Health Insurance

What Is Health Insurance?

Health insurance is a financial arrangement that helps people in covering the costs of their medical expenses. It's like a safety net in which you need to pay small amounts of money at regular intervals of time , and in return it covers your big medical bills.

Why Should You Buy Health Insurance Plans In India?

In a rapidly developing country like India , where uncertainties abound and lifestyles are evolving, the arrival of a medical crisis is more or less certain . Low wages and less savings and exploitation by major healthcare giants also adds to the sufferings of people here. Hence, to safeguard yourself against these unforeseen challenges, it becomes paramount to embrace the security offered by health insurance. Several compelling reasons underscore the importance of acquiring this invaluable shield:

• Escalating Healthcare Costs: Over time, the healthcare landscape in India has witnessed a steep ascent in expenses. The surging prices of medications, hospitalization, diagnostic tests, and related services have made quality medical care a costly affair. Embracing a health insurance plan is a prudent choice, shielding you from the financial shockwaves of unexpected medical emergencies. Tailor your plan to align with your unique healthcare needs and extend this protection to your loved ones.
• Evolving Lifestyles: The contemporary way of life places individuals at greater risk of health issues. The typical 9-to-5 grind, dietary choices, disrupted sleep patterns, and more have collectively contributed to an unhealthy existence. This lifestyle has given rise to a host of health concerns such as obesity and asthma, not to mention the escalating mental health challenges. Thus, it becomes imperative to invest in health insurance as a proactive measure.
• Network Hospitals: The presence of network hospitals, where policyholders can access cashless treatment, is a pivotal consideration. The number of network hospitals varies among health insurance providers, making it crucial to assess this aspect during plan selection. The availability of network hospitals streamlines the process of obtaining quick and cashless claims.
• Pre-existing Condition Coverage: Health insurance plans in India typically offer coverage for pre-existing conditions after a specified waiting period. For those seeking immediate coverage for conditions like diabetes or hypertension, some plans provide coverage from the outset. You can consult with your insurer to understand the pre-existing disease coverage offered in your mediclaim plan.
• Diverse Health Insurance Options: Health insurance in India encompasses an array of options, including individual plans, senior citizen coverage, family health insurance, and more. With this diversity, you can select a plan that aligns seamlessly with your unique requirements and financial availability.
• Access to Additional Discounts: The acquisition of health insurance opens the door to various discounts, such as wellness incentives and renewal savings. This translates into significant cost savings after your initial purchase.
• Peace of Mind: Knowing that you and your loved ones are shielded from medical emergencies brings profound peace of mind. With health insurance in place, you can navigate life's challenges with less stress, allowing you to prioritize quality healthcare.
• Personalised Health care: India is a country with a huge population and neither healthcare nor healthcare professionals are adequate to meet the requirements of each citizen . A huge rush in public hospitals lacks attention to detail which results in improper diagnosis. The best way to have a proper and personalised treatment is to go for a corporate hospital . However, the cost of visiting is too much . But with health insurance you can visit these hospitals and get personalised treatment and full attention.

Checklist for Buying Health Insurance?

If you want to buy Health Insurance .Here is the checklist you need to follow:

• Waiting Period: Waiting period is extremely important while availing health insurance. It is the time in which you or any policyholder shall not be able to make claims. It is different for different insurance providers . Checking the waiting period will help you in choosing health insurance plans wisely .It is always recommended to choose insurance that has a lower waiting period.
• Co - Payment: It is the payment you have to bear from your own pocket in order to get relevant coverage . It is advisable to go for insurance companies that have less co - payment.
• Grace period: It is the time in which you still have the chance to renew your plans irrespective of expiry. Always go for insurance providers that have more grace periods.
• No claim Bonus: If you make no claims in a given time frame your insurance providers do offer you a no claim bonus. Choose those providers that offer no claim bonus.

What is Covered in Health Insurance Plans?

• In-Patient Hospitalization: In case of inpatient care each and every expense is looked after by the insurance company. Be it surgery, medicine or room charge everything is paid by the insurance provider if a patient stays for more than 24 hours.
• Covers pre - existing health issues: Once the waiting period is over you . Insurance companies are liable to pay you for any existing condition you might have.
• Pre and post hospitalization: Under Pre hospitalization you get coverage for various scans , pathology tests, and in case of post Hospitalization the care if your medical bills is taken once you are discharged.
• Regular health checkups: Vaccines , appointments with various specialist, day procedures are provided without any additional cost.
• Ambulance Expenses 
• Maternity Cover: You shall get covered in case of any expense related to Maternity ( delivering if a baby )
• AYUSH: In India health insurance providers provide coverage for homeopathy treatment as well.
• Medical Health Care Cover: As per the latest guidelines issued by IRDAI coverage should be provided for mental issues like bipolar disorder, depression etc.

Variety of health insurance plans

• Family Health Insurance:  As the name suggests a family health insurance provides coverage to the entire family under a single sum. In this plan you can cover your spouses, parents and children. The number of people covered depends on the sum paid.
• Senior citizen Health Insurance: People of old age above 60 are more vulnerable to disease and old age related disease. This insurance plan covers all the Medical expenses that are included due to critical illness at old age.
• Individual Health Insurance:  In this a single policyholder is liable to receive the benefits of insurance. It covers all the day care and inpatient expenses including vaccines .
• Maternity Health Insurance: Childbirth and motherhood should be a comfortable experience and the last thing you should worry about while giving birth to your bundle of joy is finances. In maternity insurance your prenatal, postnatal and newborn baby costs are covered.

Health Insurance Terminologies

• Critical Illness Insurance:  Critical diseases are those diseases that have high mortality and unfortunately less treatments available. Cancer , renal failure strokes and heart attacks are covered in critical illnesses. The insurance provider has to provide insurance holders a huge sum of money if they ever get diagnosed by these diseases hence the premium is higher than other diseases.
• Health Insurance Renewal:  Like every other thing your insurance has also got an expiry date . Typically your insurance can have a validity of 1, 2 or 3 years depending upon your plan however once this period is over you need to renew your insurance. This way you will not lose the benefits including waiting period etc.
• Premium:  The amount you pay to your insurance company regularly (usually yearly) to maintain your health insurance coverage.
• Deductible:  The amount you must pay out of pocket for covered healthcare services before your insurance plan starts to pay.

Health insurance portability

Portability in health insurance refers to transferring your existing health insurance from one company to another. Portability helps a policyholder to switch between insurance companies while still holding the validity of their existing plans. Portability generally occurs when a policyholder is not fully satisfied with the services provider by the existing insurance company. However portability is not always between companies; sometimes a policyholder can switch between plans within the same company.

Criteria for portability:

• You can go for portability only at the time of policy renewal.
• If you are planning to port your policy you should contact the company you are willing to choose at least 30- 45 days before the expiry of your current plan.
• You need to provide all the necessary documents before porting the insurance policy.
• You need to make sure that there are no breaks in between the renewal process of your health plan.

Whether or not you should buy insurance in addition to your employee insurance

There's a lot of confusion among employees as to whether or not they should buy an insurance plan while still being covered by insurance. Here are the key considerations:

• Coverage Adequacy:  As an employee and as an individual you need to assess the coverage provided by your employee insurance (Group - GMC). This insurance typically offers basic coverage, but it may not cover all your needs. Evaluate whether it provides sufficient coverage for your medical, dental, vision, disability, and life insurance needs. Moreover this insurance often fails in catering the needs when it comes to critical diseases so relying on employee insurance completely is not advisable.
• Individual Needs:  Consider your individual circumstances and needs. If you have specific medical conditions, require specialized treatments, or have dependents who need coverage, you may need additional insurance to fill gaps in your coverage.
• Portability:  Losing a job simply means losing your insurance. This is scary but true . Employee insurance is typically tied to a job you might lose your cover if you are laid off or if your employer decides not to offer insurance any more.

Why Buy Health Insurance At An Early Age?

Many of us have a preconceived notion that health insurances are for old and middle aged people. However, that's not true as purchasing health insurance at an early age has several benefits.

• Lower premium: If you buy insurance at an early age you shall have to pay very less premium because most of the insurance providers consider you a healthier youth which puts you in the low risk category.
• Continuous coverage: Health emergencies often come uninvited and age is definitely not a criteria for their advent . A health insurance at an early age will place you at a step ahead and shall protect you against accidents or illness that might occur.

Tax benefits of a health Insurance

What if you have someone in life whom you pay a little and in return gives you more. Not only this it even helps you save from your hard-earned money . This someone goes by the name of health insurance.

Health insurance provides you with multidimensional benefits with just one investment. Insurance policy provides you with tax benefits under section 80D of Tax Act 1961, if you have an active health insurance you can enjoy tax exemption upto Certain limit.

Waiting Period of Health Insurance

Waiting period is extremely important while availing health insurance. It is the time in which you or any policyholder shall not be able to make claims. It is different for different insurance providers . Checking the waiting period will help you in choosing health insurance plans wisely .It is always recommended to choose insurance that has a lower waiting period.

How to file a health insurance claim?

Let us discuss some necessary processes you need to follow while claiming your health insurance.

• Step 1: Check your policy: 
  The first step you need to do is check your policy and verify whether or not your treatment and services are covered. As some insurance companies have some limitations on coverage make sure you have proper info on what is covered and what is not.
• Step 2: Gather your documents: 
  In case you need to make a policy claim you need to gather documents including a policy card . The claim documents that should be signed by you, All medical bills and doctors recommendation letters etc The amount you are claiming and proof of that should be attached.
• Step 3: Submit your Claim: 
  You need to submit your claim online or offline and wait until the insurance company will analyse it and see how much they can cover . However you need to be patient in this because if the case is complex it might take a long time.
• Step 4: Wait for Processing: 
• Step 5: Review The insurance company's decision 
  Once the insurance company informs you about their decision including the amount they shall cover including any deductions compare it with your expectations and review if everything is ok.
• Step 6: Pay any remaining balance: 
  If you feel some balance is left, pay it so that you avoid late fees or legal troubles.

Documents required for health insurance claim ( Reimbursement)

When filing a health insurance claim for reimbursement, it's essential to provide all the necessary documents to ensure a smooth and successful process. The specific requirements can vary depending on your insurance provider and policy, but here is a general list of documents typically required:

Claim Form: You will need to fill out a claim form provided by your insurance company. This form usually includes details about the insured person, the nature of the medical treatment, and the costs incurred.

Medical Bills and Invoices: Provide itemized bills from the healthcare provider or hospital, including dates of service, descriptions of services or treatments received, and the cost for each service.

Prescription Receipts: If your claim includes prescription medications, submit copies of the receipts or invoices for the medications.

Medical Reports: Include any medical reports or documents related to the treatment, diagnosis, and prognosis. This may include doctor's notes, lab test results, X-rays, MRI reports, etc.

Hospitalization Records: If you were admitted to the hospital, include copies of your hospital admission and discharge summaries.

Photocopy of Insurance Card: Make sure to provide a photocopy of your health insurance card as proof of your coverage.

Policy Details: Include a copy of your insurance policy or the policy number, which will help the insurance company identify your coverage.

Authorization and Assignment of Benefits: Some insurance companies may require you to sign an authorization form allowing them to obtain your medical records directly from healthcare providers. Additionally, you may need to sign an assignment of benefits form, which instructs the healthcare provider to bill the insurance company directly.

Receipts for Out-of-Pocket Expenses: If you paid for any medical expenses out of pocket (such as copays or deductibles), provide receipts as proof of payment.

Claim Letter: Write a claim letter detailing the nature of your claim, including the dates of service, the reason for the claim, and the amount you are requesting for reimbursement.

Police Report (if applicable): If your claim is the result of an accident, injury, or any incident that involved law enforcement, provide a copy of the police report.

How to Download your Insurance policy copy:

Downloading a copy of your insurance policy you need to follow a few steps:

• Visit the Website of the Insurance provider
• Login with your policy number
• Then request a copy of your policy to be downloaded
• Once it's approved, download the policy

Am I Eligible to Buy a Health Insurance Plan?

Below is a detailed analysis to check whether or not you are eligible to buy an insurance plan:

• For buying an insurance policy you need to be an adult aged 18 years or more.
• However there are certain plans like for senior citizens where you need to be aged 65 to 70 in order to buy a plan.
• Children can be covered in health insurance on an individual basis when they reach the age of 5.

Myths about health insurance:

•  Young people don't need health insurance: 
  Fact : Well, that's completely false . Young people are mostly healthy and energetic and full of life , but there are many unfortunate incidents where young people are suffering from unexpected illnesses. So young people definitely do need health insurance.
•  In order to make a claim, 24 hour hospitalization is mandatory: 
  Fact: No it's not . You can claim your money even when you go for regular checkups, scans or other procedures that are covered in the policy .
•  All Doctors Accept All Health Insurance Plans: 
  Healthcare providers may choose to participate in specific insurance networks. It's essential to check whether your preferred doctors and hospitals are in-network for your insurance plan to maximize coverage and minimize out-of-pocket costs.
•  I Can't Change My Health Insurance Plan 
  You can change your health insurance plan during designated enrollment periods or after experiencing qualifying life events. It's important to review your coverage regularly to ensure it meets your current needs.
•  Health Insurance Covers Everything 
  Health insurance typically covers essential medical services, but it may not cover elective procedures, cosmetic surgery, or certain experimental treatments. Review your policy carefully to understand what is and isn't covered.
•  Health Insurance Is Too Complicated to Understand 
  While health insurance can be complex, it's essential to take the time to read and understand your policy. Insurance providers often have resources and customer service representatives available to answer questions and provide clarification.