Health Insurance

What is Health Insurance?

Health insurance is a form of insurance that absolutely or partially covers an individual's clinical/medical and surgical expenses. It's an agreement among you and your insurance company, wherein for an annual premium, the insurer will pay for your hospitalization and other medical expenses as stated in your policy.

Health Insurance

Things you need to know - A health insurance plan is your best friend in times of a medical emergency. It is essential to have one at all times. Buy your health insurance online with myshubhnivesh.com. Hassle-free process, instant policy delivery, paperless documentation, choice in sum insured, and more!

Buy/Renew health insurance online.

The thing about medical emergencies is that they can hit anyone, anytime irrespective of age, gender or lifestyle. Since it cannot be predicted, one can always be organized for it. Health Insurance protects absolutely everyone in your own family against economic loss from the unexpected. It is a settlement among you and your insurance company, wherein for an annual premium, the insurer can pay your hospitalization and other medical/clinical expenses as referred in your policy.

BASIC HEALTH PLAN

This plan affords for the hospitalization expenses you might face in case of accidents, day-care procedures, surgical remedies or critical illnesses. However, the features, limits and sum insured will range from insurer to insurer.

SUPER TOP-UP HEALTH PLAN

Similar to top-ups for mobile network services, this adds supplementary insurance cover for your existing health plan. The intention is to increase the average sum insured with its corresponding insurer by paying an additional premium.

Features of Health Insurance

Health insurance companies offer a wide variety of policies, tailored to unique health necessities of their customers. Hence, numerous plans encompass different functions associated with medical remedies, surgeries, etc.

✚ Domiciliary Hospitalization: Medical charges incurred because of remedies undertaken at domestic for duration of greater than three days.

✚ Expenses for Organ Donation: Some health insurance plans cover medical charges incurred within the process of organ donation. If you're being donated an organ, your donor may be financially secured by way of your medical health insurance plan.

✚ Day Care Procedures: Day care methods or medical treatments like dialysis, angiography, radiotherapy, chemotherapy, appendectomy, colonoscopy, lithotripsy, hydrocele, eye surgical procedure, amongst others. Certain high-end medical health insurance plans cover all day care treatment techniques.

✚ AYUSH Treatment: Alternative clinical remedies or AYUSH, which stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy are covered for policyholders who've opted for it.

✚ Hospital Cash: Daily expenses for food, health center stay, etc. which might be incurred by way of your caretaker in the course of your hospitalization may be provided on medical health insurance plans or can be available as a rider. Health insurance plans also provide compensation for the loss of income because of health issues.

✚ Ambulance Cover: Health insurance policies cover expenses for ambulance service.

✚ Check-ups: General fitness check-ups are included with the umbrella of some health insurance plans.

✚ Vaccinations: Certain medical insurance plans cover vaccination fees for bee stings, dog bites, etc.

✚ Emergency Evacuation: Under emergency conditions whilst a patient needs to be transferred from one health facility to another, health insurance plans cover prices involved inside the relocation process.

Additional Features of Health Insurance

HOSPITAL CASH

Daily expenditures for food, hospital stay, etc. that are incurred by your caretaker during your hospitalization may be offered on health insurance plans or may be available as a rider. Health insurance plans also offer compensation for the loss of income due to health issues.

PRE-HOSPITALIZATION EXPENDITURES

Coverage extends to medical expenses incurred between 30 to 60 days earlier than hospitalization is included. (Clinical diagnostic tests, medication, etc.) Hospitalization expenditures include costs incurred for the duration of hospitalization for a minimal duration of 24 hours. Expenses generally blanketed are clinic room rent charges, operation theatre charges, ICU charges, doctors’ consultation fee, surgical operation charges, and other crucial fees like blood, anesthesia, oxygen, etc.

POST-HOSPITALIZATION EXPENDITURES

Expenditures incurred between 60 days and 180 days after hospitalization is generally covered by most insurance companies. These charges include follow-up doctors’ consultation fees, medical diagnostic tests, medication, etc.

CRITICAL ILLNESSES COVER

Some critical illnesses which can be normally blanketed with the aid of medical health insurance agencies are cancer, heart attack, coronary artery disease, stroke, paralysis, essential organ transplant, persistent lung disease, Parkinson’s, etc.

Benefits of Health Insurance

✚ Secure Health and Finances: Majority of the health-associated expenditures in India are borne out-of-pocket. A lot of people rely heavily on their financial savings, and sometimes even borrow money, to fund medical remedies. Health coverage products are designed to make certain that one's savings does now not dwindle on the grounds that the insurance agency will endure this cost. With medical health insurance, one can gain from quick cashless remedy, clinical/medical reimbursement, emergency ambulance cover and each day cash for the duration of hospital stay.

✚ Tax Benefits: The premium paid towards a health insurance coverage qualifies for tax deduction as per Section 80D of the Income Tax Act, 1961. A taxpayer (less than 60 years of age), who has availed a medical insurance policy for himself/herself and dad/mom (senior citizens) can claim a tax deduction as much as Rs. 75,000. Policyholders (above 60 years) who're paying health insurance premium for self and dad/mom can claim up to Rs. 1,00,000 under Section 80D of the Income Tax Act, 1961.

✚ Alternate Treatment Coverage: A medical insurance policy will cover costs associated with medical treatments in hospitals. However, from time to time there are conditions where alternate remedies, consisting of Ayurveda, homeopathy, etc. Some of the fine medical insurance policies within the market provide insurance for such treatments. This offers the insured more flexibility on the form of clinical/medical treatment the individual would prefer to undergo.

✚ Health Insurance Portability: Health insurance policies are portable, which means the policyholder can change their policy from one insurance company to another. In the past, when a policyholder opted for this option, it resulted in them losing certain benefits, such as the waiting period for covering pre-existing ailments. However, now the insurance regulator protects the policyholder by giving the individual the right to port his or her health insurance policy to another insurer, keeping the benefits intact. The regulator has stated that the new insurer “shall allow for credit gained by the insured for pre-existing condition(s) in terms of waiting period”.

✚ Zero sub-limits: Unlike an indemnity health insurance plan, a fixed medical insurance plan doesn't have any sub-limits on obligatory co-payment, room hire capping etc. So, the insured has the leverage to control the finances within his/her requirement. This is relevant when the policyholder moves from one insurer to any other and also from one plan to another with the same insurance provider.

This is applicable both when the policyholder moves from one insurer to another and also from one plan to another with the same company.

An essential point to be noted in case of health insurance portability is that 45 days before renewal, the policyholder needs to i) write to the old insurer requesting a shift, ii) mention the company to which the shift is being made and iii) renew the policy without a break (a 30-day grace period is applicable if porting is under process).

Cost of Medical Treatment

In recent years, advancements in medical technology has made it possible to cure ailments and diseases that were once considered incurable. However, the costs associated with them is quite high, making it difficult for middle class families to afford them.

According to various studies, medical inflation is expected to rise in the coming years which in turn would mean health care costs will also see an increase. In order to provide a solution to this, insurance companies have designed different kinds of health insurance plans, available at affordable premium rates. This makes availing healthcare facilities accessible and affordable for all.

Below are some factors that make the purchase of an effective health insurance policy essential for everyone:

  1. Life is uncertain and health issues may occur anytime, thereby creating a financial burden for the insured’s family to arrange for finances at short notice or no notice at all
  2. Keeps you financially prepared well in advance, despite rising expenses of medical treatments and hospitalization
  3. Offers financial protection against most expenditures associated with health and medical treatments
  4. Cashless facility offered by insurance companies at their network hospitals enables the insured to overcome the hassles of making payments at the time of hospitalization
  5. The insured can focus on speedy recovery, while the insurance company takes care of the incurred expenses

6 Health Insurance Myths Busted

Medical emergencies can happen anytime. And owing to the rising healthcare cost, having health insurance is a must to meet such emergencies. However, there are several myths about health insurance regarding when to buy or what are its benefits. 

In this blog, we debunk 6 such misconceptions about health insurance so that you can take an informed decision while buying one. 

Here are the 6 health insurance myths busted: 

Myth 1: I am young and healthy, I do not need health insurance

The number of ailments is low or nil for people in their early or mid-20s and usually they do not require much medical attention  And, since they do not need medical attention, many feel they do not need to buy health insurance. 

Reality: Even if you are young and healthy, you can become sick anytime. After the COVID-19 outbreak, many young people fell sick due to the virus and had to be hospitalized. The treatment cost for COVID-19 can go up to Rs 10 to 15 lakh and not having insurance would mean that one would have to pay that from one’s pocket. Again, in case one meets with an accident and needs to be hospitalized for medical attention, he/she has to pay from his pocket in case there is no health insurance. 

Also, in case of any pre-existing illnesses, there is a waiting period of two to three years in health insurance for such diseases. During that period, if the policyholder is admitted to the hospital due to any ailment related to that disease, it won’t be covered by the health insurance company. So buying health insurance early, before one develops any illness, ensures that he/she doesn’t have to go through the waiting period.  

Myth 2: I am covered under a corporate health plan, I do not need a separate health insurance plan

A number of people who are covered under their employer’s health policy do not feel it is necessary to buy separate health insurance. There are several reasons for it. First, the benefits they get from a corporate policy are similar to individual health policy. Second, usually, there is no waiting period for pre-existing illness in the case of a corporate health plan. Third, the premium amount for a corporate health policy is paid by the employer.

Reality: As much as having a corporate health cover brings peace of mind, but you cannot depend on that entirely. First of all, if you lose your job, the health insurance benefit will also stop. Also, considering the rising medical inflation, the cover under corporate policies might not be enough. 

For example, most corporate health plans provide about Rs 2 to 5 lakh insurance cover. For someone who earns Rs 80,000 or Rs 1 lakh per month, a health insurance cover of Rs 2 to 5 lakh is not enough. To fill the gap between the cover that you have and what you really need, you should buy an individual health plan.

So even if you are covered under a corporate health policy, it is always good to have individual health insurance. 

Myth 3: Benefits of health insurance start from  Day 1

There is a preconceived notion that you can avail of the benefits of health insurance from the day you buy the policy. 

Reality: This is a complete misconception. All health insurance plans come with an initial waiting period of one month, during which you cannot make any claim (However, some policies cover accidental hospitalization from Day 1). Then some health insurance plans come with a one-year waiting period for specific diseases like tonsils, hernia, cataract, etc, during which you cannot make any claim for those specific illnesses mentioned in the policy. 

Apart from that, all policies have a waiting period of two to three years for pre-existing illnesses. However, for many senior citizen health insurance policies, the waiting period for pre-existing illnesses is one year. This is primarily because the instances of hospitalization are more in the case of senior citizens. But, in case the waiting period is lower for a senior citizen policy, there is a co-payment clause. For which, the insurance company pays a part of the medical bill, while the policyholder pays the rest. 

Myth 4: If I don’t reveal pre-existing illnesses, it will be covered by health insurance

A lot of people hide their pre-existing illnesses from the health insurance company. They assume that if they do not reveal their pre-existing ailments, then the health insurance company will cover them. 

Reality: The health insurance company assumes that if you have any pre-existing illness, you will reveal it to them while purchasing the policy. However, if you do not do so and the insurance company comes to know about the ailment when you make an insurance claim, then your claim can be rejected. 

Myth 5: You need to be hospitalized for 24 hours to claim insurance coverage

A number of people believe that one can claim health insurance only in case of in-patient hospitalization, i.e. when the policyholder is admitted to the hospital for more than 24 hours. 

Reality: Apart from in-patient hospitalization, health insurance can be claimed in the case of day-care facilities also. There are procedures that can be completed in hospitals in less than 24 hours, like chemotherapy, dialysis, cataract surgery, tonsil surgery, etc. These are considered as daycare hospitalization and are covered by health insurance. Health insurance companies cover up to 20 to 50 daycare facilities. 

Myth 6: In case of hospitalization, health insurance companies cover all the expenses

It is often assumed that if one has health insurance, it will cover all the expenses incurred by the policyholder during hospitalization unless he/she exceeds the cover amount. 

Reality: This is far from the truth. Your health insurance policy can have exclusions or co-payment clause. Exclusion in health insurance means certain ailments or procedures which are not covered by health insurance. Hence, the policyholder has to pay for them. Meanwhile, for the co-payment clause, health insurance covers only a part of the hospital bill, the rest is paid by the policyholder. In the case of any pre-existing illness, the insurance company does not cover the expense for the ailment during the waiting period. Read the fine print of the health policy to understand such terms and conditions.

Also if there is a sub-limit on room rent and you exceed the per day limit, then you will have to pay the extra amount from your pocket. 

Bottom Line: 

Health insurance is a must for all. Not having health insurance means burning a huge hole in your pocket in case you or any of your family members have to be hospitalized. So ignore all the myths that you hear about when you should buy a health policy, cover under a corporate policy is enough, etc., and buy one today that fits your requirements. Also, read the policy papers carefully to learn about the term and conditions and the benefits, so that you don’t face difficulty while claiming health insurance.