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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.

1. Hospitalization Plans:

Hospitalization plans reimburse the hospitalization and medical costs of the insured subject to the sum insured. For this reason, the plans are also known as indemnity plans.

The sum assured can be fixed -
  • For a member of the family in case of individual health policies or
  • For a family as a whole in case of a family health insurance policy

For instance, consider a three-member family with an individual cover of Rs. 2 lakh each. Each member can claim reimbursement for a maximum of Rs. 2 lakh as all three policies are independent.

If the family applies for a family health plan cover of Rs. 6 lakhs, then any family member can claim medical benefit for more than Rs. 2 lakh so long as it is within the overall sum assured of Rs. 6 lakhs.

2. Hospital Daily Cash Benefit Plans:

A hospital cash plan pays you a specific prefixed amount for each day you are hospitalized. The number of days for which this benefit is paid is typically capped. This plan is useful to cover ancillary costs (medical and non-medical) that are not covered under health insurance plan and to provide for loss of income during hospitalization ( for self employed ). While deciding this plan you need to look into Daily cash limit, Number of days of coverage in a policy year and eligibility (or pre-conditions) for claiming the benefit.

3. Critical Illness Plans:

These are benefit-based health insurance plans which pay a lumpsum amount on diagnosis of predefined critical illnesses and medical procedures. The illnesses are specified at the outset. By nature, critical illnesses are high severity and low frequency and cost of treatment is higher compared to regular medical problems like heart attack, stroke, among others.

Rising cost of treatments:

Medical treatments cost rise by 15% every year due to Inflation

Financial Security:

Gives you financial security & quality healthcare access for expenses like hospitalization, day care treatments and even OPD expenses

Tax benefits:

Saves your tax under Section 80D upto INR 55,000 every year

  • Premium Vs Features
  • Sublimits on Room Rent
  • Exclusions
  • Pre-Existing Diseases
  • Bonus and Discounts
  • Premium

PREMIUM VS FEATURES

While it is very important to compare the premium of Health Insurance policy, premium should not be the sole criteria for the selection of the policy. The features of the policy or the coverage provided by the policy should also play a very important role in deciding the Health Insurance policy. Most important thing is to first identify the coverage which one wants to take. Based on the coverage, the premium should be compared and the Health Insurance Plan should be selected accordingly.

SUBLIMITS ON ROOM RENT AND OTHER CAPPINGS

Some Insurers cap the maximum amount of room rent that they will pay under their health insurance plan. Generally, such limit is to the extent of 1% of sum insured and in case of ICU (Intensive Care Unit) the maximum limit is 2% of sum insured. Similarly, there may be capping on the maximum amount based on the diseases, ambulance charges etc.

However, now there are various Health Insurance plans, which do not have any maximum limit on room rent or specific disease. Hence it is very important to check the sub-limits on room rent and other capping before buying any Health Insurance Policy.

Exclusions

Once you buy a health insurance plan, you might feel relaxed that you have covered you and your family against any possible hospitalization in future. But if you don't go through the exclusion section of your policy, then you might get surprises at the time of claim. So before finalizing on any health insurance plan go through its exclusion and select the one which has least number of exclusions and are clearly defined.

Pre-Existing Diseases

Pre-Existing Diseases are those which you are suffering from before opting to buy a health insurance plan, and therefore insurance companies do not cover them from day 1 of your policy. They have a waiting period ranging between 2-4 years in which they will not be liable for any claim arising on account of your pre-existing disease. Therefore you should look for health plans which will cover your existing disease and have the least number of years of waiting period.

Bonus and Discounts

For every year where there is no claim, the insurer is supposed to provide a No Claim Bonus. This bonus may either include a reduction in the subsequent year’s premium or an increment in the subsequent year’s coverage at the same rate of premium. Moreover, various other types of discounts are offered by insurers to attract potential customers to buy their plans. One should compare the no-claim or other bonus or discounts before buying a Health Insurance policy.

Premium

Premium you would pay is a vital aspect you should consider while buying a health insurance plan; but mind you, it shouldn't be paramount in your selection process. Just think, you buy a health plan with a very low premium without even taking into consideration the features of the policy. At the time of claim you learn that the insurance company is not liable to reimburse you as the cause for which you were hospitalized was not covered under the policy. So you should be well aware of all the feature, or else you may find yourself in a soup with a huge hospital bill to be paid.