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Decoding the Health Insurance Research Team | Posted On Monday, August 12,2019, 03:37 PM

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Decoding the Health Insurance



What is Health Insurance?

A health insurance policy is an insurance plan which covers the cost of hospitalization and medical services received by the insured; within policy tenure. The health insurance can be availed by paying a premium each month. The premium amount is based on the sum assured availed by the policyholder.

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Decoding the Health Insurance

Features of Health Insurance:

There are several types of health insurance policies in India; which help you stay prepared for medical emergencies and enjoy quality treatment in case of an accident or an illness.

Availing a health insurance policy is important to manage rising medical expenses. Listed below are some of the key features of health insurance policies in India:

  • The health insurance policies cover the cost of hospitalization and medical treatment.
  • Certain health insurance policies also offer cover for daycare treatment, pre and post-hospitalization care.
  • For claim-free years the insurer rewards the policyholder with a No Claim Bonus (NCB). A percentage of the sum assured is offered as a discount on premiums or even additional sum assured.
  • You can add riders like critical illness, personal accident, daily cash benefit, room rent cover and other riders; by paying an extra amount along with the base premium.
  • The health insurance policy covers the ambulance charges in case of emergency hospitalization and offers complimentary yearly health check-ups to the insured.
  • You enjoy tax benefits under Section 80D up to Rs 25,000 a year on premiums paid for self/spouse/children. Its 50,000 a year for senior citizens.

See Also: Can I Use Health Insurance Immediately?

Understanding Health Insurance in Simple Terms:

The health insurance policies differ across insurers. To understand your health insurance plans in a better way; you must familiar yourself with the basic health insurance terms. This helps understand the cost of health insurance, how much you pay, what are the services and how much each hospital visit costs.

Sub-Limits: The sub-limits are a form of pre-determined limits on the claim amount for a specific ailment or the room rent, or towards the daycare/in-patient care. The sub-limits are a part of the total sum assured as mentioned in the original policy document. 

Co-Pay: If you co-pay, you bear part of the hospitalization expenses. There are many health insurance policies that have the co-pay clause; where the majority of the amount is paid by the insurer. The co-pay may vary depending on the services offered.

See Also: Why Does One Need Health Insurance Policy?

Cashless Services: The cashless services are a key feature of health insurance policies. It is a feature that helps the insured settle the bills directly and reduce out-of-pocket expenses on medical services availed. The health insurance companies have tie-ups with the best network hospitals.

So, when an insured avails treatment at these hospitals; the bills are directly settled by the insurance company with the hospital. Cashless health insurance plans reduce the financial burden on the insured’s family, at the time of emergency hospitalization. The insured can avail quality treatment at the best hospitals without bothering about the expenses.

Reimbursement Claims: The reimbursement claim is availed when the insured receives medical treatment outside network hospitals. The insured has to pay for the medical services availed and then make a claim with the insurer. To get the reimbursement, the insured has to initiate the reimbursement claim and submit relevant documents like hospital bills, diagnostic bills and so on. Once the documents are verified; the insurance company will settle the claims.

See Also: Family Health Insurance Plan

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