Health Insurance

Health insurance policy is like an annual contract in which the insurance company pays for the medical expenses that occur during the policy tenure. The medical expenses include hospitalization due to sickness, accident, surgeries etc. These expenses can be availed by paying a fixed amount called premium. A medical insurance policy provides these expenses in the form of either reimbursement or cashless treatment.

Health insurance is an agreement wherein the insurance company provides medical coverage to the insured person for a fixed premium amount. Medical insurance has become the need of the hour, especially since COVID-19 pandemic started. People have become more aware of the various benefits that come with medical insurance policy.

A health insurance policy protects you from heavy hospitalization expenses during medical emergencies. This includes hospitalization expenses, day-care expenses, ICU charges, and other medical expenses. The benefits offered depend on the medical insurance plan and the insurance company you have chosen. You can also avail of tax benefits under Income Tax Act, 1961 if you possess a medical insurance policy.

When you have medical insurance, you don’t need to have a huge bank balance during medical emergencies. A health insurance plan does the following;

• Provides A Cover Of Up To 1 CR: You get a cover amount of up to 1 CR every year. You can use this amount for any hospitalization treatment throughout the year.

• Pays 90% Of Your Hospital Bill: Just get admitted & give your cashless card to the hospital. The hospital takes money from your insurance company while your treatment goes on.

• Pays For Any Accident Bills: Pays for your accident hospitalization bills from day one of your policy. Both indoor & outdoor accident hospitalization bills are covered.

• Pays For Any Seasonal Illness Hospital Bills: Pays for any seasonal illnesses like Covid19, viral fever, Dengue, Malaria, typhoid, pneumonia, diarrhoea & many more immediately after 30 days of buying the policy.

• Pays For Any Pre-Existing Illness Hospital Bills: Any pre-existing illness before buying the policy is covered after 3-4 yrs. after buying the policy. These include heart, lung, liver, kidney, diabetes, blood pressure & many more.

• Critical Illnesses Are Covered: If you don’t have any pre-existing illness before buying the policy & if you suddenly get any critical ailment, it’s covered after 30 days. These include heart, lung, liver, kidney, diabetes, blood pressure & many more.

• Pays For Any General Surgery: Pays for any general surgery after a waiting period of 2-3 years. These include piles, fissures, gallbladder, kidney stone & any surgeries listed in your health plan.

As the medical facilities are advancing, so are the health care costs. The primary benefit of health policy is that it takes care of healthcare costs. It give you a financial security if any unanticipated serious illness or accidental injuries drains all your savings. Learn how the cost of your insurance premium is determined:

• Medical History: Medical history is a major determinant of the health insurance premium. Pre-medical tests are mandatory by almost all insurance providers in India (after a certain age) before buying a medical insurance policy. While a few insurance companies don’t make medical screening mandatory, they consider your current medical conditions, lifestyle-related health risks, and the medical history of your family. That is the reason why medical insurance premiums for smokers are higher than other people.
• Gender and Age: Age is an important aspect of determining the medical insurance premium. The premium differs based on the age of the insured person. That is why it is suggested to buy a policy at a young age because the premium cost is low for young applicants. Older adults are vulnerable to cardiovascular diseases and other critical illnesses like kidney problems, cancer, etc.; thus, senior citizen medical insurance premiums are generally higher. Additionally, the cost of the premium for women’s health insurance is lower than the male candidates due to the lower risk of stroke, heart attack, etc.
• Policy Term: The premium for a health insurance plan for 2-year will be more than a 1-year plan. However, nearly all insurance companies offer a discount on long-term medical insurance plans.
• Type of Health Insurance Plans: The kind of health insurance policies you choose also change the cost of the premium. The higher the risks, the higher will be the premium and vice-versa. An online calculator for health insurance premium will allow you to compare different health insurance policy premiums.
• No-Claim-Discounts: If you make zero claims in the policy term period, you can earn a No Claim Bonus (NCB) that can range anywhere from 5% to 50%. This is also considered to be one of the most important factors that are considered while calculating the cost of the premium.
• Lifestyle: If you regularly drink or smoke, the chances are high that you will be charged a more premium amount. In that case, the insurer can even reject your medical insurance policy request.

If the policyholder is hospitalization he/she needs to submit certain documents as mentioned below for making a reimbursement claim:

• Discharge card provided by the hospital
• In-patient hospitalization bills signed by the hospital for authenticity
• The doctors’ prescriptions, along with medical store bills
• Claim-form signed by the insured
• A valid investigation report
• Doctor's prescribed consumables and disposables with complete details
• Doctor's consultation bills
• Copy of the previous year insurance policy and the current year/copy of ID Card of TPA
• Any other document(s) needed by the TPA

A policy holder does not have to carry on with their current health insurance policy provider, if he or she doesn't want to. IRDAI gives you a provision to change the insurance provider. This switch happens without the policy holder having to compromise on the existing policy benefits or accumulated benefits.

Now IRDAI allows you to switch from one insurer to another while the new insurer will have to consider the credits you have gained from your previous insurer, where the credits refer to the completed waiting period in pre-existing conditions. The same thing applies if you switch from one plan to another within the same insurance company.

What can you do

• Switch from health insurance companies.
• Family floater/individual policy can be switched.
• Get insurance cover by your new insurer up to the sum assured as the old policy has.
• Both insurers should mutually complete the formalities as per the IRDAI timeline.

Criteria

• A policy can be ported at the time of renewal only.
• There must not be any break between policy renewals.
• You need to submit a formal porting request to your current insurer at least 45 days before the renewal’s due date.
• With a new policy, the terms and conditions and the premium are at the new insurer’s discretion.
• You must mention the name of the new insurer you are willing to switch to.

A medical insurance policy needs to be renewed annually upon its expiry. On-time health insurance renewal can reap you with the following benefits:

• Tax Benefits: On purchasing or renewing a health insurance policy, the insured person becomes eligible to gain tax benefits under section 80D of the Income Tax Act 1961. In order to get annual tax benefits, one should renew health insurance policy on time.
• Stay protected: Renewing your health insurance policy on time helps ensure that you stay protected and get uninterrupted coverage. A medical emergency can arise at any time which is why you must have a valid medical insurance policy. A lapsed policy means that your medical expenses are not covered and you might also lose your No Claim Bonus.
• Premium Amount: With age, your health insurance premium also increases. Moreover, if your policy lapses you need to buy new insurance policy which comes with higher premium. In order to avoid paying higher premium amount, you need to make sure you do health insurance policy renewal on time.

A medical insurance policy is an annual contract which means it is valid for one year after which you need to renew it upon its expiry. If you do not renew health insurance policy on time, you may lose all the benefits that you have accumulated during the past tenure. Here are some basic steps to follow for health insurance renewal process:

Step 1: Visit your insurance company's official website.
Step 2: Within the website, visit the section that deals with health insurance.
Step 3: Put in your previous health insurance plan no. & your registered mobile no.
Step 4: Checkout the health insurance plans details & the plan renewal premium.

Here is the list of documents required while buying or renewing a health insurance policy.

• Valid identity proof (Aadhar Card, Driving License, Passport, Pan Card)
• Age proof
• Address proof (electricity bill)
• Previous policy documents (if applicable)
• Passport size photographs
• Medical history details