Health Insurance Simplified

Let us start with what insurance is. Insurance is a form of protection against risks. By availing insurance, we protect ourselves from sudden, unexpected financial losses. The insurance company will pay us a sum when we sustain the losses specified in that particular insurance.

What Is Health Insurance?

• Health insurance is an insurance that covers the expenses we sustain as a result of an illness. These could be expenses in the form of hospitalization, medication or a doctor’s fee.
• A health insurance policy is basically an agreement between the policyholder and the insurance company in which the company covers the medical expenses sustained by the policyholder as per the terms and conditions mentioned in the agreement.
• For this, the policyholder has to pay a premium to the company.
• The policyholder can meet the expenses out of money from his own pocket and then get reimbursed by the company on presenting the necessary bills and documents. Alternatively, in case of cashless service, the policyholder will not need to pay any of the hospital expenditure and it will be settled between the hospital and the insurance company.

The Need for Health Insurance

Illnesses don’t strike with prior notice. They can happen anytime and it is only wise and safe that we be prepared for it. Being unprepared will mean a huge financial burden that could possibly drain out all our savings.

• The average life span of people is on the increase and this translates to a possible increase in the health conditions that could afflict them.
• Lifestyle disease too are on the increase especially among our younger population.
• Buying health insurance will ease the financial burden that comes along with the mental strain of treatment.

Types of Health Insurance

People are often quite confused about which health insurance policy to buy. Since there are many types of health insurance, having an idea about all the plans will help choose the right one.

Given below is a brief overview:

Individual Health Insurance

• As the name implies, only the individual can claim and avail the benefits offered by this.
• So, you might have to consider buying one for each member of the family.
• Individual health insurance policies are very comprehensive and most of them cover hospitalization costs, costs incurred for day-care, ambulance, organ donor expenditure, costs for alternative treatments like homeopathy, ayurveda, etc., mental health expenses, annual and preventive health checks, etc.
• They usually also have a lifetime renewability offer.
• Make sure you are aware of what your particular policy offers before you buy it.
• The age of the policyholder decides the premium to be paid.

Family Health Insurance

• This plan covers all the family members.
• The entire sum insured can be used by one person or it could be availed by different family members depending on the requirement.
• The insurer will process claims up to the maximum sum that has been insured.
• Before buying this insurance, it is necessary to make sure of the premium to be paid and the insured sum.
• The age of the oldest family member decides the premium to be paid.

Critical Illness Insurance

• Coverage for critical illnesses which will require long-term treatment like heart attack, cancer, stroke, etc. is taken care of under this plan.
• The coverage amount is typically high under these policies.
• The amount will be given as a lumpsum to meet hospitalization expenditure, specialist consultations and other medical expenses.
• While buying this insurance, do ask about accidental death benefit and protection against disability. Make sure to be aware of the tax benefits too while getting this insurance.

Personal Accident Insurance

• This policy usually covers injuries due to accidents, deaths due to accidents and any kind of permanent or temporary disability as a result of an accident.
• In case of death, the nominee will be provided with the compensation.
• While buying these plans, do ask about the confinement allowance which is a form of daily cash allowance for a period of 30 days in case the accident affects income.
• Also ask about children’s education fee coverage under this plan.

Senior Citizen Health Insurance

• Citizens over 60 years of age can buy this insurance.
• There is a maximum age limit which has to be looked into.
• It offers coverage against pre-existing diseases and critical conditions.
• However, it is necessary to go through the policy thoroughly to understand any terms and conditions that may be applicable.
• For instance, some policies might cover pre-existing diseases after the first year while others may do so only after 2 or 3 years.
• Most policies cover preventive check-ups, hospitalization charges as well as pre- and post-hospitalization charges and ambulance services.

Top-up Health Insurance

• This can be combined with an existing health insurance to get additional coverage.
• However, there are some exclusions in a top-up.
• Sexually transmitted diseases are not covered; cosmetic treatment and obesity treatment are some of the other exclusions.
• Self-inflicted injuries and injuries sustained as a result of a defense operation are also excluded.

Things to Consider Before Choosing a Health Insurance Policy

• Make sure you have complete knowledge about what the policy covers and what the exclusions of the policy are.
• Policy premiums increase with increasing age. So, it is best not to delay buying a health insurance policy.
• Take your time and consider and compare various options before deciding on an insurer. An important factor to take into account is how fast the claims are processed. Do your homework and read reviews before finalizing one.
• The more the services covered by the health insurance policy, the higher will be the premium. You will have to strike a balance between what you can afford and what is covered.
• Find out if day care procedures (like cataract surgeries) are covered under the plan.
• Find out the maximum limit for room tariffs that you can claim. If it goes beyond the limit, you will have to pay the extra.
• Certain conditions will come under coverage only after a few years of the policy. Find out what these are before you buy a health insurance.
• Find out the list of hospitals where you can avail cashless treatment with your policy.