate from the attending medical practitioner stating that the patient has recovered or is recovering

Policy documents include:

The Third Party Administrator (TPA) card

Third, prepare copies of all the original documents.

Both, the original documents as well as their copies, need to be submitted with the claim form. Submission of only copies is usually not accepted. Attach the documents in serialized or chronological order.

Review the documents carefully. Make sure that none of the documents issued at the time of treatment are missing. If any documents are missing at the time of submission, the claim may not go through.

submit the documents with the correct TPA.

You can get the name of the TPA from your insurance company. When you visit the TPA branch, ask an executive to check the submitted documents. Then submit the documents with the executive.

You should also inform the health care insurance company that the claim has been submitted, by sending them a set of copied documents.

Q1.Can a person have more than one health policy?

Q2.Is medical test mandatory to purchase a health insurance policy?

Q3.Is there any difference between health insurance and a mediclaim policy?

Q4.Why do I need health insurance?

Q5.How much health insurance do I need?

Q6.When should I make a claim?