Health Insurance
What is Health Insurance
Health insurance is a policy that helps you pay for medical expenses, including doctor visits, hospital stays, and prescription drugs. With health insurance, you can access quality healthcare without worrying about the high costs associated with medical care.
Additionally, health insurance provides peace of mind and helps protect you from financial ruin in a medical emergency. Overall, having health insurance can provide a sense of security and enable you to maintain your health and well-being.
Health Insurance buying checklist
Any one illness
A continuous period of illness, which includes relapse of the illness within 45 days (from the date of last medical consultation, in the hospital of the treatment).
Associated Medical Expenses (AME)
Charges that are associated with the treatment such as doctor/surgeon/ specialists/anesthesiologist fees, room rent, nursing charges, etc. Note, that expenses such as medical devices, diagnostics, implants, pharmacy & consumables are not covered under AME.
Ayush or Alternative Treatment
Per IRDAI guidelines treatments like Ayurvedic, Yoga & Naturopathy, Unani, Siddha, and Homeopathy are to be covered by insurers; if the policyholder has opted for them as an additional cover.
Break-in policy
It is the period when the earlier policy cover has lapsed and the policyholder is yet to renew the policy. Usually, insurers will give a grace period of 30 days from the date of policy expiry.
Cashless hospitalization
The treatment is in the insurer’s network hospitals, where the payment is made directly to the facility (hospital/clinic), for treatment covered under the insurance policy.
Claim settlement ratio
A numerical metric, indicating the insurer’s capability to settle claims; against the number of claims, received in a financial year.
Co-payment
A cost-sharing arrangement between the insurance company and the policyholder in which the policyholder pays a certain percentage of the medical expenses out-of-pocket, while the insurance company covers the rest.
Day-care treatment
Treatments like cataract surgery, angiography, chemotherapy, etc., where hospitalization is less than 24 hours.
Deductible
A cost-sharing arrangement between the insurance company and the policyholder. A deductible is a way to lower the premium amount. It can be either a fixed amount or a percentage of the claim amount. This amount is to be paid by the policyholder.
Dependants
The family members of the policyholder who are dependant, such as a spouse, parents, spouse’s parents, and unmarried children (within the age limit).
Exclusions
The period in the policy cover where some conditions and/or circumstances are not included. Accident-related treatment is never excluded from the beginning of the cover period.
Free Look-in Period
Insurers generally allow 10-15 days, to cancel the policy from the date of issuance.
Grace Period
A period of time after the due date for paying the premium during which the policy remains in force, and the policyholder can still pay the premium without any penalty or cancellation.
Long-term care policy
Policies that provide for services such as nursing care, home health care, custodial care, or such specified services, for a specified period.
Major Illness Benefits
Typically, insurers categorize illness as minor or major. Major illnesses like cancer, heart-related illness, head trauma, etc., are covered for 100% of the sum insured after the applicable waiting period.
Network Hospitals
Hospitals that have an agreement with the insurance company to provide medical services to the policyholders at a pre-negotiated rate. Policyholders can avail of cashless treatment at these hospitals, subject to the terms and conditions of the policy.
No Claim Bonus
A reward or discount offered by the insurance company to the policyholder for not making any claims during a policy year.
Pre-existing diseases
Any condition, illness, symptoms, or diagnosis leading to some ailment or injury-related conditions, which have occurred/received treatment/received advice in the previous 48 months (before the new policy cover is taken).
Preventive Health Check-up
A medical examination or screening test carried out to detect and prevent potential health problems before they become more serious.
Restore Benefits
An optional feature in some health insurance policies that restores the sum insured in case the policyholder exhausts the entire amount during a policy year.
Sum insured
The pay-out amount that the insurer is liable to pay in case of a claim.
Sub-limits
A cap or limit on the amount of coverage provided for certain medical expenses or treatments specified in the policy is usually applied on a per-claim or per-policy-year basis.
Waiting Period
A waiting period in health insurance policies refers to the duration during which the policyholder cannot make claims for certain medical conditions or treatments specified in the policy (pre-existing or otherwise).
Benefits of Buying Health Insurance Plans Online through Policy Leader
Buying a health insurance policy online comes with several benefits. Take a look at them below
Comparing Multiple Plans
Policyleader.com provides an easy-to-use platform that allows you to compare health insurance plans from multiple insurers to find the best fit for your needs.
Convenient
With Policyleader.com, you can buy a health insurance policy from the comfort of your own home, without the hassle of visiting an insurer's office or agent.
Discounts
Policyleader.com offers exclusive discounts on health insurance plans purchased online, helping you save money on premiums.
Minimal Paperwork
With Policyleader.com, you can complete the entire process of buying a health insurance policy online, with minimal paperwork.
Policy Available 24x7
Policyleader.com offers round-the-clock support and assistance, ensuring that you can access your policy anytime and anywhere.
Digital Payment Options
Policyleader.com offers a variety of digital payment options, making it easy and convenient to pay your premium.
Instant Policy Purchase
Policyleader.com allows you to purchase a health insurance policy instantly, without any waiting time or delays.
Customised Plans
Policyleader.com provides personalized recommendations based on your medical needs and requirements, ensuring that you get a plan that is tailored to your specific needs.
Instant claim support
Policyleader.com offers instant support and assistance in case you need to file a claim, helping you navigate the process quickly and easily.
Personal Visit by Advisors
Policyleader.com allows you to schedule a home visit with their advisors, who can help you understand your policy and answer any questions you may have.
Health Insurance Products Include
| Feature | Group Mediclaim Policy | Individual Health Insurance |
|---|---|---|
| Policyholder | Group or Organization | Individual |
| Coverage | Coverage for a group of people | Coverage for a single individual |
| Premium | Lower premiums per person since risk is spread across a group | Higher premiums per person since the risk is borne by an individual |
| Customization | Limited customization options since the policy is designed to cater to the group's needs | More customization options available to cater to the individual's needs |
| Renewal | Renewable annually for the entire group | Renewable annually for the individual |
| Portability | Not portable, policy ceases upon leaving the group | Portable and can be transferred from one insurer to another |
| Pre-existing conditions | May have waiting periods for pre-existing conditions | May have waiting periods for pre-existing conditions |
| Coverage for dependents | Coverage may be extended to dependents | Coverage for dependents needs to be added separately |
| Waiting periods | Waiting periods may be shorter or waived off | Waiting periods may be longer |
| Sum insured | Higher sum insured options available | Lower sum insured options available |
Health Insurance Policy Exclusions
Even though the exclusions depend heavily on the terms and conditions of different policies, here are a few general exclusions that are not covered under any health insurance
Pre-existing conditions
Any medical conditions that existed before the policy was purchased, typically for 2-4 years from the date of policy commencement.
Cosmetic, Obesity or aesthetic treatments
Treatments that are not medically necessary, such as plastic surgery or hair restoration.
Alternative treatments
Treatment methods that are not recognized by the Medical Council of India, such as Ayurveda or Homeopathy, unless specifically mentioned in the policy.
Self-inflicted injuries or suicide attempts
The policy does not cover any injury or harm caused intentionally by the insured person (such as injuries suffered due to adventure sport, war, nuclear explosion, defence operations).
Pregnancy and childbirth
Unless specifically mentioned in the policy, most health insurance policies in India do not cover expenses related to pregnancy and childbirth.
Non-medical expenses
Expenses that are not directly related to medical treatment, such as travel, food, or accommodation expenses, are typically not covered by health insurance policies.
Other Common Exclusions
Initial Waiting Period
Pre-existing Disease Waiting Period
Critical Illness Waiting Period
Exclusions for Specific Events
Exclusions for Specific Conditions
Exclusions for Specific Procedures
Exclusions for Specific Treatments
Hospitalization and Common Illnesses
Diagnostic Tests and Post-Care
Adventure Sports Exclusions
Myths about Health Insurance
Here are a few common myths surrounding the concept of health insurance
Health insurance is only for the elderly
This is a common misconception as anyone can benefit from health insurance, regardless of age. In fact, it is advisable to buy health insurance at a younger age as it may provide coverage for pre-existing conditions and the premium amount will be lower.
Health insurance is expensive
Health insurance is available at different premium amounts, and there are policies to suit every budget. Moreover, it is a long-term investment that provides financial protection against unexpected medical expenses.
Only serious illnesses are covered
Health insurance policies cover a wide range of medical treatments and expenses, including outpatient consultations, diagnostic tests, and surgeries, in addition to hospitalization for serious illnesses.
Pre-existing conditions are not covered
Health insurance policies may cover pre-existing conditions, but there may be waiting periods before coverage begins. It is important to disclose any pre-existing conditions before buying a policy to avoid rejection of claims later on.
Buying health insurance is a complex process
With the advent of digital technology, buying health insurance has become a simple and hassle-free process. One can easily compare policies, calculate premiums, and purchase policies online.
Health insurance is not necessary if one leads a healthy lifestyle
While a healthy lifestyle may reduce the risk of illness, it does not eliminate the possibility of accidents or unexpected illnesses. Health insurance provides financial protection against such situations and ensures that one receives timely medical care without any financial burden.
Factors Affecting Health Insurance Premium
Age
As age increases, the risk of illnesses and medical conditions also increases, which may lead to higher premiums.
Medical history
Pre-existing medical conditions or a family history of illnesses may result in higher premiums.
Lifestyle habits
Lifestyle factors such as smoking, alcohol consumption, and a sedentary lifestyle can increase the risk of health problems, leading to higher premiums.
Geographic location
Health insurance premiums may vary depending on the city or state of residence, as medical costs and healthcare infrastructure vary across regions.
Sum insured
The sum insured is the maximum amount that the insurer will pay in case of a claim. Policies with higher sum insured amounts may have higher premiums.
Policy features
Additional policy features such as co-payments, deductibles, and sub-limits may affect the premium amount.
Policy type
Different types of policies, such as individual health insurance, family floater plans, and group health insurance plans, may have different premium amounts.
Add-ons
Optional add-ons such as critical illness covers, maternity cover or personal accident covers may increase the premium amount.
Renewal history
A history of timely premium payments and policy renewals may result in lower premiums or discounts on the premium amount.
Key Benefits of Health Insurance Plans in India
Health insurance plans offer a variety of health benefits to the insured depending on the plan. Following are the key benefits of buying a health insurance plan in India
Hospitalization Expenses
A health insurance plan covers the medical expenses incurred on getting admitted to a hospital for more than 24 hours. It includes room rent, doctor’s fee, medicine cost, diagnostic test fees, etc.
Pre & Post Hospitalization Expenses
It covers the medical expenses that you may have incurred on an illness before getting hospitalized as well as follow-up treatment expenses incurred after getting discharged. The pre-hospitalization and post-hospitalization expenses are covered up to a fixed number of days as specified in the policy document.
ICU Charges
A health insurance plan also covers the cost of availing treatment in an ICU during hospitalization.
Ambulance Cost
It covers the cost of ambulance services availed to reach the nearest hospital during a medical emergency.
Cashless Treatments
All health insurance providers in India offer cashless treatment facilities at their network hospitals. You do not have to worry about arranging money to pay the hospital bills if you get admitted to a network hospital as it will be settled by your insurer under cashless claims.
Day Care Procedures
It also covers the cost of availing day care treatment that requires hospitalization for less than 24 hours.
Pre-existing Diseases
The best health insurance policy also provides coverage for pre-existing diseases after you have completed the waiting period. Usually, pre-existing diseases are covered after a waiting period of 2 to 4 years.
AYUSH Treatment
It covers the cost of availing medical treatment through AYUSH school of medicines that includes Ayurveda, Unani, Homeopathy, Siddha and Yoga.
Medical Check-ups
Most health insurance companies in india offer free preventive health check-up facilities to the insured at regular intervals depending on the policy terms and conditions.
Documents you need to obtain a Health Insurance
Here is a list of the documents that one needs to obtain health insurance:
- ID proof, such as an Aadhaar card, Voter ID card, Passport, PAN card, or Driving License.
- Address proof, such as utility bills, bank statements, rental agreements, or passports.
- Age proof, such as birth certificate, school leaving certificate, passport, or PAN card.
- Income proof, such as salary slips, Form 16, ITR statement, or bank statements.
- Medical history includes previous health insurance policy details, medical check-up reports, and information about any pre-existing medical conditions.
Procedure for Filing a Health Insurance Claim
Here is the general procedure:
Notification
Inform the insurance company immediately about the hospitalization or medical treatment, either through the toll-free number or the online portal provided by the insurance company.
Documentation
Collect all relevant medical records and documents such as hospital bills, doctor's prescriptions, diagnostic test reports, and discharge summaries. Keep the original copies of the documents with you, and make a copy for submission to the insurance company.
Claim form
Fill out the claim form provided by the insurance company, providing all the necessary details such as policy number, details of the insured person, and details of the hospitalization or medical treatment.
Submission
Submit the filled claim form along with the relevant medical records and documents to the insurance company through the online portal or by visiting the branch office in person.
Verification
The insurance company may verify the claim documents and medical records to determine the claim's validity.
Settlement
Upon approval of the claim, the insurance company will either directly settle the claim with the hospital or reimburse the amount to the insured person, depending on the terms and conditions of the policy.
Eligibility Criteria to Buy a Health Insurance Plan
The general eligibility criteria for buying a health insurance plan is described as follows
Age
Generally, individuals between the ages of 18 and 65 are eligible to buy health insurance policies. However, some policies may have age restrictions and relaxations, such as a minimum age limit of 91 days for infants or a maximum age limit of 70 years for senior citizens.
Pre-existing conditions
Individuals with pre-existing medical conditions may be eligible to buy a health insurance plan, but the policy may have waiting periods before coverage begins. The waiting period for pre-existing conditions may range from 2 to 4 years.
Income
There is no income limit for buying a health insurance policy, but the premium amount may vary based on the individual's income and age.
Occupation
Individuals engaged in high-risk occupations such as mining, aviation, or deep-sea diving may be required to pay a higher premium or may be excluded from coverage altogether.
Medical history
Applicants may be required to disclose their medical history and undergo medical tests before buying a policy. Based on the test results, the insurer may issue the policy or may charge a higher premium or exclude certain pre-existing conditions from coverage.
Travel history
Individuals with a travel history to certain countries or regions may be required to undergo medical tests and quarantine periods before buying a policy.
Policy-specific requirements
Some policies may have additional eligibility criteria, such as a requirement for a minimum number of employees for group health insurance policies.
Why should you choose us
Experience in the health insurance (10 years in this business)
At Kataria Insurance Brokers Pvt. Ltd and Policy Leader, we have over ten years of experience in the health insurance industry. Our team of experienced professionals has in-depth knowledge and expertise to help our customers make informed decisions about their insurance needs. We have helped countless customers find the best insurance policies at the most cost-effective prices.
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Customized Individual recommendation
We understand that every customer has unique insurance requirements. At Kataria Insurance Brokers Pvt. Ltd and Policy Leader, our team takes the time to understand our client's specific needs and recommends a customized insurance solution that fits their budget and coverage requirements. We offer the best insurance quotations and help our customers compare insurance policies from multiple insurers to ensure they find the policy that is right for them.
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Quick and Hassle-Free Insurance Renewal
We value our customers' time and offer a quick and hassle-free renewal process for their health insurance policy. Our customers can easily renew their policies with a few clicks online or a phone call.
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Dedicated Claim Support
At Kataria Insurance Brokers Pvt. Ltd and Policy Leader, we provide prompt assistance and support to our clients during the claim process. Our dedicated team of professionals guides our customers through the entire process, from filing the claim to receiving the settlement amount. We work tirelessly to increase our network coverage and cashless settlements in unfortunate events of critical illness and hospitalisation.
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Multiple Insurers Under One Roof
We work with multiple insurers and offer a range of health insurance policies, ensuring our customers have various options. Our expertise in the industry and our status as leading insurance brokers in Gujarat allow us to provide our clients with the most comprehensive health insurance solutions.
Read More...Choose Kataria Insurance Brokers Pvt. Ltd and Policy Leader for the best insurance quotations, customized insurance solutions, quick and hassle-free insurance renewal, dedicated claim support, and various insurance policies.
