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Why purchase Mediclaim Insurance?

While excellent health care is now available in most Indian cities, the cost of this quality health care are increasing every year, so much so that having health insurance is no longer a luxury, but very much a necessity. Adequate health insurance coverage is necessary to pay the bills in case of hospitalization following an illness/accident. Adequate health insurance policy coverage will give confidence for the insured to access quality health care and get better treatment. Mediclaim insurance coverage ensures the policy holder to avoid debt to paying medical bills or hospitalization expenses.
Health insurance is an insurance plan that covers the whole or a part of the risk of a person incurring medical expenses or at a more basic level, it is an insurance policy which covers an individual/family against medical and surgical expenses where the policyholder chooses a limit of coverage under an insurance plan. Health insurance provides people with a much needed financial backup at times of medical emergencies. Health risks and uncertainties are a part of life. One cannot plan and get sick but one can certainly be prepared for the financial aspect. One of the ways to be financially prepared against uncertain health risks is by buying health insurance. As per the law, it’s not mandatory for an individual to have a health insurance coverage like Third Party motor insurance. But honestly, it is even more important and critical for every single individual to have health insurance since it protects not only the insured person, but also provides financial support to the family at a critical juncture in their lives. Many individuals still look at Health Insurance as an expense/cost rather than as an investment.

Some of the key reasons it is absolutely necessary to take health insurance include:

Medical Emergencies Can Be Financially Draining on Resources
With today’s medical inflation in double digits and every increasing cost of healthcare, it would not be advisable to be without sufficient health insurance. With the advancement in medicine, doctors and hospitals and starting to bill their patients much higher for routine and complicated treatments that the customer will have to cough up without sufficient health insurance.

Comprehensive Coverage Plans
Today’s insurance plans are not only about covering Inpatient hospitalisation. It also includes coverage like Pre & Post Hospitalisation, Coverage for AYUSH treatment, Maternity & New Born baby cover, Organ Donor Expense cover, Ambulance charges cover, Daycare and Domiciliary Hospitalisation expense coverage and many more.

Long Term Benefits of Remaining Insured
All health insurance plans come today with waiting periods, both the mandatory waiting period of 30 days and longer waiting periods for other names ailments/illnesses. Hence by staying insured beyond this waiting period, the insured gets covered for almost every ailment possible, barring the general exclusions. There is a propensity for elder family members to fall ill and require treatment, hence at this stage them having a comprehensive cover will help. Secondly, being insured long term also ensures that for every claim free year, the insured becomes eligible for a no claim bonus, which result in an increased sum insured at no additional cost…over a period of time, this coverage can reach 150% of the original sum insured.

Preventative Care and Early Intervention
Many insurance plans today encourage and support wellness solution and an overall healthy lifestyle of the insured. When one doesn't have insurance, one may avoid getting treated for minor issues which can escalate into bigger and costlier problems later. Preventive medicine and quick treatment are the best ways to avoid expensive hospital stays.. Some insurance plans have an inbuilt annual health check up free of cost to the insured.

Lifestyle Effects
There are many reasons to have a health insurance policy in place. The paradigm shift in our lifestyle has made us more prone to a wide range of health disorders. Commuting, hectic work schedules, wrong eating habits, quality of food, and rising levels of pollution have increased the risk of developing health problems. Health insurance once again will come to the rescue were one to be hospitalised.

Income tax benefit
Earlier, this used to be the primary reason for individuals to buy insurance. Payments made towards health insurance premiums are also eligible for tax deductions under section 80D of the Indian Income Tax Act. Individuals up to 60 years of age can claim a deduction of up to Rs. 25,000 for the health insurance premium paid for themselves, or for their spouse or children. One can also claim another Rs. 50,000 as deduction if you buy health insurance for your parents aged 60 years and above.

A few important points have to be noted while buying health insurance. It is advisable to purchase coverage at a younger age, as customer can become ineligible for certain plans as they grow older and have any medical ailments. For example, some insurance policies are not available to anyone who has diabetes. Even if a customer becomes eligible to purchase a specific insurance policy, all plans have a exclusion period during which pre-existing ailments are not covered. It should also be known that the plans do not cover sickness immediately, they usually have a thirty day waiting period before sickness is covered, hospitalization caused by accidents are however covered immediately.

Factors to consider when comparing Health Insurance Plans

Today there is an information overflow regarding insurance and the customer has many avenues to review health insurance plans before settling on the right plan for himself/herself and their families. There are comparison websites like eindiainsurance which provide all relevant information regarding the health insurance plans available and one can make a comparison between plans before settling on the most ideal option. Some of the factors to keep in mind while comparing health insurance plans include:

Choosing the Right Plan/Coverage
It is important to ensure adequate coverage while buying Health Insurance. With every increasing medical treatment costs, having an optimum coverage amount is very important. A person living in a metro city may require a higher sum insured than one residing in a smaller town, an older person should opt to have a higher coverage than a younger person. Also if one is opting for a Family Floater, having sufficient coverage for all members of the family is critical. If one has aging parents, it may be better to have them insured under an individual plan while the younger members have a family floater. So one must carefully evaluate these facts before finalising coverage for each member. Similarly opting for an insurance plan with a better set of benefits and transparent coverage wordings may help.

Cashless Hospital Network of the Insurance Company
This pertains to the number of hospitals that the insurance company has tied up for cashless treatment, ie. where the insured need not pay the treatment expenses at the time of discharge from hospital. The larger the network of hospitals, the better. Also see if the larger and better known hospitals are covered in the city of the insured’s residence.

Waiting Periods
Waiting Period is the period during which the insurance company is not liable to pay any claims to the insured for specific coverages. Most health insurance plans offer different waiting periods (ranging from 2-4 years) for different covers, one needs to review and compare them before opting for a particular plan.

Exclusions Under the policy:

One must go through the detailed list of exclusions before opting for a particular health insurance plan…these are essentially the benefits/features that are not covered under the chosen policy and the list of exclusions vary from insurer to insurer. Also once the policy is received, kindly go through the terms and conditions since there is a free look period for all policies, during which time the policy can be cancelled if the insured is not happy with the selected plan.

Co-payment Terms

Co-payment is the insured’s contribution to a particular claim – it is normally a defined percentage of the claim amount payable by the insured while the rest will be settled by the insurance company. For example, if there is 15 % co-payment in a health policy, the insurance company will pay only 85% of the covered expenses and the insured individual will have to bear the remaining 15% of the hospitalisation/treatment charges. It is important to note that lower premium could sometimes mean higher co-payment terms, so the insured needs to be wary of the same while finalising their plan.

Claim Settlement TAT / Ratio

The Claim settlement turnaround time (TAT) and settlement ratio of the insurance company should also be evaluated while finalising the insurance plan and provider. A good insurance company is one with shortest claim settlement TAT and highest claim settlement ratio. Most insurance companies also work with Third Party Administrators (known as TPAs) for claims management, while some manage the claims directly. It is important to know who one has to deal with at the time of a claim.

Websites like eindiainsurance provide information relating to the claims settlement capability of the insurance company.

Other Important Clauses

It is equally important for the insured to evaluate clauses like Day Care procedures (the number of them vary from insurer to insurer), Pre/Post Hospitalisation timelines, Coverage or Pre Existing Conditions, specific Sub Limits for certain coverages are also factors to be considered while finalising on the optimum health insurance policy.

There are different types of plans designed by Indian insurance companies. Individual plans for single person coverage, family floater to cover entire family, senior citizen plan for the elderly, specific fixed benefit policies for specific critical illness including diabetes, cancer, cardiac care etc... The prominent insurance companies like Apollo Munich, Max Bupa, Oriental Insurance, National Insurance, Bajaj Allianz, Reliance, Star Health, TATA AIG etc... offer health insurance coverage for Indians at affordable premium cost. You can get information at eindiainsurance and buy the best policy that can suit your requirements.

Types of Indian Health Insurance

Health insurance plans in India can be broadly classified as follows:

  • Indemnity Plans
    • Individual Health Insurance
    • Family Floater Health Insurance
    • Senior Citizen Plans
    • Top Up Plans
    • Women’s Plans including Maternity
    • Arogya Sanjeevani – new plan introduced by insurers on direction of IRDAI
  • Fixed Benefit Plans
    • Critical Illness Plans
    • ospital Cash Plan
    • Diabetes Care
    • Cancer Care
    • Cardiac / Heart related plans
Get free quotes for Indian health insurance plans at eindiainsurance and select as per your requirements.

The plan descriptions are as follows:

Indemnity Plans

The most popular and most sought after forms of health insurance in India are indemnity based health insurance plans, also commonly known as “Indian mediclaim insurance”, which cover the costs incurred for inpatient treatment received by the insured during the period of the policy. These India health insurance coverage provide cashless hospitalization or reimbursement of any expenses incurred in the event of hospitalization, diagnostic requirements during this treatment and post hospitalization medical care. The mediclaim insurance coverage in India can be offered as:
  • Individual India Health Insurance Plan - Individual health insurance coverage in India provides a separate and designated sum insured for each insured member. So, with these type of best individual health insurance policies, one member’s medical expenses do not impact the coverage for another family member
  • Family Floater mediclaim Insurance Plan - The family floater insurance coverage in India plan provides coverage to the entire declared family under a single sum insured. Specifically designed for nuclear families, here a fixed sum insured is available for any or all the family members insured under the plan for all claims during the tenure of the policy. A family is normally defined to include the individual, spouse, dependent children, parents and parents-in-law. Thus, if one member ends up using a large portion of the sum insured, the other member may fall short of cover when needed.
  • Senior Citizen Plans – Essentially to cover individuals who are above the age of 60 years. These plans normally come with lower sum insured and co pay / sub limits
  • Top Up Plans - Top up health plans are regarded as add-on cover or additional protection cover to your existing health cover which may at times become insufficient against increasing the cost of medical services. Top up plans are offered by several insurers and you can even buy from your existing health insurance provider.
  • Women’s Plans – A few insurance companies have now started offering insurance plans specifically for ladies given their lifestyle issues they face as they age. Maternity plans are also offered for younger women.

Fixed benefit health insurance plans

Fixed benefit insurance offer a fixed one time lumpsum benefit on the occurrence of certain defined medical situations, like the Diagnosis of a Critical Illness, Accident Related Hospitalization, Hospital Cash Benefit etc. Such plans are purchased to not only cover expenses related to hospitalization but also compensate the insured for loss of income during the injury period. The two specific advantages of such plans is that 1) they pay the complete sum insured on first diagnosis/occurrence of the incident, irrespective of the expenses incurred by the insured for treatment of the medical condition and 2) such a payout is over and above what an health insurance plan will pay to the insured by way of reimbursement or cashless expenses. Importantly one must understand that the limitation of such a plan is that it may or may not cover all medical contingencies. The variants include:
  • Critical Illness Indian health insurance(CI)– CI plans offer a fixed lump sum payment on the diagnosis of the defined critical illnesses. Each insurance company provides a list of Critical Illnesses covered under their CI plans that are covered and the benefit is paid on diagnosis of any of these illnesses. Such a payment also provides an income for the insured.
  • Personal Accident Insurance - These plans offer a defined lump sum benefit on the unfortunate incident of an accident to the insured resulting in Death, Dismemberment, Disability, Broken bones, Burns etc. These plans could also cover Education Expenses for the insured’s children as well as Ambulance expenses
  • Hospital Cash/Surgical Benefit Insurance – Such plans pay the lump sum benefit of the Sum insured as Hospital Cash, which is a defined per day allowance while the insured is hospitalized following an accident or sickness towards incidental expenses incurred by the insured. Surgical plan on the other hand take care of any major or minor surgery that the insured may need to undergo.
  • Specific plans for covering Diabetes / Cancer / Cardiac Related ailments

The table below will give a more detailed understanding of differences between both plan categories:

Fixed Benefit Plans Indemnity Based Insurance Plans
Pays a lumpsum upto Sum Insured on the occurrence of the covered event – personal accident, critical illness etc Reimbursement/cashless settlement only upto the actual expenses incurred irrespective of the Sum Insured
These plans cover only a limited / fixed set of benefits which are defined in the plan Most indemnity based health insurance plans offer wide ranging coverage for sickness to the insured
Policy / Plan expires in the event of a claim and the Sum Insured being settled to the insured Policy continues even after a claim is paid, coverage will remain upto the balance remaining Sum Insured (or back to 100% SI with Restore Benefit plans)
Fixed Benefit plans normally do not have a co-pay or deductible. Full Sum Insured settled to the insured Indemnity plans have a co-pay / deductible based on the plan chosen by the insured
Some Fixed Benefit Plan like Critical Illness have Survival periods (normally 30 days) after which expenses/SI becomes payable No Survival Period. Expenses from Day 1 of hospitalisation are payable under this plan
Premium for these plans are relatively higher Premiums based on coverage/SI chosen, but cheaper when compared to Fixed Benefit plans

Quick Reference:

Family Plan Family Floater Plan: This type of coverage will include all of your family members in a single policy. Family Floater policy will be more affordable than buying individual health insurance for each family member.
nurse Critical Illness Cover: Under this type of plan there will be coverage for medical expenses incurred for severe diseases like bypass surgery, cancer, stroke etc.
cashless money Cashless Mediclaim Plan: Plans with cashless mediclaim cover ensure tension free hospitalization. All medical expenses incurred for pre & post hospitalization cost is covered and you will get treatment at best hospitals. Medical bills at the hospital will be settled by Insurance Company.
medical test Medical Tests to Buy Health Insurance: Few plans offered by Indian insurance companies require medical test report as one of the document for issuing the policy. You can get this information from Eindiainsurance and submit the medical test report while buying policy.
payment Modes of payment: The modes of payment to buy policy can be cheque, cash, credit/debit card... This depends on the type of plan and insurance company chosen by the customers.
time Time required to issue policy: The time taken to issue policy can vary from insurer to insurer and the type of plan selected by the customers. It can be 10-15 days or less/more than that to issue health insurance policy document to customers. There are chances of even rejection for issuing policy by the underwriting team after verifying the documents. Issuing policy is subject to the terms and conditions of the insurance company and their underwriting team.

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