Health Insurance

Health insurance is an insurance policy that protects the policyholder and his/her family against the medical costs that arise due to an accident, illness or on the diagnosis of any serious disease. The health insurance plan offers cashless treatment with network hospitals or reimbursement facilities for the medical cost of the treatment. Under section 80D of Income Tax Act, 1961, you can apply for tax deductions on paying health insurance premiums.

Benefits Of Health Insurance Policy

Insurance companies offer advantages to policyholders. They are as follows:

Cashless Treatment:It allows the insured to get the required treatment in network hospitals without paying a single penny during hospitalization up to the sum assured limit. The insurance company pays on your behalf and allows you to have a complete focus on your treatment.

Pre & Post Hospitalization Expenses: The expenses prior to hospitalization and after discharge from the hospital up to a specific period are covered by health insurance policy only if the expenses are associated with the illness subject to terms and conditions of the insurance company.

Tax Benefits: On buying a health insurance policy, you will be liable to receive tax advantages for the premiums paid under Section 80D of the Income Tax Act, 1961. One can avail tax benefits up to a certain limit depending upon the age of the policyholder and his/her parents (if any).

Daily Hospital Cash: This benefit is very useful during hospitalization as this will provide daily cash to a certain limit to take care of the additional expenses in the hospital like food, traveling, etc. Usually, the benefit amount is up to Rs.2,000 per day but it may vary in case of accidents and ICU procedures.

Organ Transplant Expenses: The costs for the transplantation of an organ are bearable by the insurance company. Health insurance covers the surgery expenses related to organ donation. However, the costs for complications after surgery, organ donor expenses, and medical tests are not covered under the same.

No Claim Bonus (NCB): It is a discount that you will receive from the insurer for every claimless year. NCB comes as a discount on the payable premium at the time of the renewing policy or whenever you want to increase the Sum Assured amount. At the time of renewal, you must check for No Claim Bonus benefit.

Free Health Check-Ups: To motivate the policyholders towards a healthy life, insurance companies offer free occasional medical check-ups. Depending on the company and the type of policy, you will be eligible for a master health check-up.

Lifelong Renewability: This keeps you insured for the long term. Most of us try to follow a healthy lifestyle but illness or accidents could take us by shock. Therefore, having a health insurance policy acts as a blessing in hard times.

Restoration Benefit: Once the sum assured amount is completely used, the insurance company will restore the amount automatically and you don't have to pay any additional cost for the benefit. The plans with restoration benefits are expensive as compared to normal health insurance policies and are applicable as per the clauses of the policy.

Types of Health Insurance Plans

To deal with the different needs of customers, there are multiple forms of health insurance plans available. Such plans are mentioned below:-

Individual Health Insurance

Individual health insurance covers the health expenditure of a single person or an individual, but there's always flexibility of availing the bigger sum assured. The premium that we pay annually depends on the amount of sum assured.

Critical Illness Plan

Critical Illness plan offers a fixed benefit/payout in case of any critical illnesses specified under the policy. With the lump sum benefit, you will be able to pay the huge hospitalization costs and get the treatment on time.

Senior Citizen Health Plan

Senior Citizen Health Plan is designed especially for the old age people who are above 60 years of age. This plan is to fight against all medical contingencies during old age. As per the Insurance Regulatory and Development Authority of India (IRDA) regulations, every insurance company must insure people up to the age of 65 years.

Maternity Health Insurance

Maternity health insurance is offered by almost every health insurance company that covers pre and post-natal care, child deliveries, and sometimes vaccination expenses of newborn babies.

Family Floater Health Insurance

Family Floater Health Insurance allows to insure all family members under a single policy. All the family members can enjoy the benefit of the entire sum assured. The amount of the premium paid is less as compared to individual plans. The policyholder along with the spouse, dependent children and the parents can be included in the plan.

Unit Linked Health Plan (ULHP)

Unit Linked Health Plan (ULHP) is a combination of health insurance and investment. Along with the health protection, ULHPs will help you in building a corpus that can be used by the investor to meet expenditures that do not get covered under health insurance plans.

Health Insurance Claim Settlement Process

The most important part of an insurance policy is the claim settlement process. People often worry about the claim settlements. Some insurance companies offer direct claim settlement process and some take the help of TPAs (Third Party Administrators) for claim settlement. The claim settlement process takes place in two forms which are mentioned below:

Cashless Claim

You can avail cashless treatment facilities only in the networked hospitals of the insurance company. The TPA must be notified beforehand in case of planned hospitalization, or within a specified timeframe in case of an emergency. The hospital's insurance desk helps with all the paperwork. The TPA has to approve the mediclaim amount, and the hospital will settle it with the insurer. There are likely to be exclusions i.e., expenses that the TPA won't pay. Such expenses must be settled by the patient directly at the hospital's cash counter.

Steps to follow

  • Inform the insurance provider on a call or through email.
  • In the case where the company is not responding through any mode of communication; contact us through phone or mail. We will help and guide you to settle your claims without facing any troubles.
  • Show the health card as provided by your health insurance company along with the identity proof.
  • The hospital will examine the identity of the policyholder and will submit the pre-authorization form to the health insurance company.
  • The insurance company will examine all documents, and if everything is fine according to their norms, then they will process the claim.
  • A few health insurance companies provide a field doctor to help you with the whole procedure.
  • After the completion of all formalities, the claim is settled as per the rules of the company.

Reimbursement Claim

The insurer can avail of the reimbursement facility both at networked and non-networked hospitals. Here, you can avail of treatment facilities and settle the bill directly with the hospital. You can then claim reimbursement of the expenses from the TPA by submitting relevant bills and receipts of treatment.

Steps to Follow

  • Inform the insurance company about your hospitalization as soon as possible.
  • In the case where the company is not responding through any mode of communication; contact us through mail or Phone we will guide you to settle your claims without facing any troubles.
  • Keep all your documents ready with the bills of hospitals.
  • Submit the documents along with the claim forms. Don't forget to attach the bills of hospitals.
  • The insurance company will check all the submitted documents and process the claim according to the terms and conditions of the health insurance policy.
  • After the completion of all formalities, the claim is settled as per the terms and conditions of the policy.

Documents Required For Claim Reimbursemen

  • Proof of Age: PAN Card, School or College Certificate, Driving License, Passport, Voter ID, etc.
  • Photo Identity Proof: Aadhaar Card, PAN Card, Driving License, Passport, Voter's ID, etc.
  • Proof of Address: Ration Card, Bank A/C Statement, Electricity Bill, Passport, Voter's ID, Telephone Bill, etc.
  • Proof of Income: Employer's Certificate, Salary Slip, Form 16, etc.
  • Medical Checkup: If asked by the insurance company.
  • Photo Proof: Passport size photograph of the policyholder.

Health Insurance Companies

  • Aditya Birla Health Insurance
  • Apollo Munich Health Insurance
  • Bajaj Allianz Health Insurance
  • Bharti Axa Health Insurance
  • Cholamandalam Ms Health Insurance
  • Future Generali Health Insurance
  • HDFC ERGO Health Insurance
  • IFFCO Tokio Health Insurance
  • ManipalCigna Health Insurance
  • Max Bupa Health Insurance
  • National Health Insurance
  • New India Health Insurance
  • Oriental Health Insurance
  • Reliance Health Insurance
  • Religare Health Insurance
  • Royal Sundaram Health Insurance
  • SBI Health Insurance
  • Star Health Insurance
  • Tata AIG Health Insurance
  • United India Health Insurance
  • Universal Sompo Health Insurance