About Health Insurance
“If good health was a choice, we would never need an insurance” – Anonymous
Good health is your most precious asset, and you should protect it at all costs.
The value of health insurance cannot be overstated – Michael Lewis
With drastic changes in today’s lifestyle, health-related adversities are bound to happen no matter the precautions we take. And when such adversities strike, we undoubtedly are caught off guard most of the time. Partnering with Apna Health Insurance helps mitigate the impact of such eventualities. Our insurance experts will guide you in choosing the optimal Health Insurance plans that would not only cover medical costs but also take care of the related miscellaneous expenses.
Every individual should buy health insurance and for themselves and members of their family, based on their requirements. Buying health insurance protects individuals from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into household savings. Each person is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advancements, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.
Why Health Insurance?
- Health insurance covers the medical costs incurred in case of medical emergencies. These plans, thus, take care of the financial burden associated with medical contingencies.
- Health insurance takes care of your medical expenses and out-of-pocket expenses up to the Sum insured of the policy. This ensures the insured doesn’t end up spending their hard earned savings for medical treatment
- A health insurance policy ensures that one can avail cashless treatment at a network hospital, typically covering 30 days and 60 days pre and post hospitalization, respectively, in most of the Health Insurance plans.
- In today’s age, when illnesses and diseases are on the rise, due to individuals living sedentary lifestyles, a health insurance plan becomes critically necessary. Medical developments have provided cures for most illnesses, but at very expensive costs.
- Additional Coverages like Personal Accident (PA) Cover, Critical Illness (CI) Cover, Hospital Cash etc can be bought along with Health Insurance plans to ensure comprehensive coverage
- All health insurance plans across Insurance Companies include Coronavirus treatment cover. As per the IRDAI guidelines, insurers have also launched COVID-19 specific best health insurance like Corona Kavach and Corona Rakshak plans.
- Health Insurance also provides tax benefits as per the Income Tax Act 1961.
Firstly, let’s understand what a Health Insurance policy is and covers
Simply put, a health insurance policy is a legal contract between an insurance company and the policy owner and serves as a financial cover for unforeseen medical expenditures such as hospitalization expenses, ICU charges, Medicines, Ambulance rentals, Doctors’ fees, Daycare procedures, Critical Illness benefits, and more. The insured must pay premiums as notified in the contract to avail of the benefits (as per the Sum Insureds opted for) entitled. Claims may be in “Cashless” or “Reimbursement” depending on the medical emergency, whether it is pre planned or sudden in nature. Health Insurance also provides tax benefits as per the Income Tax Act 1961.
Does a Health Insurance Policy include Coronavirus (COVID-19) Treatment?
Yes, existing plans of health insurance in India would cover Coronavirus treatments if one is hospitalized across all insurance players. IRDAI has issued guidelines that all existing health insurance policies will need to cover expenses relating to Coronavirus or COVID-19 mandatorily. This means that if you have an existing health insurance policy or planning to buy one, any medical expenses incurred relating to the treatment of Coronavirus will be covered under the policy. IRDAI has further directed all insurance companies to expedite coronavirus related claim settlement in the case of hospitalization. However, the policy would exclude the costs of consumables incurred on such treatments and hence IRDAI has launched these plans of health insurance in India for providing complete coverage against COVID. The plans are as follows :
- Corona Rakshak : This is a fixed benefit health insurance plan which covers COVID. If you suffer from Coronavirus and are hospitalised for 3 days or more, the policy would pay the sum insured in a lump sum to provide you with the financial assistance needed for COVID treatments.
- Corona Kavach : This is an indemnity oriented health insurance plan which covers all medical expenses incurred on COVID treatments. The policy covers hospitalisation costs as well as home quarantine expenses without any deductibles or sub-limits.
Why would we need health insurance?
contingencies. In addition, the insured person(s) can avail cashless and quality medical care, extensive cover against various eventualities, free health check-ups, easy and lifelong renewal options, existing illness coverage, and more. But why do we really need Health Insurance?
- Medical insurance plans cover all inpatient medical costs incurred right from the time the insured falls sick, then is hospitalized, and also after being discharged from the hospital. Hence these plans provide comprehensive coverage.
- Cashless claim settlement is being offered by the health insurance company in partnership with the hospital which it is tied-up with. In cashless claims, the policyholder does not have to bear the burden of paying out of their pockets for medical expenses. The expenses are settled directly by the insurance company with the hospital.
- Each person is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advancements, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.
- There are value-added coverage benefits in medical insurance policies too. These include free health check-ups after a specified period, second medical opinion for serious illnesses, etc.
- Pre-existing Diseases: Coverage for any pre-existing disease is provided to you after a certain waiting period.
- Tax benefits under 80D of the IT Act 1961 can also be availed. Premiums paid for medical insurance policies for self, family and dependent parents qualify for tax deduction under Section 80D. The limit of deduction if INR 25, 000 for covering self and family and another INR 25, 000 for covering dependent parents.
- No Claim bonus is allowed in all medical insurance plans if no claim is made in a policy year. This bonus is either allowed as an increase in the sum insured or additional benefits can be availed like gift vouchers, annual health check-ups, etc.
- Avail Ancilliary Benefits: Some health insurers in India have come up with preventive check-ups and enhanced diagnostics, which usually are not included in a basic health insurance plan.
In a nutshell, a good health cover ensures peace of mind when one is faced with medical emergencies.
Now let’s look at the benefits of Health Insurance plans
Hospitalization expenditures coverage
Health Insurance plans cover most medical costs related to illness and hospitalization including the ones listed below.
- Pre and Post hospitalization medical expenses
- Doctor’s fees
- Cost of medicines
- Hospital room tariffs
- Diagnostic test charges
Coverage of expenses incurred on pre-existing illness
- Pre-existing illnesses are included after the given waiting period of 2 to 4 years depending on the policies of the Insurance company.
Coverage of Lifestyle diseases
- Lifestyle diseases such as heart attack, cancer, obesity, diabetes, etc. that require long-term treatment may also be covered under Health Insurance plans.
Daycare treatment costs
- Common daycare procedures such as dialysis, simple orthopedics surgeries, eye surgery, etc. that don’t require hospitalization for more than 24 hours are covered as well.
Domiciliary treatment costs
- Medical treatments provided at home are covered in certain Health Insurance plans
Miscellaneous expenses coverage
- Preventive health checkup fees
- Ambulance service costs
- Organ donor procedural expenses
- Maternity related medical expenses
- Covid-19 treatment costs
- Alternative treatment and medicine costs
Provisions for cashless claims
- If the insured opts for cashless claim settlement, the expenses are paid by the insurance company to the hospital directly when admitted to a network hospital. By this, the insured is saved from the hassles of arranging the required funds before being discharged from the hospital.
Tax benefits
- Under section 80D of the Income Tax provisions, the premium amounts paid towards health insurance are eligible for tax exemptions, within applicable limits.
Provisions for No Claim Bonus
- If no claims were made in a policy year, NCB (No Claim Bonus) may be availed wherein the cost of subsequent year premiums could be lower.
Flexi-payment options and more
- With multiple premium payment modes (monthly, quarterly, semi-annual and annual) and easy payment options (ECS, net banking, mobile wallets, credit cards, UPI, etc.), premium payments are a breeze.
Do consider the following factors before deciding on an insurance plan.
- Carefully examine the Inclusions and more importantly Exclusions under the selected policy.
- Does the insurance partner have a good network of hospitals that are conveniently located across the city of residence and the rest of the country
- Does the policy’s benefits and guidelines meet your requirements? Are the stated clearly on the policy document?
- Is the coverage (Sum Insured for medical treatment) offered by the insurer adequate?
- Are pre-existing illnesses covered in the selected plan?
- Are daycare treatment procedures covered? If yes, how many day care procedures are covered?
It is crucial to understand the coverage provided and the benefits offered under any selected policy to avoid ambiguity in the future.
Health Insurance Policy Exclusions
Though medical insurance plans provide comprehensive coverage for most of the medical expenses incurred for almost all illnesses, there are some expenses which are not covered. Some common exclusions include the following:
- Pre-existing illnesses during the waiting period
- Congenital Diseases
- Pregnancy-related Treatments expenses, unless specifically covered
- Illnesses or injuries occurring due to war or related perils, aviation, nuclear contamination, self-inflicted injuries, alcohol or drug abuse, etc.
- Waiting Period - Illnesses occurring within the first 30 or 60 days of buying the policy are not covered
- Cosmetic treatments
- HIV/AIDS infection
The individual must read the prospectus/policy wordings (terms and conditions) to understand what is covered and not covered under the plan opted for. Different medical insurance policies have different inclusions and exclusions. So, understanding the policy details before buying the policy becomes essential. It’s best to disclose your medical history truthfully and upfront before you buy a policy to ensure your claim expectations are met.
Health Insurance Claim Settlement Procedures
One must be aware of the Claims settlement process as well to ensure at the time of claim the insured and family members the process is followed to ensure timely settlement of claims in the below-mentioned processes:
Cashless Claims Settlement
| Step 1 | The policyholder should inform the insurance company of the claim by contacting them on the Toll Free nos etc This information is to be given by filling up and submitting a pre-authorisation form. |
| Step 2 | Insured can get admitted to the hospital of their preference, or the nearest one (in case of emergency) but preferably to a network hospital of the insurance company. Kindly note that Insured person is entitled for cashless only in network hospitals. |
| Step 3 | At the hospital, the insured will need to show your Health Insurance card issued by the insurer along with a valid identity proof to be able to use your insurance. This will give the hospital the details they need to contact the insurer for enabling the cashless hospitalization process. |
| Step 4 | The insurance company analyses the form and approves cashless claim settlements. The form should be submitted at least 3-4 days before a planned hospitalisation. If, on the other hand, the hospitalisation was an emergency, the form should be submitted within 24 hours of hospitalisation |
| Step 5 | The insured will be discharged from the hospital after receipt of final authorization letter from the insurer. Any inadmissible expenses (consumables), deductibles or copayments will have to be paid by the insured directly to the hospital. Post discharge of the insured, the hospital will send the original claim documents supported by the bills to the insurer. |
| Step 6 | On receipt of the complete set of claim documents, the insurance company will evaluate the claim and payment will be made to the hospital accordingly as per policy terms and conditions. |
Reimbursement Claims Settlement
| Step 1 |
Contact the Insurance Company or the TPA’s Toll Free Number to report/register the claim Insured can get admitted to the hospital of their preference, but preferably to a network hospital of the insurance company (details will be available on the company website. |
| Step 2 | The insured then avails the appropriate treatment at the hospital and payment for the treatments would have to be done by the policyholder himself directly to the hospital. |
| Step 3 | At the hospital, the insured will need to show your Health Insurance card issued by the insurer along with a valid identity proof to be able to use your insurance. The insured should collect the original bills from the hospital and then arrange to submit the same to the insurance company for reimbursement. |
| Step 4 | The insurance company analyses the form and approves the reimbursement settlements subject to the policy terms and conditions directly into the customer’s bank account. |
Documents to be Submitted for a Reimbursement Claim
- Duly Filled Claims Form + Original Discharge Summary document
- Original Hospital Bill with detailed Cost Break-up + Original Paid Receipts
- All Investigation, Lab and Test reports including the physical examination report
- Copy of Invoice/Stickers/barcode in case of implants
- Medico Legal Certificate (in case of Accident Cases)
- Photo Identity of Patient along with Health Card
- KYC documents
Documents required for Cashless Claim settlement
- The claim form, filled and signed
- Pre-authorization form for cashless claims
- Doctor’s recommendation for advice on hospitalisation
- All original medical bills
- All investigative and diagnostic reports in original
- Consulting medical practitioner’s certificate
- All pharmacy and medicine bills
