Whenever we hear the term “Health Insurance” or in general any “Insurance” related term, the first few thoughts are “What is the use?”, “How much do we need to pay annually?”, “What are the benefits that come along with it?” and most important of them all: “Which insurance plan can be the best for me and my family?”.
Before we spend too much time thinking about the Health Insurance Plans, we should know what health insurance actually is? According to Medical News Today, “Health Insurance is a type of insurance coverage that covers the cost of an insured individual’s medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.
In health insurance terminology, the “provider” is a clinic, hospital, doctor, laboratory, health care practitioner, or pharmacy. The “insured” is the owner of the health insurance policy; the person with the health insurance coverage.”
Many of us assume that health claims and med claims are the same and they both provide same kind of facility. But, it is not. Though Mediclaim and Health insurance plans are related to one’s health but they both work parallel, for example, Mediclaim pertains specifically to hospitalization. Or to put it in simple words, it covers only hospital related expenses. Thus, for filing a Mediclaim, hospitalization is required. While Health Insurance Plans is considered to be more comprehensive and it not only covers your hospitalization charges but also includes the pre and post hospitalization expenses, ambulance charges and more. One can file for health insurance claim for an eventuality regardless of hospitalization requirement.
IMPORTANCE OF HEALTH INSURANCE
The Health Insurance Marketplace offers a variety of high-quality health coverage choices for routine and non-routine medical services that can work for your family and budget. We all know that the medical expenses, even if it’s just a simple surgery, are sky-rocketing! Thus, buy a health insurance that will provide you financial protection in case of a medical emergency, allowing you to get the best treatment without having to worry about the expenses.
THINKING ABOUT HOW CAN YOU GET ONE?
Before getting into any other details, you must first decide who all need to be covered by the health insurance plan you wish to invest in?
Here are some TYPES OF INSUARANCE PLAN AVAIALBALE
- Individual Health Insurance Plan– This insurance plan provides coverage to an individual against certain illness, offering the benefits of cashless treatment, hospitalization charges recovery and various other add-ons.
- Family Floater Health Insurance– offers a fix cumulative amount towards the medical expenses of the whole family. This can be availed by any of the family members during the tenure of the policy. These plans work on the assumption that not all members of the family get ill at the same time. The expenses covered are for both pre and post hospitalization conditions.
- Senior Citizen Health Insurance Plan– As name suggest these kinds of health insurance plans are for older people in the family. It provides covers and protection from health issues during old age. According to the IRDA guidelines, each insurer should be provided with health insurance plan above an age of 50 years (if they never had any, before). If the person was using a regular/ individual health insurance plan, it is advisable to keep continuing it. Senior citizen health insurance plan, in that case, is not required to be purchased. It is because; the Senior Citizen Health Insurance Plan is considered to be very restricted and comes with certain guidelines including:
- Co-payments: Co-payment is typically a mandatory feature in all senior citizens health insurance plans. When the hospital bill comes, the insured has to share a portion of it i.e. make a co-payment. For example, copayment could be applicable on room rent and specific illness and surgeries including day care surgeries. In some plans, there could be 20 percent co-payment, if the treatment is taken in a hospital other than a network hospital.
- Sub-limits on hospital expenses: Sub-limits refer to the extent, usually a percentage of the sum insured, to which the insurance company will pay the claim for different hospital expenses. Doctors’ fees, surgery/operation charges, nursing expense, medicine cost and room rent, can have a specific cap called the sub-limit.
- Waiting period: more than anyone else, senior citizens should be very careful with the waiting periods in the policy. No diseases get covered during the first 30 days from the commencement of any policy and only the accidental hospitalization gets coverage from day one. Further, some diseases are covered only after the expiry of a specified period. There are 1-year, 2-year, 3-year and 4-year exclusions for certain diseases. Pre-existing illnesses are mostly covered after the after the expiry of four claim-free years.
- Pre-existing conditions: Coverage of pre-existing ailments is an important element in health insurance plans especially in the case of senior citizens. Get clarity on their coverage – by when will they be covered and up till what amount – from the insurer while buying them. Few companies allow coverage of pre-existing conditions after 24 or 36 months but may pay up only 50 percent of the claim in case of any such condition. In some plans, the pre-existing conditions like hypertension, diabetes and its complications are covered after 18 months of continuous insurance but only on payment of additional premium.
- Surgery and Critical Illness Insurance Plan– This insurance is brought as a standalone insurance plan or a rider for the treatment for various critical illnesses, for example, kidney failure, loss of motion, cancer, heart attacks and so forth. As the treatment for such diseases is costly, the cover needed is also high. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or a number of the specified conditions.
- Maternity Health Insurance– Medical insurance providers today take care of expenses, including both pre and post-natal care, child delivery (ordinary or caesarean), which also sometimes incorporates immunization of babies. It likewise covers transportation expense for transferring the mother to-be to the closest clinic/hospital of choice.
- Personal Accident Cover– These personal accident plans are frequently provided as riders to standard health plans. They incorporate hospitalization and bear medicinal cost, in case of a mishap. These are issued as fixed benefit policies, where specific amount is to be paid on the occurrence of the mishap or unforeseen events/accidents. If the person who is the victim is dead while getting him/her to the hospital or after getting s/he admitted, the insurance policy does not pay-out the charges in such cases.
Though there are more categories covering even the minute details, but these 5 are the major categories under which the Insurance Plan is based upon.
KEY ADVANTAGES AND FEATURES OF GENERAL HEALTH INSURANCE
- Cashless Treatment:
Most hospitals today have tie-ups with most major Insurance providers across the nation and have made their management efficient by creating a separate desk for Insurance related queries. There, one can always get the required information along with the benefit that the insurance plan has to offer. So, if the victim is insured with a health policy then after few stages of verification, the claim is generated i.e., all they need is to provide their valid documents for verification and the rest is taken care by the authorities of the hospital itself.
- Pre and Post Hospitalization: This element of a medical coverage deals with both pre and post hospitalization expense over a period of 30 to 60 days, based on the policy Pre-hospitalizationexpenses refer to the expenses incurred before a patient is moved to a hospital for inpatient treatment. Following expenses can be considered as part of the pre-hospitalization expense in a health insurance policy: Medical Test, Medicines, Vaccinations and Doctors’/Medical practitioner’s fees. While Post-hospitalization expenses are similar in nature, and sometimes referred to as ‘recuperation expenses’. Meaning the medical expenses incurred by the insured to regain his/her pre-illness/injury condition. Both pre and post-hospitalization expenses will be covered, only if the following conditions are met:
- The insurer has accepted the claim for hospitalization expenses
- The expenses have been incurred for the same illness/injury/disease for which the hospitalization was required.
- The expenses have been incurred within the time limits prescribed by the insurer:
- Pre-hospitalization time limit ranges between 30 to 60 days before hospitalization
- Post-hospitalization time limit ranges between 60 to 90 days after hospitalization
- Ambulance Charges/Fee: The individual is free from the burden of transportation expenses, as it is covered in the claim.
- Free CHECK UP: Yes, it is true. Health insurance policies comes with the benefit of free check-up. Usually the insured thinks that by availing these offers of free check up, they might escalate the rate of their policy. But it’s time to break the myth. Health policies gives free check up benefits without impacting the premium rate.
FACTORS TO CONSIDER BEFORE GETTING YOURSELF AN INSURANCE PLAN:
· Inquire about the agent offering Insurance Product- Before purchasing any insurance term plan, it is crucial to get the correct agent and clarity after checking the license of the agent.
· Check the history of the company and their past records of health insurance plan: It is always advisable to know every detail of the company and how their insurance plans are benefiting their customers.
· Kind of Health Insurance Policies given by the company: before you jump to any conclusion, it is recommended to go through the types of Insurance plans offered and compare their facilities with the other insurance plan. As a saying goes, the bigger the better!
· Convertible/Non-Convertible policies: It is very important to check whether the health insurance plan is giving the flexibility to the customer of converting their insurance plans as per the convenience of the insures.
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