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How Health Insurance Works in India?
Medical inflation is one of the biggest reasons for bankruptcy in India. eople lose their lifelong savings if they are diagnosed with a critical illness or get severely injured in an accident. If you are looking for ways to protect your savings from medical expenses, buying a health insurance policy is your best bet. Let’s know how health insurance works in India.
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- How Health Insurance Works in India?
How Does Health Insurance Work in India?
Health insurance is designed to provide financial assistance to the policyholder in case he/she incurs a covered medical expense. In return, the policyholder is required to pay a premium regularly. The medical expenses are covered up to the sum insured limit, which is the maximum claim amount provided by the insurance company.
Not every medical expenditure is covered under health insurance.
Usually, a healthcare insurance policy provides coverage for hospitalization expenses, day care procedures, organ donor expenses, ambulance charges, maternity expenses, AYUSH treatments, etc. However, the scope of coverage is not the same for all mediclaim policies and varies from one policy to another.
Besides, health insurance plans also come with certain add-on covers that can be added to your policy to increase its coverage. For instance, reduction in PED waiting period, critical illness cover, OPD cover, hospital daily cash, etc. are some of the most common health insurance add-on covers.
Besides, the premium of all health insurance plans is not the same.
The premium of a health insurance policy depends on several factors, such as the age of the insured, medical history, city of residence, sum insured, coverage, deductibles, add-on covers, etc. The deductible is the amount that you agree to pay at the time of claim settlement.
How Does Health Insurance Renewal Work?
When you buy a health insurance policy, you pay a premium amount. However, this premium is valid only for a fixed time period. Usually, health insurance plans are available on an annual, bi-annual, quarterly or monthly premium payment.
Once the validity of a health plan expires, the policyholder needs to renew the plan. This is essential because insurance coverage ceases to exist as soon as the policy expires. So, if you want medical coverage at all times, renewing your health insurance policy before its expiry date is non-negotiable.
To renew your health policy, you need to contact your insurance company and request them to renew your policy. Alternatively, you can also renew your health insurance policy online. Just visit the insurance provider website, select the policy to be renewed, pay the renewal premium and the validity of your policy will get extended.
How Does Health Insurance Claim Work?
When you incur a medical expense, you are required to raise a claim to get your insurance company to pay for it. But as soon as your insurer receives your claim, they will first check if the illness/treatment is covered under the ambient of your health insurance policy.
The medical reimbursement will be available only if your illness/treatment is covered by your policy.
If your treatment/illness is covered by your policy, the insurer will check the hospital where you are availing the treatment. In the case of a network hospital, you are eligible to avail cashless hospitalization facility and the third party administrator (TPA) will be responsible to settle your hospital bills on behalf of the insurance company. The TPA will go through your medical documents and ensure that you pay the deductibles before they pay the hospital bill.
Remember… Every health insurance company in India has a network of affiliated hospitals where cashless hospitalization is available.
But if you are receiving treatment at a non-network hospital, you cannot avail cashless treatment. In such a case, you will have to pay your hospital bill as soon as you get discharged from the hospital. You can raise a claim with your insurance company after getting discharged by submitting the required documents.
Don’t forget to collect your medical documents from the hospital at the time of discharge.
When your insurance company will receive your reimbursement claim request, they will go through your documents and check if your policy offers coverage for your illness/treatment. If it does, the claims team will initiate reimbursement of your medical expenses.
In a Nutshell
Health insurance is easy to buy and useful to claim. Just make sure that you understand how health insurance works so that you have a hassle-free experience.
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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in
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*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.
*Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.
*All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.
**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.
*₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.
*₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases
*₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases
*₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.
*₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.
*No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
*The values taken for effective cost calculation are indicative values and may change as per the selected plan.
*Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.
*Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.
*The scope of coverage may vary from plan to plan.
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##On ground claim assistance is available in 114 cities
Tax Benefits are subject to changes in tax laws. GST Exemption depends on fulfilment of qualification criteria and submission of relevant documents as required by the insurers. For more details on risk factors, terms and conditions, please read the sales brochure and applicable rules and regulation carefully before concluding a sale.
STANDARD TERMS AND CONDITIONS APPLY. For more details on risk factors, terms and conditions, please read the sales brochure carefully before concluding a sale.
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