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Health Insurance Plan

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What is a health insurance plan?

You have to pay a sum of money (Health insurance premium), to avail a health insurance policy. Your medical bills will be paid back to the extent you have insured yourself (premium you have paid).

The health insurance plan pays your hospitalization expenses/bills, if you are hospitalized for at least 24 hours. You can also take a health insurance plan for your family under the family floater plan.

Things to know before buying a health insurance plan:

Know the waiting period of your health insurance plan

A health insurance plan has a waiting period of 1 month after you avail it. The health insurance plan will not pay your medical bills for any disease you contract, within a month of taking up the health insurance plan.

You are hospitalized after a week of availing the health insurance plan .When the hospital bill is presented you get a nasty shock. Your bills are not settled by the health insurer as you are hospitalized within a week of availing your health insurance plan. You are covered by the health insurance plan only a month after availing it.

Why buy Health Insurance?

Cashless Hospitalization

All you have to do is show your health insurance card at the hospital. You get free treatment, at any of the network hospitals under the health plan.

Lifelong Renewability

The health insurance plan offers you health insurance across your lifetime, as long as you pay the health insurance premiums.

Minimum Entry Age

Health insurance plans offer first time buyers, the option to enter health insurance plans, even at 65 years of age.


Tax Benefits

Premiums on health plan, tax deductible up to INR 25,000 a year. If you are under 60 years. If you are over 60 years, it is INR 30,000.

Eligibility for Health Insurance

You can buy the health insurance policy for any family member, children and even your parents.
You/ Proposer need to be above 18 years. You get coverage upto 65 years of age, which varies from Company to Company.
Individuals who propose to have insurance whose age is 46 years and above, have to undergo medical tests at designated diagnostic centers.

Key factors to consider for Health Insurance

What if you have a pre existing disease before availing the health insurance plan?

A pre existing disease is a disease that exists before availing the health insurance plan.Life style diseases like diabetes or heart ailments are common pre existing diseases. You are covered for pre existing diseases only 2-4 years after you avail the health insurance plan. This depends on the type of health insurance plan you avail.

Will the health insurance plan pay your hospital room rent if you opt for an expensive room?

Your health insurance plan does pay for the hospital room charges , but only up to a limit called a sublimit. The health insurance plan would pay up to INR 1000 per day for the room rent depending on the health plan you take. If your hospital room rent exceeds this amount, you have to pay it from your own pocket, called an out of pocket expense. Your health insurance plan might not pay for certain surgical procedures you might undergo and you have to pay this from your own pocket.

If you are a senior citizen will the health insurance plan pay for the total hospitalization expenses you incur?

If you are a senior citizen, then your hospitalization expenses will be very high and possibly frequent. The health insurance plan will cover you only under the co payment clause.You will have to pay part of the hospitalization expenses yourself, and the health insurance plan will pay the remaining amount. This could be determined at the time you avail the health insurance plan, as a fixed percentage. You will have to pay say 10% of the hospitalization expenses yourself, and the health insurance plan will pay the remaining 90%.


Individual Health Insurance Plan:This is designed to cover an individual against various illnesses with cashless hospitalization and other add-on features.

Family Floater Insurance Plan:With this plan, you can cover all your family members against diseases under a single policy.

Surgery and Critical Illness Insurance Policy:This is usually brought as a standalone policy, or as a rider in case of treatment against serious illnesses like cancer, kidney failure, heart attack, paralysis and so on. As the treatment of such diseases is expensive, the premium is also on a higher side.

Senior Citizen Health Insurance Plan:This offers to protect you from health issues during your old age. According to IRDA norms, every insurer must provide cover for people up to the age of 65 years.

Preventive Healthcare:Undoubtedly health care is expensive and who wants to fall sick. So now insurers' have preventive health care that offers to take care of you and not let you fall sick. This includes preventive care treatments like regular checkups, consultation charges and other tests or x-ray fee concessions. The idea is to monitor your health at timely intervals and provide overall health care benefits.


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Concepts & FAQ's Health Insurance Plan

What is Health Insurance?

Health insurance come under Life Insurance and is also commonly called "medi claim" policies.Health insurance protects you and your dependants against any financial constraints arising on account of a medical emergency.

Tax benefits:Health insurance policies also qualify for tax benefits, as stated under Section 80D

Cashless settlement:Some health insurance provides you with cashless settlement, which means you can get admitted to a hospital and undergo treatment without paying anything to the hospital except displaying your medical insurance card to the concerned person. The insurance company will settle all your expenses with the hospital.

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Frequently Asked Questions

Why do I need Health Insurance?

Healthcare is expensive. Technological advances, new procedures and more effective medicines have driven up the cost of healthcare. This increase has to be borne by the consumer, making treatment unaffordable for too many. Health Insurance overcomes these obstacles so that you remain free of anxiety regarding your health. Think for a moment about the enormous medical costs you would incur if you suffered a major accident tomorrow or were suddenly stricken by an illness. Uninsured people live with such risks every day. Health insurance seeks to shield you from that risk. It provides the much needed financial relief. You also get tax benefit under section 80D of the Income Tax Act.

Are there any tax benefits that one can avail on purchasing Health Insurance?

Yes, there is a tax benefit available under Section 80D of the income tax act 1961. Every tax payer can avail an annual deduction of Rs. 15,000 from taxable income for payment of health Insurance premium for self and dependants. For senior citizens, this deduction is up to Rs. 20,000. To Know the extent of your tax benefit, call us on 080 67974000.

Can I buy more than one Health Insurance policy?

Yes, you can have more than one Health Insurance policy. In case of a claim, each company will pay ratable proportion of the loss.

Enlist some of the important exclusions under mediclaim policy?

Some general exclusion's under this policy are: 1. Pre-existing diseases i.e. Any condition, ailment or injury or related condition(s) for which insured person had signs or symptoms and/or was diagnosed and/or received medical advice/treatment within 48 months prior to his/her health policy with the company. 2. Any disease contracted during the first 30 days of inception of policy except in case of injury arising out of accident. 3. Certain diseases such as cataract, piles, hernia, and sinusitis etc. are excluded for specified periods if contracted or manifested during the currency of the policy. 4. Injury or diseases directly or indirectly attributable to war, invasion, act of foreign enemy, war like operations. 5. Cosmetic, aesthetic treatment unless arising out of accident. 6. Cost of spectacles, contact lenses and hearing aids. 7. Dental treatment or surgery of any kind unless requiring hospitalization. 8. Charges incurred at Hospital or Nursing Home primarily for diagnostic, x-ray or laboratory examinations, without any treatment. 9. Naturopathy or other forms of local medication. 10. Intentional self-injury / injury under influence of alcohol, drugs 11. Diseases such as HIV or AIDS. 12. Expenses on vitamins and tonics unless forming part of treatment for disease or injury as certified by the attending physician. 13. Convalescence, general debility, run-down condition or test cure, congenital external diseases or defects or anomalies, sterility, venereal disease.

What is the maximum number of claims allowed over a year?

Any number of claims is allowed during the policy period. However the sum insured is the maximum limit under the policy.

Is a Medical check up again required at the time of renewal of the policy?

No, the medical checkup has to be taken only once, during the inception of taking a policy and only if you are 46 years of age or above.

What information one needs to furnish while intimating a claim?

The following information needs to be furnished while intimating a claim: 1) Name of Insured person who is sick or injured 2) Nature of Sickness/Accident 3) Contact Numbers 4)Policy Number (as reflecting on the Health Card) 5) Date & Time in case of accident, commencement date of symptom of disease in case of sickness 6) Location of accident

What is a TPA?

Third Party Administration (TPA) is a service given to a Mediclaim policyholder by providing cashless facility for all hospitalizations that come under the scope of his/her Mediclaim policy. To know more about Health plan for free, call us on 080 67974000.

What is Health Insurance?

The term health insurance is a type of insurance that covers your medical expenses. A health insurance policy is a contract between an insurer and an individual /group in which the insurer agrees to provide specified health insurance cover at a particular "premium".

What are the forms of Health Insurance available?

The commonest form of health insurance policies in India cover the expenses incurred on Hospitalization, though a variety of products are now available which offer a range of health covers, depending on the need and choice of the insured. The health insurer usually provides either direct payment to hospital (cashless facility) or reimburses the expenses associated with illnesses and injuries or disburses a fixed benefit on occurrence of an illness. The type and amount of health care costs that will be covered by the health plan are specified in advance.

Why is Health Insurance important?

All of us should buy health insurance and for all members of our family, according to our needs. Buying health insurance protects us from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into household savings or even lead to indebtedness.Each of us is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advances, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.

What kinds of Health Insurance plans are available?

Health insurance policies are available from a sum insured of Rs 5000 in micro-insurance policies to even a sum insured of Rs 50 lakhs or more in certain critical illness plans. Most insurers offer policies between 1 lakh to 5 lakh sum insured. As the room rents and other expenses payable by insurers are increasingly being linked to the sum insured opted for, it is advisable to take adequate cover from an early age, particularly because it may not be easy to increase the sum insured after a claim occurs. Also, while most non-life insurance companies offer health insurance policies for a duration of one year, there are policies that are issued for two, three, four and five years duration also. Life insurance companies have plans which could extend even longer in the duration. A Hospitalization policy covers, fully or partly, the actual cost of the treatment for hospital admissions during the policy period. This is a wider form of coverage applicable for various hospitalization expenses, including expenses before and after hospitalization for some specified period. Such policies may be available on individual sum insured basis, or on a family floater basis where the sum insured is shared across the family members. Another type of product, the Hospital Daily Cash Benefit policy, provides a fixed daily sum insured for each day of hospitalization. There may also be coverage for a higher daily benefit in case of ICU admissions or for specified illnesses or injuries. A Critical Illness benefit policy provides a fixed lumpsum amount to the insured in case of diagnosis of a specified illness or on undergoing a specified procedure. This amount is helpful in mitigating various direct and indirect financial consequences of a critical illness. Usually, once this lump sum is paid, the plan ceases to remain in force. There are also other types of products, which offer lumpsum payment on undergoing a specified surgery (Surgical Cash Benefit), and others catering to the needs of specified target audience like senior citizens.

What is cashless facility?

Insurance companies have tie-up arrangements with several hospitals all over the country as part of their network. Under a health insurance policy offering cashless facility, a policyholder can take treatment in any of the network hospitals without having to pay the hospital bills as the payment is made to the hospital directly by the Third Party Administrator, on behalf of the insurance company. However, expenses beyond the limits or sub-limits allowed by the insurance policy or expenses not covered under the policy have to be settled by you directly with the hospital. Cashless facility, however, is not available if you take treatment in a hospital that is not in the network.

What are the tax benefits I get if I opt for Health Insurance?

Health insurance comes with attractive tax benefits as an added incentive. There is an exclusive section of the Income Tax Act which provides tax benefits for health insurance, which is Section 80D, and which is unlike the section 80C applicable to Life Insurance wherein other form of investments/ expenditure also qualify for the deduction. Currently, purchasers of health insurance who have purchased the policy by any payment mode other than cash can avail of an annual deduction of Rs. 15,000 from their taxable income for payment of Health Insurance premium for self, spouse and dependent children. For senior citizens, this deduction is higher, and is Rs. 20,000. Further, since the financial year 2008-09, an additional Rs 15,000 is available as deduction for health insurance premium paid on behalf of parents, which again is Rs 20,000 if the parents are senior citizens.

What are the factors that affect Health Insurance premium?

Age is a major factor that determines the premium, the older you are the premium cost will be higher because you are more prone to illnesses. Previous medical history is another major factor that determines the premium. If no prior medical history exists, premium will automatically be lower. Claim free years can also be a factor in determining the cost of the premium as it might benefit you with certain percentage of discount. This will automatically help you reduce your premium.

What does a Health Insurance policy not cover?

You must read the prospectus/ policy and understand what is not covered under it. Generally, pre-existing diseases (read the policy to understand what a pre-existing disease is defined as) are excluded under a Health Insurance policy. Further, the policy would generally exclude certain diseases from the first year of coverage and also impose a waiting period. There would also be certain standard exclusions such as cost of spectacles, contact lenses and hearing aids not being covered, dental treatment/surgery ( unless requiring hospitalization) not being covered, convalescence, general debility, congenital external defects, venereal disease, intentional self-injury, use of intoxicating drugs/alcohol, AIDS, expenses for diagnosis, x-ray or laboratory tests not consistent with the disease requiring hospitalization, treatment relating to pregnancy or child birth including cesarean section, Naturopathy treatment.

Is there any Waiting Period for claims under a policy?

Yes. When you get a new policy, generally, there will be a 30 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurance companies. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies under renewal.

What is pre-existing condition in health insurance policy?

It is a medical condition/disease that existed before you obtained health insurance policy, and it is significant, because the insurance companies do not cover such pre-existing conditions, within 48 months of prior to the 1st policy. It means, pre-existing conditions can be considered for payment after completion of 48 months of continuous insurance cover.

If my policy is not renewed in time before expiry date, will I be denied for renewal?

The policy will be renewable provided you pay the premium within 15 days (called as Grace Period) of expiry date. However, coverage would not be available for the period for which no premium is received by the insurance company. The policy will lapse if the premium is not paid within the grace period.

Can I transfer my policy from one insurance company to another without losing the renewal benefits?

Yes. The Insurance Regulatory and Development Authority (IRDA) has issued a circular making it effective from 1st October, 2011, which directs the insurance companies to allow portability from one insurance company to another and from one plan to another, without making the insured to lose the renewal credits for pre-existing conditions, enjoyed in the previous policy. However, this credit will be limited to the Sum Insured (including Bonus) under previous policy. For details, you may check with the insurance company.

What happens to the policy coverage after a claim is filed?

After a claim is filed and settled, the policy coverage is reduced by the amount that has been paid out on settlement. For Example: In January you start a policy with a coverage of Rs 5 Lakh for the year. In April, you make a claim of Rs 2 lakh. The coverage available to you for the May to December will be the balance of Rs.3 lakh.

What is 'Any one illness'?

'Any one illness' would mean the continuous period of illness, including relapse within a certain number of days as specified in the policy. Usually this is 45 days.

What is the maximum number of claims allowed over a year?

Any number of claims is allowed during the policy period unless there is a specific cap prescribed in any policy. However the sum insured is the maximum limit under the policy.

What is "health check" facility?

Some health insurance policies pay for specified expenses towards general health check up once in a few years. Normally this is available once in four years.

What do you mean by Family Floater Policy?

Family Floater is one single policy that takes care of the hospitalization expenses of your entire family. The policy has one single sum insured, which can be utilised by any/all insured persons in any proportion or amount subject to maximum of overall limit of the policy sum insured. Quite often Family floater plans are better than buying separate individual policies. Family Floater plans takes care of all the medical expenses during sudden illness, surgeries and accidents.


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What is Co-Pay in a Health Insurance Policy?

Friday, July 12, 2019, 5:32 PM

Co-pay refers to the part of the claim amount in an insurance policy which is borne by the insured out of pocket. It is generally provided in a percentage term and is applicable on the claim amount in General Insurance Policies. It may range from 10% to 50% in health policies.

When should you opt for a floater health plan?

Monday, September 10, 2018, 3:56 PM

The idea behind a family floater plan is that an individual, spouse and children are covered for the policy period without a specific limit on each member. If you are married, it is recommended to consider a floater plan. Under this plan, the premium amount is dependent on age and health status of the eldest member of the family.

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Pradhan Mantri Jan Arogya Abhiyaan (PMJAA) popularly known as Ayushman Bharat would be launched on the birth anniversary of Pandit Deendayal Upadhyay. The scheme aims to take care of the health needs of 50 Crore Indians. Pradhan Mantri Jan Arogya Abhiyaan makes sure the poor in India get access to quality healthcare at affordable rates.



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