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What Is Health Insurance? Research Team | Posted On Monday, January 07,2019, 06:32 PM

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What Is Health Insurance?



Health Insurance is an Insurance Policy under which the insurer pays the insured’s hospital bills, when the insured is hospitalized. The insured pays premiums to keep the policy active. The extent of cover depends on the premiums paid and the kind of plan opted. Most Health Insurance plans have a waiting period. Waiting period is the time in which your insurance claim will not be honored by the insurer. Waiting period is generally one month from the start date of the policy.

Importance Of Health Insurance

Availing a Health Insurance is a must for all individuals. Healthcare is getting expensive each day. If something untoward happens that leads to hospitalization, then you will end up spending all your savings on hospital bills, if you don’t have a health insurance plan. You can avoid this by simply availing a health insurance plan. Health Insurance is not a luxury as many think. It is rather a necessity in the modern world of uncertainty. 

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SEE ALSO: Low Cost Health Insurance in India

What Is Health Insurance?

What Are The Types Of Health Insurance?

In the year 2000, Insurance Regulatory and Development Authority (IRDA) liberalized and allowed private companies to enter the insurance sector. Private companies came up with many innovative insurance policies, which saw good results. There are many health insurance schemes, but you need to assess your requirement closely, before starting one. Below mentioned are the different types of Health Insurance in India:

  • Hospitalization Plans: These are indemnity plans that cover hospitalization. Maximum amount covered is the sum insured. This sum insured is applicable to individuals in case of individual Health Insurance. In case of family floater plans, all members under the plan are covered.
  • Top-up Policy: This plan is targeted at the employees who are covered under their company’s Health Insurance plan, where cover may be not enough. They can enhance cover with a top-up policy.
  • Family Floater Health Insurance: This plan covers all the members of the family under a single plan. This policy is based on the assumption that not more than one person of the family falls sick at a time.
  • Pre-Existing Disease Cover Plans: This plan is targeted at those individuals who have a pre-existing disease. This plan covers them under the policy for their pre-existing disease, after a waiting period of 2 to 4 years.
  • Senior Citizen Health Insurance: This plan covers older individuals. As per IRDA guidelines, all the Insurance companies must cover individuals under their Health Insurance policies up to the age of 65 years.
  • Maternal Insurance Policy: This policy covers expenses related to maternity. Both post and pre maternity expenses are covered under the policy. Maternal Insurance Policy has a wide range of hospitals covered under its network.
  • Hospitalization Daily Cash Benefit Plan: This plan pays a fixed sum for each day when the insured is hospitalized. 
  • Critical Illness Plan: This plan comes in handy when the insured is diagnosed with a critical illness. Each plan has certain critical illnesses that are covered. Few insurers make part payments that would benefit the insured.
  • Pro-Active Plans: These plans are designed on individual basis. The plan is designed by looking at the medical history of the individual.

SEE ALSO: How To Choose Health Insurance Plans For Parents?

Eligibility Criteria OF Health Insurance Plan 

In India, the individuals under the age of 45 years are not mandated to undergo medical tests before availing a Health Insurance. Individuals having any pre-existing disease including diabetes and/or hypertension should disclose it to the insurer. If any health complication arises due to pre-existing disease, then your insurer might not pay your bills, if you have not informed your insurer about it.

To avoid this, you need to inform your insurer about any pre-existing disease that you have contracted. You will still be insured, but at higher premiums. The premiums for individuals having pre-existing disease would be high as the risk involved is high.

Benefits Of Having A Health Insurance Policy

  • Coverage: Health Insurance Policy can save you from spending life savings on your hospital bills. Health Insurance policy would take care of your hospitalization from the financial aspect. There is a wide range of network hospitals covered under the insurer.
  •  Renewal: Health Insurance Policy can be renewed periodically.
  • No Claim Bonus: If you have not made any claims over a period, then you are entitled to a higher sum assured called ‘No Claim Bonus’.
  • Maternity Coverage: Few insurance policies cover both pre and post maternal expenses. Health Insurance Policies covering maternity have wide range of hospitals under their network.
  • Cashless Hospitalization: Availing Healthcare facilities at a network hospital would facilitate cashless hospitalization. Meaning, your insurer would take care of most of your hospital bills.
  • Tax Benefits: Availing a Health Insurance entitles you for tax deduction under section 80D of Income Tax Act.   

SEE ALSO: Where To Buy Health Insurance From A Bank Or An Insurance Company?

Documents Required When Buying A Health Insurance Policy:

Just like any other policy, you need to furnish certain documents to avail Health Insurance. You need to produce a document for identity proof, medical reports (if any) and address proof along with your latest photograph.

List of documents accepted as identity proof;

List of documents accepted as address proof:

  • Ration Card
  • Voter ID
  • Valid Passport
  • Telephone Bill
  • Gas Connection Bill
  • Electricity Bill
  • Water Supply Bill
  • Bank Passbook

Health Insurance Claim Process

Health Insurance can be claimed in two ways:

i) Cashless Hospitalization: If you avail healthcare facilities at a network hospital, then all your expenses will be taken care of by the insurer. If you want other facilities, then those expenses are to be borne out of pocket.

ii) Reimbursement: Due to emergency, if you cannot avail healthcare facilities at a hospital under your policy’s network then, you need to pay all your hospital bills up front and then make a claim. Your insurer would ask for all your medical bills and reimburse for those that were covered under the policy.

Healthcare Schemes By Government Of India:

The Central Government of India these days is stressing a lot on the importance of availing a Health Insurance Policy.  The Indian Government has launched various medical insurance schemes to help the poor avail healthcare facilities and make it accessible for individuals belonging to different classes, regardless of income. Below mentioned are the popular Healthcare schemes launched by the Government of India:

  • Rashtriya Swasthya Bima Yojana (RSBY) 
  •  Pradhan Mantri Suraksha Bima Yojana (PMSBY)
  • Central Government Health Scheme (CGHS)
  • Aam Aadmi Bima Yojana (AABY)
  • Janashree Bima Yojana (JBY)
  • Employment State Insurance Scheme (ESIS)
  • Universal Health Insurance Scheme (UHIS)

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