Health Insurance

If you already have a medical insurance policy, then you must note the following:

• An initial waiting period is applied, which is 30 days in most health insurance plans.
• The claim process for COVID-19 is the same in regular health insurance plans like any other medical condition.
• Cover for pre-hospitalisation and post-hospitalisation expenses is offered as per the terms and conditions of the policy selected.

Apart from COVID-19 cover in existing health insurance plans, the IRDAI had also launched COVID-19 health insurance policies namely Corona Kavach and Corona Rakshak policies. Both are short-term health insurance plans that cover families and individuals, wherein the former is an indemnity-based health insurance policy, and the latter is a benefit-based health insurance policy. Both the plans help you feel financially secure in case of a positive diagnosis of COVID-19.

What is Mediclaim?

Mediclaim is a health insurance policy that gives you specified financial protection only for expenses arising due to hospitalisation. It covers you for hospitalisation required due to an accident, in case of sudden illness or surgery, or in case of any surgery during the policy term. Mediclaim is of two types, viz., cashless and reimbursement.

What is Health Insurance?

Health insurance is an insurance cover that provides you complete protection for medical and surgical expenses in case of emergencies. With a health insurance policy, you can avail of cashless treatment or get reimbursement for the amount paid to avail of the treatment covered.

To understand the difference between a medical insurance and mediclaim policy, kindly refer to the table below:

When choosing between a health insurance policy or a mediclaim policy, you must consider the following factors:

• Your financial condition
• Your and your family members’ pre-existing conditions if any, age,
• Add-on covers
• Sum insured
• Policy term
• Members to be covered under a health insurance policy

If you have a big family or one with senior parents, then an individual health insurance policy is recommended as a family floater policy might not be sufficient for you. You can also buy a separate senior citizen health insurance policy for parents in this case.

Whereas a family floater medical insurance policy is recommended for a young couple or a small family. Kindly note that when going for a family floater health insurance policy, you must choose a higher sum insured so that it is sufficient for all family members.

When choosing which type of health insurance policy you should buy, you must consider a few things other than just the premium. The right approach will be to seek maximum coverage for all the family members at the most affordable premium. It is recommended to do enough research in order to zero down the most suitable health insurance policy for yourself and your family.

Also, once you decide which health insurance policy to buy, you can also add add-on covers to it for extensive coverage. It is not mandatory to buy add-on covers but you can include them in your policy voluntarily at the time of policy purchase, by paying an extra premium. Some popular add-ons offered under health insurance plans are room rent waiver, hospital daily cash, second e-opinion, critical illness cover, air ambulance cover, etc.

Lower Premium - As you age, you are required to pay higher health insurance premiums. This is because, in old age, you have a higher possibility of getting ill, due to a weaker immune system. For instance, a person aged 20 years will be required to pay a lesser health insurance premium than someone aged 52 years, due to lesser health issues involved.

Lesser Exclusions - Many medical insurance plans come with restrictions on coverage offered, due to which you may not be able to avail full-fledged cover on buying a policy in later years of life. But if you buy a health insurance policy at an early stage in life, when you do not have any health condition, then you will be able to enjoy a full-fledged health cover.

No Health Check-Up - Another reason why buying health insurance at an early stage in life is recommended is because you would not be required to undergo a medical check-up then. But if you buy the policy in old age, let us say 50 years, then most health insurance companies will ask you to undergo the same. Also, in case there is a health condition in the medical test results, then you might be required to pay a higher premium due to higher chances of hospitalisation involved.

No Claim Bonus - You will be able to start accumulating No Claim Bonus early on by buying a health insurance policy timely. You can use this NCB in the later years of life when you might be more vulnerable to illnesses and may need to make a claim. But if you buy the policy during later years of life, then you would not be able to enjoy such increased coverage.

Aligned Finances - If you buy a health insurance policy at a young age, then you have time to plan your finances for a long term. But if you buy it in later years of life, then financial planning may go haywire. Hence, it is recommended to buy a health insurance policy when young so that financial planning can be started early, and also that you are prepared for emergencies irrespective of their magnitude.

Waiting Period - Health insurance plans come with waiting periods for specific conditions, cover for some of which you may require in old age. The advantage of buying health insurance plans when young is that you can complete the waiting period early and avail of the coverage benefits when you actually require them.

Rejections - As you will be more prone to illnesses in your old age, therefore there are higher chances of your health insurance application getting rejected then. Therefore, buying health insurance plans when young is recommended so that there are lesser chances of your application getting rejected.

Pre-Existing Conditions - When you buy a health insurance policy in later years of life, then there are chances that you may already be suffering from pre-existing diseases. But then, you will be required to complete a waiting period to get coverage benefits for the same. On the other hand, if you buy the policy when young, then by the time you may need cover for pre-existing illnesses, you would already have completed the waiting period and will be able to avail the required coverage.

Co-Payment - Health insurance plans reimburse you for the healthcare expenses during a treatment that is covered under the policy. But if the insured, as well as the insurance company, share the expenses at the time of claim, then it is a case of co-payment. Generally, health insurance plans with a co-payment clause come at comparatively lesser premiums. Mostly, this feature can be seen in senior citizen health insurance plans.

No Claim Bonus - It is a reward that a medical insurance company gives to the insured for not making a claim in a particular year. For instance, an increase in the sum insured by a fixed percentage according to the policy, not more than 50% of the sum insured, if the policy has been renewed continuously.

Deductible - Deductible is similar to co-payment. It is a fixed amount in rupee terms that are shared by the policyholder, and not the insurance company, at the time of claim. It is, however, decided by the insurance company if the insured is required to pay this amount per year, per life, or per event.

Dependents - Dependents are family members of the insured who are financially dependent on him/her. These can be a legally wedded spouse, and unmarried children (natural or adopted).

Exclusions - Every health insurance policy comes with a list of conditions that the insurance company will not cover the insured for, during the policy term. These are known as exclusions. Some common exclusions under health insurance plans are treatments required due to participation in adventure sports, Injuries due to self-harm, insured committing a breach of law, etc.

Grace Period - The grace period is a specific period starting immediately after the expiry of the due date or premium payment, given to the policyholder to pay the premium to continue availing coverage benefits under the policy. If the premium is paid during this period, then you can continue availing of the policy benefits. But if the premium is not paid even during the grace period, then your policy will lapse and you will lose all the accumulated benefits. Hence, it is recommended to keep renewing health insurance plans when the premium is due.

Insurer - The insurance company.

Premium - A fixed amount to be paid periodically in order to keep availing of health insurance policy benefits.

Policy - It is a legal contract between an insurance company and the insured, that contains all the terms and conditions of the insurance.

Pre-Existing Disease - It is any condition, ailment, or injury for which the insured already had symptoms, within 48 months prior to buying a health insurance policy. Generally, pre-existing conditions are covered by the policy after a specific waiting period. Hence, it is recommended to disclose pre-existing diseases, if any, to avoid any hassle at the time of claim settlement.

Network Hospital - Every insurance company has a tie-up with hospitals wherein the insurer can avail cashless treatment. These hospitals are known as network hospitals. It is recommended to choose an insurance company with a high number of network hospitals, for utmost convenience in case of an emergency strike in the future.

Portability - Portability is an individual health insurance policyholder’s right that allows him/her to switch from one insurer to another or from one health insurance policy to another of the same insurer if the policy was maintained without any lapse. Portability allows you to transfer the accumulated benefits as well such as waiting for period benefits, NCB, etc.

Sum Insured - It is the payout amount that an insurance company is liable to pay to the insured in case of a claim. For instance, if the sum insured of a health insurance policy is Rs. 5 Lakh and the hospitalisation expenses incurred are Rs. 2 Lakh, then the insurance company will cover the expenses. But if the expenses exceed the sum insured limit, then the insured will have to bear the remaining expenses.

Waiting Period - This is a fixed time period for which the medical insurer does not cover you, even after the commencement of the policy term. Waiting periods can be of different types such as initial waiting period, waiting period for specific diseases, waiting period for pre-existing diseases, etc. The waiting period is calculated from the date of commencement of the policy.

Free Look Period - Free look period is the time that an insured gets to understand his/her health insurance policy better. During this period, if not satisfied, the insured can cancel the policy.

The tool does the calculation after considering several factors such as BMI, age, income, lifestyle, gender, members to be covered under the policy, etc. You must note that the premium is decided on the basis of these factors and hence you must provide the correct information to avoid any discrepancy in premium calculation.

To use a health insurance premium calculator, you must follow the below-mentioned steps:

• Visit InsuranceDekho and click on ‘Health’.
• Fill in your personal details as required in the form. You will be required to enter your name, Age, Gender, City, Mobile Number, Email ID, Members to be covered, etc. Then click on ‘View Instant Quote’.
• As per the information entered, you will see the most suitable health insurance plans displayed on your screen with their premiums.
• From them, you can select the most suitable one as per the premium and coverage benefits offered.

Age - Generally, companies offering medical health insurance plans follow the rule-higher the age, the higher the premiums. This is because, in old age, people are more vulnerable to illnesses, which increases their chances of making health insurance claims. Hence, the higher the age, the higher the premiums, and vice versa.

Past Medical History - If you have a history of any medical condition, then you will have a higher chance of hospitalisation and hence you will be required to pay a higher health insurance premium. But if there is no history of a medical condition, then you will be charged a comparatively lesser premium.

Lifestyle Habits - Lifestyle habits such as excessive smoking or drinking deteriorate your health and make you more prone to illnesses. If you follow this lifestyle, then you may be at higher health risk and hence will be more likely to make a claim. This is why your health insurance premium will be higher as compared to someone who does not smoke or drink regularly.

Policy Term - Policy term is another crucial factor that decides the premium for a health insurance policy. You can choose from different policy terms such as 1 year, 2 years, or 3 years, according to its terms and conditions. The higher the policy term you opt for, the higher premium you will be required to pay, due to the higher coverage offered.

Add-On Covers - You can include add-on covers to your health insurance policy for extensive coverage. For this, you will be required to pay an extra premium at the time of policy purchase. The greater the number of add-ons covers you buy, the higher premium you will be required to pay for it.

Co-Payment - Premiums for medical insurance plans that come with a co-payment clause are generally low, due to the cost-sharing involved. Therefore, if you choose a health insurance policy with a co-payment option, then you will be required to pay a lesser premium and vice versa.

Body Mass Index - If your Body Mass Index is higher than normal, then you will be at higher risk of suffering from health issues. This is why your premium will be high. But if it is normal, then you will be charged a lesser premium.

• Valid identity proof.
• Duly signed and completed original claim form.
• Doctor’s prescription recommending hospitalisation.
• Original pharmacy bills.
• Original prescription for medicines, consultation, and diagnostic tests.
• Indoor case papers.
• Ambulance receipt.
• First Information Report (FIR), if applicable.
• Policy details with the insured person(s) name, policy number, illness, and address.
• Any other document if required by the insurer.

Listed below are additional documents required in case of a cashless medical insurance claim:

• Pre-authorization form.
• Valid identity proof along with a photograph.
• Documents like voter ID card, driving license, PAN card, and Aadhar card.

Myth 1: Health insurance plans is not required when young and healthy

Reality: The ideal time to buy health insurance is when you are young and healthy. This is because if you buy a health insurance policy at a young age, then you will be able to get the cover at an affordable premium as the risk of getting hospitalised then is minimum. Also, health insurance plans come with waiting periods during which no claims are admissible. On buying health insurance when healthy, you can complete this waiting period without any worries as you may not need to make a claim then.

Myth 2: I will only be covered for hospitalisation

Reality: It is true that health insurance plans cover you for hospitalisation expenses only when the hospitalisation of at least 24 hours takes place. But it is not true that the plans only cover you for these expenses. In most cases, they also cover you for daycare procedures such as sinusitis, radiotherapy, chemotherapy, etc, which do not require hospitalisation of at least 24 hours. Other expenses covered are OPD expenses, road ambulance expenses, second medical opinion, medical check-up, etc.

Myth 3: People who smoke cannot be covered under any health insurance policy

Reality: You can still buy a health insurance plan even if you are a smoker. But medical insurance companies are concerned about pre-existing conditions, which may even lead to the cancellation of your health insurance application form. So, if there is any pre-existing condition due to smoking, then you must disclose the same to your insurer. It will not deny you the policy but may charge you a higher premium because as a smoker, you will be more prone to illnesses.

Myth 4: Health insurance plans are bought to save taxes

Health insurance plans do not only help you save taxes as per the prevalent tax laws but most importantly, cover you for healthcare expenses, which may help you save even more in the long term.

Myth 5: It is not safe to buy health insurance plans online

It is completely safe as well as quick to buy health insurance plans online at reliable platforms such as InsuranceDekho. All you need to do is fill a quote, compare the most suitable health insurance plans from the ones displayed on the screen, shortlist the one you wish to buy for yourself and your family, and pay the premium online via a secured payment gateway. These are different premium payment modes like Credit card, Debit card, or e-wallets that you can choose as per your convenience.