Health Insurance- Types, Premium, Precautions, Apply, etc All Information

Health Insurance is a complex topic to discuss and understand, here we have tried to simplify and absorb the basics of Health Insurance in India which can ultimately help you in deciding whether you should take a Health Insurance Policy or not and if you are interested to take health insurance then, it will help you choose the best health insurance policy for you.

However, Health Insurance is not an enough discussed topic in India. So let’s understand what is health insurance and all the terms and conditions related to Health Insurance.

So, What is Health Insurance?

Like any other Insurance, you give some monthly or yearly amount to the insurance company and in return, you get the assurity that the hospital expenses for you and your family will be incurred by the Insurer (depending on some terms and conditions).

If any emergency situation arises where you or any family member falls sick or is hospitalized, in that situation the insurance company will take care of your expenses. Most of the insurance companies have tie-ups with the hospitals where they provide you a cashless treatment facility.

Should I Take Health Insurance?

Do I really need Health Insurance? Lets find the simple and straingt answer.

If you belong to a middle or upper-middle class family, then it is highly recommended that you should have health insurance. You can avoid health insurance only in these two conditions

  • You have so much excess money that you don’t bother about the hospital bills in any type of emergency situation or critical disease.
  • You cant afford to have Health Insurance (even if it may cost you around Rs. 100 per month)

Benefits of Health Insurance

There are a lot of benefits of Health Insurance and everyone is suggested to have it. Let’s explore the benefits of Health Insurance.

  • We all know that the hospital treatments have become very costly these days, So the illness of any family member can grasp all the savings or even can burden you with debt. So, the most important benefit of Health Insurance is that it protects you against any unexpected burdon of expenses due to the illness of any family member.
  • Tax Benefit: Under Sectin 80D of the Income Tax Act, Health Insurance Premium is given a tax exemption.
  • It helps to remove the fear in the mind of the family about any emergency medical condition.
  • Health Insurances are not so costly and easily affordable which give you the freedom to use your savings on other things.

Health Insurance Terminology

Before we proceed further let’s make you understand the terminology used in the Health Insurance Field. You can comment in the comment box below if you won’t know about any other terminology used in Health Insurance.

  • Insurer: The insurance Company
  • Premium: It is the amount which is paid by you to the Insurance Company to avail the Insurance Policy
  • Floater Plan: The Insurance plan for the complete family
  • Individual Plan: Insurance Plan for one person
  • Network Hospitals: The hospitals which have tie up with the Insurance Company and you can have cashless treatment.
  • Cashless Treatment: The insurance company directly pays all the expenses to the hospital after the treatment and before you got discharged from the hospital. You dont need any cash to pay to hospital.
  • Reimbursement: When you got treatment in such hospital which is not in the list of Network Hospitals of that Insurance Company, then you need to pay the hospital bill yourself and then claim to the insurance company for the reimburshment.
  • Claim Processing Time: The time period in which the insurance company pays you the reimburshment. As per the IRDA guidelines the claim processing time cannot be more than one month.
  • Claim Settlement Ration: The ratio of the number of claims paid to customers by the insurance company to the total number of claims received.
  • Incurred Claim Ration: It is the ratio of the total value of claims settled by the Insurer to the total vlaue of premiums collected by the insurance company in a givne period.
  • Cover/ Coverage Amount: The maximum amount you can get in your insurance policy.

Types of Health Insurance in India

  • Individual Insurance Plan
  • Family Floater Insurance Plan
  • Senior Citizen Insurance Plan
  • Critical Illness Insurance Plan
  • Maternity Insurance Plan

Watch Video to Understand Health Insurance

Things to Consider while taking Health Insurance

As we said earlier, choosing Health Insurance is a complex process, still, we have simplified some important points which you should consider while choosing the best health insurance for you and your family. For better understanding, you should read all the policy-related documents carefully.

✅ Floater or Individual

The first thing to consider is that you should choose a Family Plan or Individual Plan. You should keep in mind that the premium is decided by the highest age of the insured family group. So, if you have elders in your family you should have a separate policy for them, otherwise, it will significantly increase the premium amount. Suppose if you have two kids, parents, and a wife/ husband in the family. Then choose one policy for the parents and another one for the Husband, Wife, and Kids/Children.

✅ Private Company or Govt Company

While choosing the company for the Health Insurance, go for the brand which is trusted by the people. You can also check the Claim Settlement Ration (CSR) and Incurred Claim Ration (ICR) of the Company. You can choose anyone out of Government or Private Company Health Insurance keeping in mind the other things and terms & conditions mentioned of the policy. But keep the brand value in your mind.

✅ Base Cover/ Policy Amount

You have to choose how much amount you may require in any medical emergency condition. You can start with 1 Lakh which can go up to 1 Crore. So depending upon the health condition, routine, type of work, etc you have to decide how much base cover you have to choose. Most of the people adopt health insurance in the range of 3-20 Lakhs cover.

✅ Top Up & Super Top Up

Top Up policy is like a top-up recharge of a mobile phone. This amount will be used while the credit of the base policy is exhausted. Suppose you have a base cover of 5 lakhs and a top-up of 5 lakhs, in the medical emergency situation your expenses are 8 lakhs. So if the 5 lakhs will be used from the base cover and 3 lakhs will be used from the top-up.

There is some difference between top-up and super top policy. Suppose after some time you have another medical emergency and your expenses are 2 lakhs then you will not get the benefit of 3 lakhs remaining in the top-up policy, but if you have a super top-up policy then you can have that benefit.

Make sure your top or super top policy is restoration-based, so that it may be restored to the original amount if consumed fully or partially with some extra increase in the premium.

✅ Room Rent Cap

In some policies there is a room rent cap, it means that you have a limit on the type of room which you can have during the hospitalization period. If you occupy a higher value room then the additional charges will not be incurred by the Insurer and also if the room rent is linked with the other expenses, then the proportionate amount will not be given by the Insurer. So, to avoid any difficulties at a later stage, choose the policy which does not have a room rent cap or if it has a cap on room rent then it should not be linked with the other expenses.

✅ Disease Based Cap

Before you buy an insurance policy, check if the policy has a cap over amount (which can be paid) in case of some diseases. Suppose the policy has a cap of 2 lakhs in cancer disease, and you had expenses of 5 lakhs, then you can be paid only Rs. 2 Lakhs in that case. So check if you policy has any cap for particular diseases or not and decide accordingly.

✅ Co- Pay (Co Payment)

Some companies may ask you to pay 10-20% amount of the bill at a reduced premium. Suppose if you have taken a co-pay policy of 20% and in a medical emergency, you have expenses of Rs. 5 lakhs, then you have to pay Rs. 1 lakh yourself and the rest 4 lakhs will be paid by the insurer. So it is suggested to avoid the co-pay policies.

✅ Zonal or PAN India Network Hospitals

Before choosing a company for Health Insurance, check how many network hospitals they have and if they are in your city/ locality or not. So, it will be better to choose a company with a bigger hospital network.

✅ Reasonable & Customary Clause

If your insurer has multiple hospitals nearby for the same treatment, and there is a difference in the rate of treatment in those hospitals, then the insurer may pay you as per the lower rate of treatment even if you have your treatment at a higher rate. So check this clause before buying health insurance.

✅ Waiting Period Duration

There is always a waiting period after buying the policy before it actually starts. This is called the waiting period. This rule is introduced to avoid any frauds from availing the policy benefits. The generally waiting period may vary from 30 days to 90 days. But in the case of pre-existing diseases or slow-growing diseases, it may vary from 1 year to 4 years. So check the waiting period in case of your policy before buying it.

✅ Pre & Post Hospitalization Charges

There may be extra charges of tests, diagnosis, OPD, etc before actually admitting to the hospital and getting treatment. And there may also be expenses after you got discharged from the hospital. So these charges of before and after hospitalization period are called pre-hospitalization charges and post-hospitalization charges respectively. Generally, there are 30-180 days of pre and post-hospitalization period. So check it in case of your policy.

✅ Day Care Coverage

Check whether your policy covers the daycare or not. Daycare coverage means if you have such treatment which was completed in a day time and you were not admitted in the hospital. In that case, the insurer will pay or not, check this point before buying health insurance.

✅ Extended Coverage

In some cases, you may require some other type of treatment such as Ayurvedic, Cosmetic, Naturopathic, etc. To check if your policy gives extended coverage or not. Suppose you need that type of treatment and your policy does not cover that, then it will be a waste to have that policy.

✅ Ambulance charges

Check if your policy covers the ambulance charges or not and if it covers, then what is the charge of the ambulance which can be afforded.

✅ Cashless Hospitals in Your City

Before buying the health policy, check that if they have a sufficient number of cashless hospitals in your city or locality.

✅ Free Health Checkup

Some companies provide free health check-ups for their customers, So check if you can get a free health checkup. It is also suggested that you should have medical checkups from time to time. It also helps in proving that you were not having any diseases before the policy period; if any such conditions arise.

✅ No Claim Bonus

Before buying a health insurance policy, check how much no claim bonus you can get if you don’t claim the policy during a period. You may definitely get some benefits at the renewal time if you have not claimed during the previous period.

Factors Affecting Health Insurance

The top factors which affect the amount of premium of your health insurance policy include the following main things.

  • Age
  • Past Medical History
  • Occupation
  • Body Mass Index (BMI)
  • Smoking/ Drinking Habits
  • Geographical Location
  • Plan You Choose
  • Marital Status

Major Health Insurance Companies

There is a list of top Health Insurance Companies/ Agents in India. You can choose Affordable Health Insurance from this list.

Insurance Company/ InsurerLink
Star Health InsuranceClick Here
Religare Health Insurance/ Care InsuranceClick Here
Aditya Birla Health InsuranceClick Here
HDFC ERGO Health InsuranceClick Here
ICICI Lombard Health InsuranceClick Here
ICICI Prulife Health InsuranceClick Here
Tata AIG Health InsuranceClick Here
SBI Health InsuranceClick Here
Bajaj Allianz Health InsuranceClick Here
LIC Health InsuranceClick Here
Policy Bazaar Health InsuranceClick Here
Bharti AXA Health InsuranceClick Here
MAX Bupa Health InsuranceClick Here
IFFCO Tokio Health InsuranceClick Here
Bajaj Finserv Health InsuranceClick Here
HDFC Life Health InsuranceClick Here

FAQs

How much is Health Insurance?

How much health insurance you will get depends upon a lot of factors like age, medical conditions, type of work, nature of duty, family medical history, etc., and the premium for an Rs. 5 Lakh Health Insurance may vary from Rs. 10000/- to Rs. 20000/- per year depending upon these factors.

How much does health insurance cost?

Health insurance cost depends from person to person and policy type. First, you should decide your requirements and then chose the policy accordingly. However in general the health insurance may cost Rs. 10000/- to Rs. 20000/- for a family cover of Rs. 5 Lakhs.

How to get health insurance?

You can get health insurance online or offline from any bank branch or through an agent. The list of major health insurance companies is given in this article.

How much is health insurance a month?

Depending upon a lot of factors the health insurance may vary from Rs. 500/- to Rs. 2000/- per month for insurance of Rs. 5 Lakhs.

What is Health Insurance?

Like any other Insurance, you give some monthly or yearly amount to the insurance company and in return, you get the assurity that the hospital expenses for you and your family will be incurred by the Insurer (depending on some terms and conditions).

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