All You Need to Know About Health Insurance Policy in India

A health insurance plan fundamentally holds immense importance and plays a major role in terms of providing you with financial security in the event of various health issues that could come out of nowhere. With a health insurance policy your insurance provider gives you legal declaration to offer you financial support in diverse cases of health problems that you could encounter.

It is tremendously important to understand your health insurance plan if you really want to avail the benefits of your health insurance plan. If you are waiting for an illness to come or an accident to meet with you to know about your health insurance policy, then you are certainly committing a blunder. I am telling you so because at that time you will you will be in a situation that you won’t even understand your medical bills then how will you be able to know about your health insurance policy. This is the reason why the ideal time to understand your health insurance policy is now and the perfect day is today to know your health insurance policy well.

I am writing this article to guide you to understand how health insurance policy works. It doesn’t matter from which company you purchased your health insurance policy; here you will get a complete understanding of your health insurance policy.

Let’s begin with the ‘tough’ health insurance terms, or what do they call it, Jargons?

Most or the people don’t have any clue when it comes to dealing with the hard-to-understand health insurance terms. These jargons can literally trick you into a situation that may turn ugly later on. That’s why it’s better to know about some of the health insurance terms. It will help you understand you policy better.

  • Waiting Period: In case you already don’t know it, every health insurance policy comes with a waiting period which a specified time period that must pass before some or all of your healthcare coverage can start. Therefore, no claim can be registered with your health insurance provider under this waiting period. 

It’s important to keep in mind that different coverage and health conditions have different waiting periods and follows different rules for the same. There’s an initial waiting period of 30-90days before you can get the benefits of your health insurance policy whereas there’s a waiting period of 12-48months before any pre-existing condition can be covered. The maternity waiting period can be anywhere between 9-48months.

  • Survival Period: The term, Survival Period is mainly used in critical insurance plans. Under a critical illness plan, policyholder/insured must survive for at least a survival period of 30 days following the diagnosis of the major illness in order to avail the claim benefits.

  • Network Hospitals: All the health insurance companies are associated with some hospitals; these hospitals or medical institutions are termed as network hospitals of the insurance provider.

  • Pre-Existing Diseases: Pre-existing diseases or illnesses basically stands for the illness that you already had before purchasing the health insurance plan. Majority of the health insurance providers do not provide coverage for pre-existing diseases prior to the completion of 4 years of the policy. However, this time duration which is also known as the waiting period, may vary from one insurer to another. If you have continued your health insurance for the consecutive years of waiting period, then the insurance provider may consider covering your pre-existing illnesses under the plan.

  • Inclusions: Everything that is covered under your health insurance is termed as the inclusion of your plan. The inclusions of the policy are generally mentioned in the policy documents.

  • Exclusion: Everything that is not covered under your health insurance plan is termed as its exclusion. The exclusions of your policy are mentioned in the policy documents. Keep in mind that there are some common exclusions under most of the health insurance plans, such as dental treatment, self-injury, treatment of AIDS, etc. 

What are the features and benefits of health insurance?

Take a glance at the basic features or benefits that the majority of the health insurance plans offer in India.

  • Cashless Hospitalization: If go for medical treatment from any of the network hospitals associated with your insurer, then you will not have to your hospitalization expenses. In order to enjoy this benefit, you will only be required to show the card provided by your health insurance company and get your treatment done without any hassle as per the coverage offered by your policy. However, if owing to some reason, you are not admitted to a network hospital, then you have to settle your medical bills from your own pocket and get them reimbursed by your health insurance provider by filing a claim later.

  • Grace Period: The term refers to a particular time period offered by your insurance company following the due date of your policy expiry. The grace period is basically offered so that you can pay the premium within this period, keep your health insurance policy valid and keep hold of the claim benefits. Nearly every of the health insurance companies offer a grace period of 15 days.

  • Pre and Post Hospitalization: Majority of the health insurance companies in India provide the facility of both pre and post hospitalizations. Usually, the health insurers offer coverage for pre-hospitalizing expenses for 30 days and 60 days in case of post-hospitalization expenses.

  • Day Care Treatment: Some of the health insurance providers will only accept your claim if you have spent at least 24 hours in the hospital. However, there are some medical insurance plans that come with coverage for day care treatments. Under day care treatment the insurer will not ask you to spend a minimum number of hours at the hospital in order to get the claims benefits.

  • Policy Portability Feature: If you wish to upgrade or improve your mediclaim insurance policy or if you wish to switch your health insurance company without losing the benefits of your current plan, then you can choose the health insurance policy portability feature. You can easily port your health policy but only at the time of its renewal. You have to start the procedure of portability minimum 45 days before the expiration date of your existing/current plan.

  • Online Policy Renewal: After the completion of your policy term, you can easily renew your mediclaim policy online. You easily do this by simply visiting the official website of your health insurance company. Some of the health insurers like Star Heath, Apollo Munich, etc. offer a very quick and simple policy renewal procedure.

  • Claim Settlement: Every insurance company in India follows its own claim settlement process. Hence, the health insurance claim settlement process for each insurer may differ from one provider to another. Therefore, it is advisable that you get yourself familiar with the claim settlement process of your insurer. You must also ensure that you are attentive to the documents that are required in order to file a cashless claim. It is highly important to fully understand the claim process of your health insurer if you want to have a seamless claim approval.  

  • Complaint Correction: If you have any grievance about your health insurer, then it is advisable that you address it. The insurance company is legally accountable to acknowledge this complaint within 3 working days. Furthermore, if you are not satisfied with the solution offered by your insurer, then you can take up the matter to the Insurance Regulatory and Development Authority (IRDAI), either via call or mail.

How many types of health insurance plans are there?

There is a number of different health insurance plans offered by diverse health insurance companies in India, however, in this bellow-mentioned list, I am only providing some of the most common health insurance plans that are offered by the majority of the insurers:

  • Individual Health Insurance: As the name suggests, this is a health insurance plan specifically designed to offers healthcare protection to individuals.

  • Family Health Insurance: This health insurance plan provides coverage for the whole family. This plan is also known as a family floater policy. In general, under a family floater health insurance plan, a family of 4 (2 adults & 2 dependent children) are covered. However, the policy too comes with variation as some health insurance providers offer option to add your parents and parents-in-law under the plan as well.

  • Senior Citizen Insurance: This particular health insurance plan has been introduced to offer wide-ranging health insurance coverage to those who are over 60 years of age. Some of the health insurance plans like Star Health Insurance for Senior Citizens offers a really widespread coverage under this policy.

  • Maternity Insurance: This mediclaim policy has been introduced to provide incessant medical coverage to pregnant women. Some mediclaim plans under this policy offers coverage for the mother as well as their newborn babies.

  • Critical Illness Insurance: Opting for this health insurance plan is a wise choice if you are diagnosed with some critical illness.

Apart from these above-mentioned types of medical insurance policies, some insurance providers offer policies for cancer, personal accident, etc. among others. So, if you are looking for any particular health insurance plan, simply search the website of your health insurer or contact their customer support.

Takeaway

Hopefully, this piece of writing has helped you to acquire a fundamental understanding of a health insurance policy. However, it is advisable to understand the terms and conditions of a mediclaim policy completely before buying it. Opt for a plan only after you feel that you are totally satisfied and you have figured out that it is providing you with all that you need from your health cover.

 

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