Health Insurance

Health InsuranceWe know that Health Costs are high; bearing the skyrocketing treatment and medication costs can be a nightmare. Health insurance covers reimbursements towards amount spent for hospitalization costs occurring due to ailments or accidents. General Insurance Companies offer a gamut of Health Insurance products also known as Mediclaim, depending on the person’s age and previous medical history.

Various Individual Health Insurance Plans are available in India. They can be broadly classified as below:

Individual Mediclaim Insurance: Under individual mediclaim Insurance, each insured would have separate sum insured. If two or more family members are covered, family discount in premium is allowed.
Family Floater Health Insurance: Under family floater health insurance, you share the entire sum insured among the family members covered under the policy, without any individual sum insured.
Senior Citizen Health Insurance: Senior Citizen Insurance plans are is exclusively designed for the senior citizens, which covers medical expenses incurred during hospitalization period and Pre / Post Hospitalisation.
High Deductable / Top-up Health Insurance: Also known as Surplus plans allows you to extend your health insurance cover. It takes care of the additional hospitalisation expenses over and above the deductible amount.

Some prominent coverage and benefits of having a Mediclaim Insurance are mentioned below:
Expenses towards Hospitalisation
Domiciliary Hospitalisation
Pre Hospitalisation
Post Hospitalisation
Ambulance Services
Day Care Treatment
Cashless Facility across network hospitals for obtaining treatment
Insured can also opt to go for treatments at non-network hospital; in case of treatment taken at non-network, insured will have to make payment and expenses will be reimbursed by insurance company after submitting relevant documents.
Pre-existing Diseases are covered after 4 year waiting period
Family Discount is given on mediclaim premium if 2 or more members of family members are covered under one policy.
Cumulative Bonus is added to sum Insured for every claim free year.
No Medical Checkup is required up to 45 years of age. In case of age above 45 years and based on medical history, mediclaim policy can be obtained after undergoing simple medical check-up

General Exclusions in Health Insurance Policy:
Pre existing Diseases (Covered after 4 claim free years)
Claims pertaining to Maternity
Congenital Diseases
Cosmetic Surgery
Accidents while under the influence of Drugs / Liquor
Suicide / Self Injury

Coverage and exclusions varies between different Insurance Companies and different plans. For Details coverage, please refer policy wordings.

Health Insurance claims are usually settled by TPA (Third Party Administrator). The TPA’s basic role is to function as an intermediary between the insurer and the insured and facilitate cash less service at the time of hospitalization. Some insurance companies have in-house TPA’s.