All You Need to Know About Health Insurance in India
Updated 25 February 2019
A health insurance plan plays a major role in providing you financial stability in case of various health issues. This is because by it your insurance provider gives you legal assurance to offer you financial help in different cases of health issues.
To avail the benefits of your health insurance plan, it is extremely important to understand your health insurance plan. If you are waiting to fall ill or meet with an accident to get to know your health insurance policy, then you are definitely committing a blunder. We are saying so because at that time you will not be in a situation to even understand your medical bills, then how will you be able to understand your health insurance policy. Therefore, the perfect time is this time and the perfect day is today to know your health insurance policy full well.
This article is a guide for you to understand health insurance irrespective of the insurance provider from which you have taken a plan.
Health Insurance Terms
Enlisted are some of the jargons that are used in the health insurance industry:
- Survival Period: This term is majorly used in critical insurance plans. Most of the times the policyholder have to survive for at least 30 days after the diagnosis of the medical condition in order to avail the claim benefits.
- Pre-Existing Illnesses: Pre-existing illnesses or diseases is the illness that you have before you have purchased the insurance plan. Most of the insurance providers do not offer coverage for pre-existing diseases before the completion of four years of the policy. If you have continued your health insurance policy with the same insurance provider for four contentious years, then the insurer may consider covering your pre-existing illnesses.
- Network Hospitals: All the health insurance providers have tie-up with some hospitals; these hospitals are termed as network hospitals of the insurer.
- Waiting Period: Every health insurance policy has a waiting period. It is a time after which you can avail the benefits of your health insurance plan. However, exceptions such as emergency hospitalization due to an accident are covered even before the waiting period is over. The tenure of waiting period may vary with the insurance provider and the plan you take, but for general health insurance policies, it is mostly 30 days.
- Inclusions: All that is covered in your health insurance policy is considered as the inclusion of your plan. The inclusions are mentioned in the policy documents.
- Exclusion: All that is not covered in your health insurance plan is known as its exclusion. The exclusions are mentioned in the policy documents. There are some exclusions that are common in most of the health insurance plans, such as treatment of AIDS, dental treatment, self-injury, etc. are a few standard exclusions.
Features of Health Insurance Plans
The basic facilities/ features that most of the health insurance plans have are:
- Cashless Hospitalization: If you take treatment from any of the network hospitals of your insurance provider, then you will not be required to pay for your medical expenses. To avail this feature, all you have to do is to show the card provided by your health insurance provider and get your treatment done as per the coverage of your policy. However, if due to any reason, you have to be admitted to a non-network hospital, then you have to settle your bills by your own and get them reimbursed by your insurance provider later.
- Online Policy Renewal: After completion of the policy year, you can renew your health insurance plan online. You can do the same by going to the website of your insurance provider. The renewal process of some of the insurers like Star Health Insurance renewal is very simple and quick and you can do it on your own.
- Day Care Treatment: Some insurance providers accept your claim only if you have spent at least 24 hours in the hospital. However, there are some plans that also cover day care treatments and do not ask you to stay at the hospital for any minimum number of hours.
- Pre and Post Hospitalization: Most of the health insurers provide the facility of both pre and post hospitalizations. Generally, 30 days of pre and 60 days of post-hospitalization care is taken into consideration by most of the health insurance plans.
- Grace Period: It is time period offered by the insurance providers after the due date of your insurance expiry. The grace period is given to the policyholders to pay the premium in order to keep his/her health insurance policy valid and retain claim benefits. Most of the health insurance providers offer 15 days of grace period.
- Policy Portability Feature: If you want to upgrade your health insurance policy or want to switch your health insurance provider without losing the benefits of your current plan, then avail the portability feature. You can port your health insurance plan only at the time of its renewal. You have to initiate the process of portability at least 45 days prior to the expiration date of your current plan.
- Complaint Correction: If you have any complaint about your health insurance provider, then it is advised to address it. The insurance provider is liable to acknowledge this complaint within 3 working days. In addition to this, if you are not satisfied with the solution given by the insurance provider, then you can escalate your issue to IRDAI, either via mail or call.
- Claim Settlement: Every insurance provider has a process to settle claims however, it differs with the organization. Therefore, it is suggested to get yourself familiar with the claim settlement process of your insurance provider. Make sure you are aware of the documents that are needed in order to file a cashless claim. To have a seamless claim approval, it is required to understand the process of claim full well.
Types Health Insurance Plans
There are several types of health insurance plans provided by different health insurance providers, however, under this list, we are providing some of the common policies that are offered by most of the insurers:
- Individual Health Insurance: A plan that offers health insurance coverage to individuals is termed as an individual health insurance plan.
- Family Health Insurance: It provides coverage for complete family and also known as a family floater. Generally, in a family floater plan, a family of 4 (2 adults and 2 dependent children) is covered. However, it too has variants as some providers give facility to add your parents and parents-in-law as well.
- Senior Citizen Insurance: To provide wide health insurance coverage to those who are more than 60 years, this health insurance plan is introduced. Some of the insurance policies such as Star Health Insurance for Senior Citizens provide really extensive coverage in this policy.
- Critical Illness Insurance: If you are diagnosed with some critical illness, then taking this policy is recommended.
- Maternity Insurance: To provide uninterrupted medical services to pregnant women, this health insurance plan is introduced. Some plans under this policy cover the mother as well as their new-born babies.
Apart from the above-mentioned types, some insurance providers offer insurance plans for cancer, personal accident, etc. So, if you want some specific policy, search the website of your insurance provider or contact its customer support.
Hopefully, this article has helped you to get a basic understanding of a health insurance policy. However, it is suggested to understand the terms and conditions of a plan completely before purchasing it. Take a plan only after you get completely satisfied and found out that it is providing you all that you need from your health cover.
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