Health Insurance

About Health Insurance

The health insurance covers a part or whole of the risk of the person incurring the medical expenses, spreading it over many people. With an estimate of the overall risk of the healthcare system and the expenses incurred related to the risk, the insurer can design a finance structure like the payroll tax or monthly premium for providing the finances for health care mentioned in an insurance agreement. The healthcare benefits offered to the patients is regulated by a nonprofit organization, government agency or private business. Health insurance covers the payments due to injury or sickness. It covers the expenses incurred due to accidents, disability, dismemberment, accidental health as well the medical expenses.

Importance of Health Insurance

There is an array of merits associated in purchasing a health insurance plan. Apart from the regular benefits of outpatient, inpatient care, preventive services, lab tests, behavioural, physical, occupational and psychotherapy, the health insurance plans offer an attendant allowance, domiciliary hospitalization, alternative treatment and no loading charge on premium during the time of renewal of the health insurance plan.

Best Health Insurance Policies in India by Top Insurance Company

  • Apollo Munich Easy Health Exclusive
  • Star Family Health Optima Insurance Plan
  • Max Bupa Heartbeat Health Gold Plan
  • Reliance Healthwise Family Floater
  • ICICI Lombard Health Advantage
  • Bajaj Allianz Health Guard
  • Oriental Happy Family Floater
  • United India Family Medicare
  • New India Mediclaim
  • National Insurance Varishtha Mediclaim

Types of Health Insurance Policies or Plans

  • Individual Plans: This individual health plan covers policy holders against different illnesses with various add-on features and cashless hospitalization. Under this plan, the complete insured plan covers a single individual.
  • Maternity Insurance Plans: This insurance plan covers the expenses related to the normal or cesarean delivery. It covers the pre and post hospitalization expenses to 30 days before the admission date and to a maximum limit of about Rs.5000. Room charge, anaesthetist, medical practitioners, surgeon and nursing fees are included in this insurance cover. It even includes the delivery charges along with the post and prenatal delivery cover and newly born cover.
  • Family Floater Health Plans: This plan covers all the members of the family under a single plan. The insured sum is fixed but gets exhausted when any member of the family makes the claim or avails the medical services. The members who are covered under this plan include the policy holder as well as his parents, children or spouse.
  • Personal Accident Covers: This insurance policy provides compensation in physical injury, mutilation, impairment or demise due to an accident related to the rail, air or road or drowning, burn injury, fall etc. The policy covers all the dependent members of the insured person in case of an unfortunate accident. This insurance cover assures certified and easy claim process. It provides substantial worldwide coverage and at a low premium as well as around the clock support service. It offers funeral, legal and child education expenses.
  • Senior Citizen Plans: This health insurance plan is beneficial for the senior citizens aged between 65 and 80 years, who are either living on their pension or on the interest on their savings or planning a retirement. There are many insurance companies that offer good senior citizen plans and it is advisable to choose one that covers pre-existing and critical illnesses at a reasonable price. You should select a plan that allows renewal at a maximum age and with a minimum co-payment.
  • Critical Illness Insurance Plans: This health insurance plan offers the insured a lump sum of money in case he is diagnosed with a debilitating disease such as sclerosis, cancer, heart attack, coma, kidney failure, paralysis etc. this insurance policy covers all those critical illnesses that are excluded from the standard health insurance policy. All hospital related expenses are covered by this policy.
  • Group/Employee Insurance Plans: The employer of a company purchases the corporate/employee or group health insurance for its employees. This insurance policy can also provide cover to the employee’s family members. The plan covers the hospital expenses such as the fees of the surgeons and anaesthetist as well as the charges for the oxygen, anaesthesia and the diagnostic materials added to the dialysis and the X-ray costs. It provides post and pre hospital charges, cashless facility and the settlement of the hospital bills directly. Some plans even cover pre-existing illnesses with added premium as well as domiciliary expenses.

  • Health Insurance Buying Tips

    • Compare the features and prices mentioned in the policy before buying.
    • For a family person, it is advisable to go for a family floater policy that offers a wide coverage and covers each and every member of a family.
    • You can take the advice of a broker before buying an insurance policy as he is knowledgeable, independent and would provide information on the best insurance policies. He is paid for a specific policy and not working for a particular company and there is no urge for him to push the insurance products of a specific company. You can check the authenticity of a broker by checking his license number from the IRDA website.
    • Avoid insurance agents as they have the tendency to push the insurance products of the company they work for.
    • It is not advisable to buy an insurance policy that has a cashless tie-up with a local hospital. Instead, go for the insurance policy that would fulfil your requirements sufficiently.

    Key Advantage and Features of Health Insurance

    The health insurance plans offer an array of benefits to the insurer such as follows:

    • It offers outpatient and inpatient care to the patients.
    • The health insurance plans include behavioural health therapy, psychotherapy, and counselling.
    • It includes lab tests, prescription drugs and preventive services like screening, vaccines, and counselling for dealing with chronic diseases.
    • It covers the paediatric services that include vision and dental care for children.
    • It covers the cost of the devices and services that can help you in recovering in case of disability, injury or chronic condition. It even covers occupational and physical therapy, psychiatric rehabilitation and speech pathology.
    • It covers the expenses of the emergency room.

    Factors Based on Which You Should Buy a Health Insurance Plan

    • Renewability: It is obvious that with time your health would deteriorate and so it is advisable to go for a health insurance plan that covers your health lifelong. Thus buy a plan that has lifelong renewability.
    • Co-Pay: The co pay is a fixed percentage of your hospital bill that you have to shell out when you make a claim. The rest of the amount would be paid by your insurance company. It is recommended to go for a no ‘co-pay’ plan.
    • Pre-existing Disease Waiting Period: Pre-existing diseases are those that are present in a person before purchasing the health insurance plan. All the pre-existing diseases are not covered from the first day of purchasing the health insurance plan. Time taken for covering the pre-existing diseases vary from one plan to another. Before investing in a plan, you should check the time needed for covering the pre existing disease in the plan and opt for one with a minimum waiting period.
    • Room Cost: The type of room you book for your hospital stay matters, such as a private room, shared room or a room with luxurious amenities. It is wise to go for a plan with a high limit for room rent per day.

    Eligibility of Health Insurance

    When you purchase health insurance, the insurer or insurance company makes sure you go through specific medical tests. After the age of the individual, health is next important factor that enables the insurer in estimating the value of an individual’s health risk. Health evaluation according to specific parameters helps the underwriters for setting a premium on the plan.

    Most of the insurance companies do not require the insurer to go through the medical test if his age is below 45 years. In such cases, the person buying the insurance is required to submit a health report indicating his good health condition. The insurers provide the healthy individuals competitive rates of premium on the insurance. Purchasing a health insurance by those with a pre-existing medical condition is beneficial during the time of making the claim.

    The medical tests comprise of primary physical screening, urine and blood tests. These tests can furnish a lot of information on the health of a person, such as the level of blood sugar, the condition of the various organs like kidney, liver etc. The insured person may have to bear the additional tests when he chooses a comprehensive insurance coverage or crosses 55 years of age.

    Be careful while choosing an insurance plan as many insurers advertise that they would offer an insurance plan without the need for the purchasers to go through a medical examination. Be alert as these advertisements are to lure more customers. Moreover, these plans provide lower coverage in comparison to conventional plans that require the insured person to go through the physical tests.