Health Insurance: Types, Benefits, Eligibility

October 10, 2021
By Life & General

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I have often come across people who say, “Why do I need health insurance when I have other investments. It’s money down the drain if nothing happens to me.”

To this, I often want to say, “God forbid, what if something does happen?”

The last two years have taught us, that health is the most investment and we must all take it seriously.

So, we are here to help you understand what health insurance is and learn about its benefits.

What Is Health Insurance?

Health insurance is a form of insurance that pays for medical costs incurred as a result of an illness. These expenditures might include hospitalisation bills, medication prices, or medical consultation fees.

What Are The Types Of Health Insurance?

Different health insurance caters to different needs of the consumers.

1. Health maintenance organizations (HMOs): HMOs require you to pick from a local network of participating doctors, hospitals, and other health care professionals and facilities. You must also select a primary care provider (PCP) from the network for these sorts of health insurance policies.

2. Exclusive provider organizations (EPOs): An EPO provides you with a network of participating providers from which to select. Except in the case of an emergency, most EPO plans do not cover out-of-network treatment.

3. Point-of-service (POS) plans: A combination of HMOs and PPOs. However, the provider network is usually smaller than a PPO network and the costs are also lower. In this type of plan, you also need to choose a primary care provider.

4. Preferred provider organizations (PPOs): A plan that provides a huge number of doctors, hospitals, and other health care professionals and facilities to choose from.

How To Know If You Are Eligible For Health Insurance?

Before providing medical insurance, companies often ask for a health check-up and declaration of pre-existing conditions. The company might also ask a few lifestyle-related questions related to drinking and smoking.

What Are The Benefits Of Health Insurance?

Health insurances are essential for the following reasons:

Coverage against medical expenses: A medical insurance might help you get total coverage on hospital expenses, medicine and surgery expenses. Depending on your cover.
Tax benefit: It helps save taxes and can be claimed while filing returns. Tax can be saved by showing health insurance premiums as expenses.
Cashless transactions: Health insurance can help by providing cashless transactions between hospitals and insurers.

How Does Health Insurance Work?

Health insurances are simple to understand and can be understood in the form of steps.

First, you find a medical insurance policy that fits you. You then get the policy and begin paying premiums. The policy will have a certain limit after which it can be used (usually a month). In the event of a medical emergency, once you pay a deductible (the amount you must pay before you claim policy) the insurer starts taking care of your expenses.

In case, the policy goes claim-free, every year, the insurer might provide a cover extension.

What is Covered in Health Insurance Plan?

There may be exceptions to what your policy does and does not cover. Let us look at what is covered in the policy:

In-patient Hospitalization Expenses: Policy takes care of hospitalisation charges.
Pre and Post Hospitalization Expenses: Ambulance, First treatment, and post hospitalisation care like nursing care provided.
In ambulance Charges: In case an ambulance is required to transfer the patient.
Maternity or Newborn Baby Cover: All the pregnancy-related care in the hospital.
Preventive Health Check-ups: Preventive health checkups are often covered in a policy
Day-care Procedures: In cases where hospitalisation is not required for more than 24-hours.
AYUSH Benefit: All the Ayush benefits are also taken care of under the policy.
Mental Healthcare Cover: A few policies also provide insurance against mental healthcare.

What Is Not Covered In Health Insurance Plan?

Here are all the things covered in most insurance plans:

Claims made during the first 30 days after purchasing a health insurance plan are not covered unless they are caused by an accident.
Pre-existing illness coverage is subject to a 2- to a 4-year waiting period.
A 90-day waiting period is generally required for critical illness coverage.
War, terrorism, and nuclear activity-related injuries or even self-harm
AIDS and other diseases of a similar kind are examples of terminal illnesses.
Cosmetic/plastic surgery, hormone replacement surgery, and so on.
Expenses for dental or eye surgery
Bed rest, hospitalisation, and rehabilitation, as well as common diseases, are all factors to consider.
Treatment/diagnostic testing, as well as follow-up procedures

How to Claim Health Insurance?

Here are the general steps to claiming health insurance:

Completed claim form
The treating doctor’s signature is required on the medical certificate/form.
Original discharge report or card obtained from the hospital.
All receipts and bills (original)
Prescriptions and hospital cash memos
Report on the investigation
If it’s an accident, you’ll need a police report or a Medico-Legal Certificate (MLC).

Choosing The Right Health Insurance For You?

Choosing health insurance can be tricky, so we made a checklist for you, here are a few tips for choosing the right health insurance plan for you.

Check the Scope of Coverage
Adequate Sum Insured
Waiting Period Clause
Policy Type
Co-payment Clause
Room Rent limits
Network of Cashless Hospitals
Renewability Option
Premium Loading Factor
Claim Settlement Ratio

Which Are The Top Health Insurance Providers In India?

Here is a list of 5 top health insurance providers in India:

Aditya Birla Activ Assure Diamond Plan
Bajaj Allianz Health Infinity Policy
Bharati AXA Health Insurance
Care Health Insurance
Digit Health Insurance

What Is Considered The Best Health Insurance Plan In India?

While selecting a plan, it is very important to weigh all your options. Consider the following as an essential guide to selecting the best policy:

A vast number of network hospitals: Ensure that the insurer has a wide network of hospitals in most metro cities across the country. Also, ensure that the hospitals have the best service when it comes to medical facilities.
Cashless hospitalization facility: Ensure that the hospital has a facility for cashless transactions
Good claim settlement ratio: Check the claim settlement ratio for the insurance provider
Range of sum insured: What is the range of sum that can be insured considering increasing costs.
Customer reviews: What are the customers saying about
Home care facility: How many days of home care is covered under the policy

Difference Between: Health Insurance & Life Insurance

This is often confusing. Most people overlap the terms and use them incorrectly. Let us look at the essential difference between the two.

In the event of your untimely death, life insurance provides a lump payment to the beneficiaries. The assumption is that the death benefit will be enough to replace lost income in the future, as well as cover existing expenses and obligations like funeral charges, hospital bills, and other debts—or to finance college savings accounts or retirement years. Despite the loss of you and your wage-earning capability, this provides financial stability to the family, ensuring that they do not struggle.

On the contrary, Health insurance covers medical expenditures such as doctor’s visits, hospital stays, prescriptions, tests, and treatments. Making it easier for people to pay for medical treatment and stay healthy.

Why Buy A Policy Via A Health Insurance Consultant?

Simply because they can guide you better and help you choose the right policy to best fit your needs. Also read further how to choose a health insurance broker in India.

Summary

Health insurances are absolutely essential and can help us be better prepared for different forms of medical emergencies. There are multiple benefits of having health insurance, which other investments may or may not provide.

It keeps you better prepared for the future.

Willing To Buy An Individual or Corporate Health Plan?

We hope our guide has helped you understand the importance of health insurance and you are looking forwards to insuring your future. LNG provides health insurance consultation service that can help you choose the right health insurance for you and your family.