Health Insurance

What is Health Insurance?

Health Insurance is a contract between the policyholder and the insurer where the health insurance company provides financial coverage to the insured upto the sum insured limit. It offers medical coverage for healthcare expenses incurred on hospitalization along with multiple benefits, like pre & post-hospitalization cover, medical check-ups, cashless facility, etc.

Health insurance at a glance

Benefits of Buying Health Insurance Plans Online

Buying a health insurance policy online comes with several benefits. Take a look at them below:

• Easier to Compare Plans

  It is easier to compare health insurance plans from different insurers online at websites like Adf Policy.com to make an informed decision.

• More Convenient

  It is more convenient to buy the policy online as you do not have to visit the branch of the insurance company or take an appointment to meet an insurance agent.

Benefits of Buying Health Insurance Plans Online

Medical inflation is increasing every day making treatments expensive. If you get hospitalized for a critical illness or lifestyle disease, you may end up losing all your savings. The only way to afford quality medical treatment during a health emergency is by buying a health insurance policy. Take a look at some of the top reasons to buy a health insurance plan below:

• Beat Medical Inflation

  A health insurance policy can help you pay your medical bills, including pre and post-hospitalization expenses, today as well as in future despite the rising medical costs.

• Afford Quality Medical Treatment

  It helps you to afford the best quality medical treatment and care so that you can focus only on getting cured.

Key Benefits of Health Insurance Plans in India

Health insurance plans offer a variety of health benefits to the insured depending on the plan. Following are the key benefits of buying a health insurance plan in India:

• Hospitalization Expenses

  A health insurance plan covers the medical expenses incurred on getting admitted to a hospital for more than 24 hours. It includes room rent, doctor’s fee, treatment procedures, medicine cost, diagnostic test fees, etc

• Pre & Post Hospitalization Expenses

  It covers the medical expenses that you may have incurred on an illness before getting hospitalized as well as follow-up treatment expenses incurred after getting discharged. The pre-hospitalization and post-hospitalization expenses are covered up to a fixed number of days as specified in the policy document.

What is Covered in a Health Insurance Plan?

Most health insurance companies in India cover the following medical expenses under a health insurance policy:

• In-patient Hospitalization Expenses

  The hospitalization expenses incurred during the treatment of an illness or injury are covered

• Pre-existing Illnesses or Diseases

  After the completion of the waiting period, you can file a claim for the expenses incurred on the treatment of any pre-existing illness.

• Pre and Post Hospitalization Expenses

  Medical expenses incurred on blood tests, x-ray, and other medical check-ups that are required before hospitalization are taken care of by the insurance company. Similarly, the cost of medicines and preventive health check-ups that are done to ascertain your health after the discharge from the hospital is covered under the health insurance plan.

• Ambulance Charges

  Although the coverage amount varies from insurer to insurer, most medical insurance plans cover emergency ambulance charges.

• Maternity Cover

  Medical expenses incurred during the pregnancy and delivery are covered along with newborn baby expenses.

What is Not Covered in a Health Insurance Plan?

The following medical expenses and situations are not covered in a health insurance plan:

• Unless there is an accidental emergency, claims arising during the initial 30 days of buying a health insurance plan are not covered.

• Coverage of pre-existing diseases is subject to a waiting period of 2 to 4 years

• Critical illnesses coverage usually comes with 90 days waiting period

• Injuries caused by war/terrorism/ nuclear activity

• Self-inflicted injuries or suicide attempts

• Terminal illnesses, AIDS, and other diseases of similar nature, allowed subject to some conditions

• Cosmetic/plastic surgery, replacement of hormones surgery, etc. allowed subject to some conditions

• Dental or eye surgery expenses, allowed subject to some conditions

• Bed rest/hospitalization and rehabilitation, common illnesses, etc.

• Treatment/diagnostic tests and post-care procedures

• Claims arising out of adventure sports injuries

Key Factors to Consider before Buying a Health Insurance Plan

There are a few factors that you should consider closely to make the right decision while buying a health insurance plan:

• Check the Scope of Coverage

  The policy coverage and the sum insured amount will decide the type of illnesses and surgeries that you can claim during the policy term. Closely look at the benefits offered like hospitalization expenses, daily cash benefit, COVID hospitalization cover, critical illness cover, maternity cover, etc. while choosing a health plan.

• Adequate Sum Insured

  The sum insured amount is a crucial deciding factor in selecting a medical insurance policy. Looking at the ongoing inflation it is advisable to buy a health insurance plan with a minimum sum insured of Rs 10 lakh that can go up to Rs 1 crore. If it’s a family floater policy or senior citizen insurance, the higher the sum insured the better the coverage will be.

• Policy Type

  There are different types of medical insurance policies that are available in India. As per your requirement, you can choose to buy individual health insurance, senior citizen health insurance, family floater or critical illness plans. Moreover, you can buy Top up and Super Top up health insurance along with your existing health plan to enhance the coverage. This is beneficial in case your base sum insured gets exhausted during the treatment. You can choose this option at the time of policy purchase and renewal.

• Waiting Period Clause

  Your health insurance policy only comes into action once the initial waiting period is over. If any claim is filed during the initial waiting period except for accidental hospitalization claims, the insurer can reject it. Moreover, the waiting period clause also applies to pre-existing diseases like thyroid, blood pressure, diabetes, etc. It is also applicable to specific illnesses, treatments, and maternity cover. You can choose a plan with a minimal waiting period.

• Co-payment Clause

  Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (insured). The co-payment option does not have any effect on the sum insured. It allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Only opt for this clause if you can pay off a portion of your hospitalization bills, that can be 10% and above without a financial burden.

• Room Rent Sub-limits

  Your medical insurance policy may have a co-payment clause, which means a certain percentage of the claim amount should be borne by you (insured). The co-payment option does not have any effect on the sum insured. It allows you to reduce your premium to a certain extent but certainly increases your out-of-pocket expenses. Only opt for this clause if you can pay off a portion of your hospitalization bills, that can be 10% and above without a financial burden.

• Network of Cashless Hospitals

  Check the list of network hospitals for an insurance company where cashless claims can be filed. The maximum number of network hospitals you have in your vicinity,the better are the chances of availing cashless hospitalization benefits.

How to Calculate Health Insurance Premium?

In order to keep the policy in force, regular payment of a fixed premium is essential. Did you ever think about how this premium is calculated? There are certain factors that affect health insurance premiums such as the medical background of your family, sum insured, cumulative bonus, your personal medical history and so on.

Based on that, you might want to calculate your premium to figure out how much you would have to pay for the policy. It can be done through a . A premium calculator is an online tool that calculates the premium to be paid as per the information provided by you, such as the preferred sum insured, age of the insured, etc. At Adf Policy.com, you can calculate your health insurance premium online easily.

Eligibility Criteria to Buy a Health Insurance Plan

The eligibility criteria to buy a health insurance plan depends on a number of factors such as the age of the policyholder, pre-existing diseases, etc. In most health insurance plans, the following eligibility criteria should be met:

• Age Criteria

  The entry age criteria for adults and children varies and can range from 18-65 years and 90 days to 25 years respectively. The actual age can vary from one medical insurance policy to another

• Pre-medical Screening

  Pre-medical examination is required for applicants mostly above the age of 45 years or 55 years. However, most of the senior citizen health plans require pre-medical tests before policy issuance.

• Pre-existing Diseases

  Any pre-existing illness is covered after the completion of the waiting period i.e. 2-4 years. Most health insurers ask the applicant if they are going through any medical conditions like blood pressure, diabetes, cardiovascular diseases, kidney problems, etc. at the time of buying a health insurance plan. If you are a smoker or an alcoholic, then you need to disclose it to the insurance company.

Do not keep it as a secret as it may cause problems at the time of claim settlement. It can even lead to rejection of you claims. Based on this criterion the insurance company decides to offer medical coverage to the applicant.

Documents Required for Health Insurance Claim Reimbursement

In the event of a hospitalization, the policyholder needs to submit certain documents as mentioned below:

• Discharge card issued by the hospital/network hospital

• In-patient hospitalization bills signed by insured for authenticity

• Doctors’ prescriptions and medical store bills

• Claim-form with insured’s signature on it

• Valid investigation report

• Consumables and disposables prescribed by the doctors with complete details

• Bills of doctors’ consultation

• Copies of the Insurance policy from the previous year and the current year/copy of ID Card of TPA