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Health Insurance


Health Insurance or Mediclaim as commonly know refers to protection that is provided to a policyholder as a cover against unexpected medical emergencies. Today there are over 200 Health Insurance Plans available to a consumer. With each of these Health Insurance Plans having their own unique USP, but they all can be differentiated on the bass of 8 broad categories.

a. Waiting Period & Duration before Pre-Existing diseases are covered in the Policy
b. Lifelong Coverage
c. Type of Health Insurance
d. Extra Coverage's of Critical Illnesses
e. Presence of Maternity coverage's for females
f. Day Care treatments covered
g. Product Premium
h. Co – Payment options

Though these may not be all the parameters you can compare all Health Insurance Plans on, but they surely help in narrowing search for the best suited health insurance plan.

Types of Health Insurance

With over 200 hundred plans available in the market, which can be segregated into 8 broad types of health insurance:

Cashless Mediclaim

Cashless Mediclaim plans are those which allow a policyholder to get admitted into a network hospital without the need of a paying any upfront admission fee and discharge fee as the same is paid by the health insurer. The cashless mediclaim reimbursement is capped to the level of sum assured the person has and the coverage's under the plan.

Family Floater Plan

Family Floater Plans refer to those which cover the entire family under one plan. Under a family floater plan the people covered share the total health insurance available to them. The benefit under such a plan is that since a large group of people share the same insurance cover the premium to be paid is far lesser in case they all would have bought an individual plans for themselves.

Taking an example, if a family of 4 (2 Adults and 2 Children) takes a family floater plan then there premium for a health cover of say around Rs. 5 Lacs would be close to Rs. 10,000, whereas, if all of them had a separate plan of Rs. 5 Lacs their premium would have exceeded Rs. 12,000 easily.

Individual Health Insurance

Individual Health Insurance plan offer more protection to a policyholder, as in such a policy the policyholder can consume the entire amount alone without have to worry about sharing it with other members of his family incase of a floater policy.

Group Health Insurance

Whenever a large group of people say over 20 who work, stay or are bonded by some nature of job are willing to get a Health insurance plan, they should opt for a Group Health Policy. Under a group health policy people who may have adverse health condition can also easily get health cover due to the greater negotiating power that a group contains versus a individual policy.

Travel Health Insurance

Whenever a person is travelling outside the geographical boundary of his / her health insurance plan it is always advisable that they take a Travel Health insurance plan. This is advised so that the person in-case falls sick or has any other medical emergency abroad need not worry about the high cost of healthcare in a foreign land. This is also mandatory to buy before travelling to a certain countries.

Critical Health Insurance

A critical health insurance policy hels cover certain set of diseases as prescribed under a policy only. As the name suggest critical health insurance, they cover all those major diseases which are either terminal or can reduce the human body to a vegetative state. Some of these would include, Alzheimer's disease, blindness, deafness, kidney failure, major organ transplant, multiple sclerosis, HIV/AIDS contracted by blood transfusion or during an operation, Parkinson's disease.

Hospitalization

Hospitalization plans only pay a pre-fixed amount as per the level of coverage for the room rent only. These plans are cheaper when compared to full indemnity plans as they do not pay for any treatments and medicines used during the course of hospitalization, as they only pay for room rent.

Senior Citizen Health Insurance

As a person enters the golden age as many state of 60yrs, they start to lead a new life a life of a retired person. The needs and wants of a person at this age are completely different from those that they would have had at age 40 yrs or 50 yrs. Thus they need health insurance plans which are suited best for them at this age, but sadly enough there aren‘t many. When a person above 60yrs of age goes to buy a health insurance plan he needs to check:

i. The network hospital closest to his residence
ii. Co-Payment options which will ensure his hospital bills are never stopped
iii. Lowest time frame for coverage of pre-existing disease
iv. Lowest amount of waiting period

Maternity Insurance

Standalone maternity insurance are a rarity, thus many insurers include this as a part of their regular policies and also critical illness policies that they specifically design for women. Under maternity insurance, the female is covered for any complication that arises during her pregnancy and related to child birth.

Health Insurance Contract Terms

We have always been taught to check before we sign the dotted line and this also stands true for a health insurance plan contract. We often hear news of claim rejection this is due to a simple reason that we never read that the proposal form or the health insurance contract stated. This is always due to a hurry we are in and the insurance agents who are ready to make a quick buck. Health insurance contract terms define the coverage's that your policy offers and the other tiny details that would ensure that your claims are never rejected.

Health Insurance Claim Process

The process of claim filing is different from a network to a non network hospital. While filing for a claim in a non-network hospital a policyholder needs to fill up a claim form, attach all original bills to be claimed and share the same with the branch of the health insurance provider who then reimburses this amount. In case of network hospital all formalities are done by the hospital.

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