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Health Insurance is an insurance policy that ensures that you get cashless treatment or expense reimbursement, in case you fall ill. It is a contract between a general insurance company and one, which considers expenses incurred when availing treatment. However, the insurance company would pay for your treatment if the medical condition is covered by your policy. As per IRDAI, the premiums payable towards such an insurance policy have tax advantage under section 80D of Income Tax Act, 1961.

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Importance of Health Insurance

There is no debating on the importance of having insurance in a country like India that ranks very low on human life index. Everyone must buy a good health plan that includes medical outlay, hospitalization costs, medication and laboratory test costs, including critical illness. As is rightly said, “Health is wealth”, one must be prepared to manage such a situation in life. Don’t get confused with questions like – Which health policy to buy? Does this consider everything? What illnesses are excluded from this cover? Solution 4 Finance is here to resolve all such confusions.

Just compare health insurance policies from top health insurers on our website

and buy the best health plan. Let us know your basic requirements and we will find the best-suited health insurance quotes. You can, then, compare health insurance policies side by side, based on the parameters like health insurance cost; riders etc., and choose the best health insurance for self and/or your family members.

The treatment cost is getting way too expensive. Health insurance prevents a medical emergency from turning into a financial emergency. It makes sure that health care needs of one are taken care of without depleting one’s savings and compromising on one’s future goals. The contract of health insurance requires the provider to pay some or all of one’s health care costs in exchange of a periodic imbursement. Additional advantages of health insurance policies include regular health check-ups, cashless services, pre and post hospitalization expense reimbursement etc.

Health insurance policies allow you save thousands on taxes under section 80D of Income Tax Act, 1961. The premiums paid towards the policy reduce your annual tax liability, thereby reducing your taxable earnings per year.

Types of Health Insurance Policies in India

One needs to ensure the security of health of oneself as well as of the family. With the increasing cost of healthcare in India, health insurance has become almost mandatory for everyone. Health insurance makes sure not only health security but also hassle-free claim resolution. In today’s world of advancements, people have different choices when it comes to purchasing health insurance. There are various plans readily available in India to include every aspect of a medical emergency. Some popular types of policies are explained below:

Individual Health Insurance Policies:

This health insurance policy considers one against several illnesses, offering advantages like cashless hospitalisation and various add-ons. The entire amount is available for only one and is determined by the age of the insured. Under this policy, each insured member is entitled to receive the entire amount separately.

Family Floater Health Insurance Policies:

With this health insurance policy, you can include all your family members against multiple diseases under a single cover. Family floater Mediclaim offers a fixed assured amount for the family members that can be availed either by one or as a lump-sum for treatment of one person. Family benefit means that the sum, as specified for the proposer under the policy, is available for any one or all members of his/her family for one or more claims during the tenure of the policy. Family mediclaim plans come at a marginally incremental expense.

Surgery & Critical Illness Insurance Plans:

This is usually brought as a standalone policy or a rider for the treatment of various critical illnesses, such as kidney failure, paralysis, cancer, heart attack etc. As the medication of such illnesses is expensive, the imbursement is also very high. A critical illness is a serious, possibly terminal disease, strictly defined by the provider. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or a number of specified terminal conditions.

Pre-Existing Disease Cover:

After a time of 2-4 years, various policies consider pre-existing diseases, e.g. diabetes, hypertension, kidney failure, cancer etc. Pre-existing disease cover includes the illness that the insured had before purchasing the policy.

Senior Citizen Health Insurance Plans :

This health insurance plan is designed particularly for anyone with age above 60 years, offering protection from health issues during old age. According to IRDAI, every firm must include people up to the age of 65 years.

Preventive Healthcare:

Undoubtedly, healthcare is very expensive and nobody wants to fall ill; anyways. So, now we have preventive health care that takes care of you and does not let you fall sick. This policy considers preventive care, such as regular health check-ups, concession in X-ray fees, consultation fee etc. By offering various healthcare good, this plan aims at keeping you healthy, thereby considering health check-ups at regular intervals. Preventive care is medical care rendered not for a specific complaint but focused on prevention and early-detection of ailments.

Maternity Health Insurance:

Health insurance companies today covers such additional costs, including both pre and post natal care, child delivery (normal or caesarean), which sometimes lead to vaccination of newborn babies. This insurance covers the newborn baby up to the validity of this insurance policy. It also covers transportation fee for ferrying the mom-to-be to the nearest network hospital of choice.

Personal Accident Cover:

These personal accident plans are frequently provided as riders to standard health insurance plans, which consider hospitalisation and bear medical outlay, in the event of an accident. These are issued as fixed benefit policies, where specified sums are paid on occurrence of specified or unforeseen events, such as accidents. Such events can result in death or disability of the person. However, the payout is not related to the expenditure.

Which Health Insurance Policy You Should Buy?

What you seek What you should get
Coverage for your expenses and surgical bills Medical insurance offering cashless facility and claim reimbursement
A fixed amount of cash of daily basis to bear expenses when at the hospital Hospital cash plan
A lump-sum pay out to let your family manage their daily expenditure (inclusive of cost of medicines) because you diagnosed with a serious disease Critical illness insurance
A fixed amount of cash to avoid any financial trouble while availing treatment for total/partial temporary or permanent disability causing loss of earnings due to an accident Personal accident insurance
Coverage for expenses in the event of caesarean and normal delivery Maternity insurance
Insurance & coverage For Entire Family during medical emergency Family Health Plan
Coverage for senior citizen health issues Senior Citizen health Insurance

Key Advantages & Features of Health Insurance Policies

The cost of healthcare in the modern days is increasing at a high pace while one’s earnings do not seem to match up that level. Regular health check-ups are getting out of one’s range of affordability since multiple expenditures of thousands are common in such scenarios. A patient looking forward to availing frequent health check-ups is no longer expected. A comprehensive health plan comes packed with features. Understanding the following features makes purchasing health insurance policy easy:

Cashless Treatment

Every health insurance organization has tie-ups with various nursing homes across the country or ‘empanelled hospital’. If you get admitted, you don’t need to pay anything. Just tell your policy number and everything else will be taken care of by the hospital and your insurer. This type of plan is mostly preferred because there is no stress of claim resolution and arranging documentation. However, if expenses go beyond the sub-limit specified by the insurance cover or marked as not covered by the provider, then they have to be settled by the person directly with the hospital. Another important thing to remember is that cashless Mediclaim is not available if one gets treatment in a hospital that is not part of the hospital network of provider.

Pre and Post Hospitalization

This feature of a health insurance policy takes care of both pre and post hospitalisation fee over a time of 30 to 60 days, depending on the plan purchased. It takes into account costs incurred during a certain number of days both prior to and post hospitalization for a specified period from the date of discharge as part of the claim, provided the expenditures are related to the disease/sickness.

Ambulance Fee

The person is free from burden of transportation fee, as it is borne by the firm. This is an add-on benefit and you should opt for it while purchasing.

Pre-Existing Disease Cover:

After a time of 2-4 years, various policies consider pre-existing diseases, e.g. diabetes, hypertension, kidney failure, cancer etc. Pre-existing disease cover includes the illness that the insured had before purchasing the policy.

No Claim Bonus

NCB (or No Claim Bonus) is an advantage provided if the person does not file a claim for any treatment in the previous year. Advantage could be in any form, either an increment in the sum assured or a discount in the cost. You can avail this advantage on renewal.

Medical Check- Up

Health insurance policy entitles the insured to receive regular medical check-ups. Free check-up is provided by few insurers, provided you have a good history of no claim bonus.

Room Rent in Your Health Insurance Sub-limits

A healthy insurance policy may have various sub-limits associated with it; room rent is one of those sub-limits. General Insurance Companies provide you with coverage max up to sum assured. However, they can deliberately trim down their liability by introducing the sub-limit clause in the coverage for the room rent.

A sub-limit on room rent in case of hospitalization works on per day basis. For instance, if your health insurance policy covers your daily room rent max up to Rs. 3,000 and the particular room costs you Rs. 5,000 per day, then you will have to pay the remaining Rs. 2,000 out of your own pocket. Besides, the room charges are directly associated with the type of room you are availing, i.e. a single room or on a sharing basis. Everything else is calculated proportionately.

If the total cost incurred for your treatment at the hospital is Rs. 5, 00,000, the table shown below illustrates the proportionate expenses to be borne by your insurer and you, respectively.

Sum Assured by Your Policy (in Rs.) 5,00,000
Room Rent as per Sub-Limit (in Rs.) 3,000
Room Rent Per Day  (in Rs.) 5,000
Room Availed at the Hospital (in Days) 10

 

Actual Hospital Bill (in Rs.) Reimbursed Amount (in Rs.) To be Borne by You (in Rs.)

Room Charges (in Rs.) 50,000 30,000 20,000
Doctor’s Fee (in Rs.) 20,000 12,000 8,000
Medical Tests’ Cost (in Rs.) 20,000 12,000 8,000
Operation/Surgery Cost (in Rs.) 2,00,000 1,20,000 80,000
Medicine Cost (in Rs.) 15,000 15,000 0
Total (in Rs.) 3,05,000 1,89,000 1,16,000

 

In this case, the total cost to be borne by you is Rs. 1, 16,000 out of the total expense incurred, i.e. Rs. 5, 00,000. Thus, make sure you choose wisely if you want any such sub-limits in your health insurance policy or not.

Tax Benefits

According to India’s tax system, if you are paying the premiums, then you can avail income tax rebate u/s 80D of ITA of up to Rs.25000 for Indians in the age group of 18 to 60 years while the premiums paid for anyone above 60 years of age reaches Rs.30000 for anyone.

Co-Payment

According to this feature, you can lower the health insurance cost. Medical insurance plans offer co-payment option that pre-defines the voluntary deductibles to be borne by the firm. So, in the event of medication, some amount is paid by the customer and the rest by the provider. It is a cost-sharing requirement under a health insurance policy, which states that the organization or the person will bear a certain share (in percentage) of the total admissible cost. However, the co-payment option does not have any effect on the sum assured.

Health Insurance Portability

Health insurance portability enables an insured to changes one health insurance company without losing continuity advantages with respect to pre-existing ailments, waiting period, and other time bound exclusions earned in the earlier policies. For this, they have to first switch to a plan offered by their current health insurance organization, and after a year, they are allowed to switch to a firm of their choice. Health insurance portability has come as a breather for policyholders who were trying to change their insurance firm but were unable to do so earlier. With this, they can now try out the policies they prefer with the insurance companies they prefer.

Tax Benefits of Health Insurance

Health insurance policies entitle you to receive tax benefit under section 80D of income tax act, 1961. The premiums you pay towards health plan for self or your family members get you a tax rebate, irrespective of whether they are dependent on you or not. The tax benefit offered with respective to the premiums is subject to the age of the person while there is a cap of maximum benefit that can be availed. You can save max up to Rs. 25, 000 in taxes a year unless your age is above 60 years. If your age is above 60 years, then this cap of maximum tax benefit increases to Rs. 30, 000.

If you are paying the premiums for health insurance of your parents as well as of your own, then you are eligible for tax exemption of up to Rs. 55, 000 a year under section 80D, provided your parents are senior citizens.

Learn More About Benefits of Health Insurance

Factor to Consider Before Purchasing Best Medical Insurance Plans?

 

There are few factors that you should consider closely to make the right decision and choose the best.

Caps and sub-limits

The amount you pay for a health insurance policy has impositions of co-payments, sub-limits, and other caps, which would alter the good in the long run. To make the most of your health insurance policy, you must understand these factors before you pay for a plan.

Claim settlement record

This is an important criterion to assess the credentials of an insurer. You should always go with a company with a good claim settlement record. Thus, you can ensure that your claims would not be wrongly withheld. Always ask for the company’s claim settlement ratio before purchasing their health plans and save yourself from unnecessary harassment./p>

Ambulance Fee

The person is free from burden of transportation fee, as it is borne by the firm. This is an add-on benefit and you should opt for it while purchasing.

Scope of cover

Don’t buy a plan by just comparing health insurance cost. Less cost does not necessarily mean a good plan. On the contrary, such a plan might not consider your needs properly. Closely look at what the plan includes. Buy a comprehensive plan.

No Claim Bonus

NCB (or No Claim Bonus) is an advantage provided if the person does not file a claim for any treatment in the previous year. Advantage could be in any form, either an increment in the sum assured or a discount in the cost. You can avail this advantage on renewal.

Renewability

It is important to see how many years the plan proposes to protect you. You should not be left without a proper guard when you need it the most, say during your old age. Health insurance Mediclaim policies are usually annual contracts. The automatic re-establishment of in-force status affected by the cost is known as renewal. In other words, the issuance of a new policy or the continuation of the current policy that is effective, once the old policy’s plan year ends is termed as renewal. At the end of the policy term, the policy has to be renewed by the insured. There should be continuous renewal of the policy because if there is a break, then the person will lose the good of insurance, in the event of a contingency.

Cashless Hospital Network

Check if a hospital around you is included by the company you are considering to buy from. You and your family won’t be required to run around collecting documents and filling reimbursements. The provider or its Third Party Administrator has a tie-up with a range of nursing homes. The insured can get admitted in any of these nursing homes and medication for a disease covered by the policy. However, cashless mediclaim resolution is subject to limits and sub-limits, which are subject to the sum assured of the policy.

Premium Loading

Loading is an additional cost built into the insurance policy to consider losses, which are higher than anticipated for an insurance company, arising from insuring a person who is prone to a form of risk. Premium Loading is the amount an insurer needs to consider its expenses and generate profit. We would strongly recommend you to check the terms and conditions pertaining to premium loading. This will save you from paying a high incremental premium post making a claim. This aspect, though ignored in the beginning, usually becomes a bone of discontentment at a later stage. The best practice would be to verify the cost fluctuation data of the plan for previous 5 years at the very least.

Internal Team

Check for the plans from firms who have a dedicated internal team for handling Mediclaim. This comes in handy while expediting the Mediclaim resolution process. Most of the players use a third-party administrator to process the claims and do the paperwork. Even though most of these Administrators provide great services, the fact that they are a third party slows down the process. There are certain rules and regulations to be followed when an administrator processes a claim before it is handed over to the insurance company. These affect the turnaround time.

Floater (family) Size

Everyone has a different family size, so you should always look for the family size allowed under the plan before purchasing it. If you are a person in your late 20s and your parents in their 40s, 50s or 60s, then purchasing for one does make sense. Alternatively, if you are married with or without kids and have dependent parents, parents-in-law, siblings etc., then a family health plan is best for you. Checking the cost, family size covered, critical illnesses or other benefit will ensure that you are able to purchase the plan you need.

Health Insurance Portability

It is wise to choose a health insurance company that offers health insurance portability. Earlier, policyholders had to stick to a policy just to retain the advantage. Now, health insurance policies allow you to switch from one insurance company to another without losing the waiting period advantages earned in your current policy. Moreover, with the policy landscape changing so regularly, life insurance companies regularly come up with better policies and it will make sense to opt for health insurance portability. Also, some companies may charge if you prefer to move away from their plans to some other players’ using the free health insurance portability option provide by the new organization. Ensure that you do not end up paying for health insurance portability instead of staying with the old firm. Health insurance portability is a good thing to check when you are finding the best health insurance policy or mediclaim for yourself.

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