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What are the Requirements for Health Insurance and its Benefits?

Do I qualify for health insurance?

A million-dollar question.

Eligibility criteria for buying health insurance may vary.

Let me help you find out how you can qualify for health insurance and its benefits in India.

Requirements For Health Insurance Policy

1. Pre-medical Tests

When you buy health insurance plans, the insurance company may ask you to go for certain medical tests.

A pre-medical test allows insurers to assess your eligibility for a health insurance product. It enables them to set a value on the health risk of an individual.

So, pre-medical tests are necessary to be eligible to buy health insurance (subject to the policy you have chosen). Based on the test, insurance companies evaluate the insured’s health and set a premium.

In general, the insured below 45 may not need to undergo medical check-ups (depending on the insurers and plans) before opting for a health insurance policy.

But, it does not mean you don’t account for a pre-existing condition. If you don’t want to go for the medical tests, you may have to submit a declaration of good health and must disclose any disease like diabetes and hypertension if you are suffering from it.

It’s eventually beneficial to disclose a pre-existing disease as it eases the claim process.

What do the pre-medical tests cover?

The medical tests vary from case to case.

It primarily consists of physical examinations, urine tests, and blood tests. These tests are done to detect any problem in the kidney function, or liver function, or find out a rise or fall in blood sugar.

The tests also include tests for cholesterol levels and HIV I & II.

Urine tests reveal whether or not you consume alcohol and tobacco. It ensures that the cotinine levels found in the samples are within an acceptable range.

If you want to go for high insurance coverage or have crossed the age of 55, you may have to bear some additional tests.  

In addition, in case you or anyone in your family has a history of illness or diseases, the insurer may ask for some more tests.

2. Minimum and Maximum Age

The minimum entry age for a health insurance plan is 18. However, children from the age of 3 months are also covered subject to both parents being covered by the same health insurance policy.

For example,

For SBI General’s Health Insurance Policy - Retail, the minimum age for adults is 18. However, this policy also covers children of 3 months subject to both parents concurrently covered by SBI General’s Health Insurance Policy - Retail.

The maximum age for health policy is 5 years (70 and above, based on the plan and insurer).

Buying health insurance at an early age is cost-effective. This is because pre-medical tests are not required during this age. However, in certain situations, pre-medical tests may be necessary.

3. No Claim Bonus

No claim bonus (NCB) is a reward offered by health insurance providers. You can be eligible for it by not making any claim in a policy year.

One can avail of NCB at the time of renewing his/her policy.

For example,

Some insurance companies offer a 5% no-claim bonus or a cumulative bonus for every no-claim year. The percentage of the amount may vary from company to company.

4. Family Discount

A family discount is available if another family member is covered by the policyholder. It is offered at a flat rate. Also, this discount does not increase with the increase in the number of family members.

5. Discount Vouchers

You can avail of discount vouchers depending on the type of health insurance. Certain health insurance companies in India provide discount vouchers to the insured these days.

You can use these vouchers when purchasing medicines or availing of medical treatments. However, these vouchers are available at specified outlets.

For instance, certain health insurance plans may offer you a discount of 5% to cover 2 members and 10% for 3 or more members. Many plans do not give more than 10% discounts for covering more than 3 members.  

6. Cumulative Premium Payment Discount

You’re eligible for a cumulative premium payment discount. For this, you have to pay 2 years of premiums together while buying health insurance. The discount may vary from company to company.

7. Wellness Rewards

Wellness rewards are a new trend in the health insurance industry.

There are insurance companies that offer these rewards to insured persons. You can be eligible for wellness rewards by maintaining a healthy lifestyle. Today, many companies are launching some more rewards for customers who maintain their health.

For example, Apollo Munich offers a premium discount of up to 25% for people with diabetes to stay healthy.

8. Girl Child Discount

This is another discount offered by some of the best insurance companies in India to empower women and support their healthcare needs. Some policies offer certain discounts on the premium if the policy is proposed by a woman. Such discounts are also available in case a girl child is included in the family health insurance plan.

For instance, Reliance Health Insurance provides a discount of 5% for a girl child or a single woman.

Group Health Insurance Plan

Many companies offer group health insurance plans to their employees. This health plan is available only for permanent employees. However, only being the owner or working in a higher position can’t make you eligible to avail the benefits of this program.

To be eligible for a group health insurance plan, you need to work for an average of at least the minimum number of hours each week. You need to actively work and perform for the growth of the company. Then only you can be eligible for health insurance coverage.

Other Requirements

To avail of the best health insurance policy, understand your family’s needs. Knowing the exact number of family members and their age plays a crucial role in identifying the right policy.

For instance,

A family with senior citizens should go for a larger floater cover, while a young family can opt for a basic cover of Rs. 5 lakh.

In addition, if you are not planning a baby, better choose a plan without the pregnancy cover which comes along waiting periods and almost doubles the premium.

Conclusion

Equipped with a host of attractive benefits, and added discounts, a health insurance policy is a must for every individual. In India, many insurance companies are providing a host of health insurance policies to people. But, before picking any plan, it is essential to know about inclusions, exclusions, coverage, features, premiums, etc. of the plan. Try to get as much information about the policy as possible. The good news is that you can get complete information about several health insurance plans online.

Also Read:

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