Health Insurance

Basic details

HEALTH INSURANCE :

Evolution of man-kind has not only made them destroy nature but also themselves and with the increase in the number of health issues for man, even the cost of medicines and treatments are rising rapidly. However, a person who finds it difficult to pull together all his/her funds to meet their own medical expenses like, illness/surgical/hospital expenses and so on, the policy of a Health Insurance acts as a guardian. The policy holder will be credit with the required amount according to their Health Insurance plan, which will aid the holder from getting depressed/tensed about his/her financial crisis at an important hour.

A Health Insurance Policy not only funds for hospital expenses but also for bills of other expenses. Mostly, the policy holders, because of their ignorance about the complete benefits of their policy, try to keep some of the services unused. So a Health Insurance policy is not only about focusing on its features but also on how they are put to work.

THE BENEFIT OF CONVALESCENCE:

Convalescence refers to the total time spent on the recovery of a sick person. These Health Insurances, however, make sure that their policy holders are funded properly for their medical and medical-oriented expenses. In case the hospitalization gets prolonged for a week or so, then the insurer, to avoid further financial crisis, does pay a lump sum for their policy holder. In some policies, the cost incurred while the family members make a compassionate visit, is also covered. The supplementary costs are paid to their policy holders for hospitalization, when their income falls down. The expenses involved in alternative treatments are also included.

ORGAN DONOR EXPENSES:

Now-a-days, Organ donor / Organ transplantation costs in lakhs or even more. One of the main advantage of health insurances is that, they help with your medical expenses and therefore you can avoid any kind of stress before going for your organ transplantation as most of the insurance companies cover Organ Transplant Surgery as part of their health insurances. However, there are a few restrictions in this aspect. The cost incurred in hospitalizing the donor, the complications of post-surgery and the screening costs are not included under these policies. Either the entire cost is reimbursed or is offered as an add-on benefit by the insurer.

DOMICILIARY TREATMENT:

Not all sick people get treated in the hospitals. Some get their treatments at home under some medical supervision. The Health Insurance policies also cover the costs involved in such home-based treatments for their clients. The insurer have capped the overall amount that can be offered to their client and also the number of days for which the benefit will be valid/available

ALLOWANCE FOR ATTENDANTS:

In case the insured is a child and is hospitalized, then the insurer will offer an allowance for the adult attender. The terms of this aspect makes the payment of attendant allowance by the insurer fixed, in terms of days.

DAILY HOSPITAL CASH ALLOWANCE:

The Health Insurance policy not only takes care of its client and the attendants but also the expenses required for food and travelling, which are not included in the policy/plan. The insurer aims to focus on providing additional financial protection as allowance to their clients, through this process.

FREE HEALTH CHECKUP:

The insurer also offers free periodic health checkup to their policyholders after every 4 or 5 claim- free years, as per the guidelines of the health insurance policy. They also offer cashless health checkup, in case the tests are conducted at empaneled hospitals or centers.

OTHER SERVICES INCLUDED:

The Insurer not only focuses on the above mentioned expenses but also on the dental treatments and Bariatric (Weight loss) surgeries. These dental treatment expended are dealt with once in a few years with sub-limits and these bariatric surgeries are no longer regarded in the cosmetic category but is seen as a life-saving treatment for obese patients. However, these bariatric surgeries will be funded by these insurers only when they are done for a medical purpose.

The Eligibility Criteria are usually set by the insurer / the insurance companies after assessing the risk involved and the ability of the insured to pay the respective premium amounts. Depending upon these aspects, there are 2 categories of people who can be insured and they are called the ‘Prosper’ and ‘Dependent’. Following are the criteria required to avail the health insuranceEvolution of man-kind has not only made them destroy nature but also themselves and with the increase in the number of health issues for man, even the cost of medicines and treatments are rising rapidly. However, a person who finds it difficult to pull together all his/her funds to meet their own medical expenses like, illness/surgical/hospital expenses and so on, the policy of a Health Insurance acts as a guardian. The policy holder will be credit with the required amount according to their Health Insurance plan, which will aid the holder from getting depressed/tensed about his/her financial crisis at an important hour.

  • Proposer / Policyholder:
  • 18-21 years of age is the minimum entry age and the maximum age for the policy could be between 60-100 years of age, or this could be extended to their entire life also.

  • Dependents:
  • Depending upon the type of policy, the spouse, parents or children can be allowed to be protected under the same policy. However, the child need to be at least 9 days old to be eligible and they can be insured under their parent’s policy up to the age of 18years, which can furthermore be extended to 25 years of age.

  • Renewability:
  • These Health insurance policies are renewable for a lifetime but it deals with medical screening that happens beyond a certain age and an increase in the premium amount.

Whenever you are subjected to apply for a health insurance policy, make sure you submit proper and accurate information as false information can be stated for rejecting your health insurance claim. In case, you are a smoker / a drinker, these information needs to be disclosed to the insurer for being on the safer side.

  • AGE PROOF: Age proof is one of the most important proof required for availing health insurance as the health insurance premium depends primarily on your age. In order to prove your age, valid documents are to be submitted for verification. Some commonly accepted proofs are:
    1. Birth Certificate
    2. Voter’s ID Card
    3. Pan Card
    4. Aadhar card
    5. Driving License
    6. Passport, etc.
  • IDENTITY PROOF: To authenticate your identity, proper valid proof is required for which any of the following documents can be submitted:
    1. Voter’s ID Card
    2. Passport
    3. Aadhar Card
    4. Driving License and so on.
  • ADDRESS PROOF: An address proof is mandatory as very important documents like the policy bond and other communication from the insurance company will be addressed to your location. The following documents are all a valid proof for your address among which you can submit any one.
  • Utility bills like electricity bills, telephone bills and so on.
  • Ration card
  • Driving License
  • Passport
  • Rent Agreement if you are a tenant, etc.
  • A copy of your Pan Card is also mandatory.
  • A copy of your Aadhar Card is required.
  • A passport sixe photo of yours if essential.
  • In case you have undergone any pre-entrance medical check-ups, those medical examination
  • ports are to be submitted as it’s required by the insurance company.
  • Last, is the Proposal form duly and accurately filled in and signed
  • Once these documents are submitted, the insurance company will analyze these documents and verify if the provided information are correct and then the health insurance plan is issued.

    Health Insurance plans, if looked in detail, consists of many types of plan to make it easy for the clients to choose them according to their requirements.

    As the name suggests, these policies are designed only for an individual person and therefore the premium on these plans will be low because the risk is borne only for a single person. Number of illness will be considered under the plan and the costs like the in-patient care, post- hospitalization, medical examination charges, laboratory charges, maternity care expenses and consultation fees will be funded by the insurer. The premium amount for these plans will depend on the factors like age, previous medical condition, location and many more.

    Family Floater, the name itself refers to the feature of this policy, on how these plans are formed for multi members of a family and some cover up to 15 people. The minor kids, along with their parents can be covered under one single plan, instead of two different policies. The members of the plan either receive their insurance amount as a whole sum or depending upon the insurance provider, each member will receive an equal amount of coverage. The big advantage of this type of plan is that, if one person from the family requires a substantial amount for treatment, the amount can be withdrawn from the entire sum assured. This feature helps one to balance out the cost of those who wants a claim and who doesn’t. As a whole family is put together under this plan/ policy, the premium will be higher but will surely be a money saver because there’s no need to spend on separate health insurance policies for each member.

    Senior Citizen refers to those who have attained the age of 60 years. They are totally eligible for this plan. Insurance companies require low premium amounts or offer discounts on premium to be paid for all those who opts this plan and will require a medical check-up before selling the plan. The main purpose of many insurance companies offering this plan is to cater to the medical needs of the aged.

    Any particular illness which are critical to the health of a person and if they have a family history of a specific disease or is more prone to it then these will be funded under this plan. Illness like cancer, organ transplant, multiple sclerosis, blindness, heart value surgery, coma, heart attack, paralysis, kidney failure and the like are treated as ‘Critical Illness’, by the Insurance companies. These plans are either offered as a Standalone plan or as a plan that can be attached to a base plan

    Maternity refers to women who plan to bear children. Maternity plans refers to the insurance catered to such women, either as a standalone plan or as a plan that can be attached to a base plan. Both the mother and the new-born are covered under this category, in addition to this, even the end-to-end prenatal and post-natal expenses incurred, complications that may arise and the hospitalization costs are all included.

    Offering insurance to employees to safeguard their interests will boost the job position to be attractive and to mitigate risks also. Premiums are relatively low and a more lenient way of coverage is practiced in terms of covering pre-existing illnesses and so on. As the members enter and exit the organization, the schemes include and exclude them.

    A regular check-up and care are necessary to avoid or prevent any disease / illness and the costs associated with these preventive healthcare measures are all funded by this type of health insurance plan/policy. Even the annual physical exams come under this category as they are one of the way to check for early symptoms and for nipping any problems at the starting stage itself.

    Accidents in this fast-moving world will never come to an end and any unforeseen/unexpected even can lead to major injuries that can seriously affect you financially, physically and mentally. These plans are very helpful to meet the expenses for those who have met with an accident. In case of death / disablement / injury / impairment / mutilation as a result of violent, hazardous, visible and external means, these plans provide compensation. These plans are usually either a benefit of the base plan or can be attached to it as a rider.

    Online insurance claims are much easy than the old physical method which involved a lot of paperwork and multiple visits to the insurance office. There are 2 options available, in case you need to make a claim with a valid insurance policy and they are:

    1. Reimbursements
    2. Cashless claims

    REIMBURSEMENT CLAIMS:

    These claims work only after the insured person gets treated at any hospital, pays the full bill and later files for insurance reimbursement within the stipulated time. As the insured is expected to pay the full money, this may appear to be a burden financially for the insured. In case the insured is hospitalized, then the insurance company should be informed in advance.In case of Emergency , The insurance company can not be intimated in advance where the reimbursement claims are used.For making a reimbursement claim the following steps are to be followed:

    • Inform the company about the claim.
    • Ensure you collect all bills, invoices, discharge summary, reports, prescriptions and many more after receiving the treatment and settling the bill.
    • Fill the insurance claim form and submit it along with the necessary documents.
    • Along with the necessary documents, submit the filled insurance claim form.
    • The insurance company will process your claim and verify the documents.
    • The reimbursement will be paid, if everything stays in order.
    • The company will send a query in case of need for more information.
    • The claim can be rejected if the insurance company finds the stated reasons good enough.

    CASHLESS CLAIMS:

    If the insured person gets treated in a network hospital and if the insurance provider offers cashless facilities, then these cashless claims can be claimed by the customer, so that the customer receives a medical treatment without paying for the bill. In order to make sure that the insurance claim is settled fast and easy, the insurance companies tie up with many hospitals across the country. However, the insured has to pay for the non-medical expenses / for any treatment that is not included in the policy documents. To attain this facility the following steps are to be followed:

    • Make sure that you locate a network hospital, else, ensure that the hospital you choose falls
    • Under the insurance company’s network.
    • As per the stipulated time, intimate the claim to the insurer.
    • Planned hospitalization – usually 24-28 hours prior to admission.
    • Emergency hospitalization – immediately or up to 48 hours of hospitalization.
    • Ensure to present the insurance card and a valid ID at the designated desk in the hospital.
    • Procure and fill out the claims form, and submit it to the concerned person at the hospital.

    Once these are done, the hospital will find out if the insurer approves your request. Within 24hours of request the insurer will verify the claim and will send an approval if they are satisfied. Though this a cashless claim, it is still advisable to collect a copy of all bills, discharge summary, reports,prescriptions and the like.