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INDIVIDUAL HEALTH INSURANCE

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  • Detailed information on all kinds of medical cover
  • Widest choice from all Health Insurance providers
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  • #What is Health Insurance

    The insurance that covers the cost of the insured person’s medical and surgical expenses is defined as Health Insurance. It covers the ‘insured’ against expenditure that could arise out of hospitalization due to reasons of illness and or injury. It is a ‘bond’ between the Insurer (Insurance Company) and the Insured, which states that the insured will pay regular premiums and the insurer, will provide the ‘financial cover’ in case of an unfortunate eventuality.

    Subject to the kind of ‘coverage’ in the health insurance, the individual may either pay the hospital the entire sum of the treatment, which would then be reimbursed by the insurance company or the insurer could make payment directly to the health care provider.

    • Who falls under the realm of health care provider?
    • Within the gamut of health insurance, a ‘provider’ could be a hospital, clinic, doctor, health care practitioner, pharmacy, and or laboratory.

    What does Health Insurance Cover?

    Rising demand from customers has given rise to the innovative and modern health insurance policies, which are designed to cover just about every unfortunate and unforeseen eventuality. These policies include the entire, albeit undesirable journey of ill-health, from being hospitalized to the day of discharge. In addition, medical expenses 60 days prior to hospitalization and 90 days post discharge are covered too, providing the needed relief from the skyrocketing medical expenses of today.

    The options and plans offered today by modern health insurance are akin to selecting from a wide array buffet – where one can select exactly one wants to ‘consume’.



    #
    Health insurance companies now offer a variety of add-on features, customized according to the specific requirement of those seeking insurance.

    The ‘inclusions or covered services’ would be –
    • Hospitalization – admittance for treatment for 24 hours at least in a hospital that is in the insurer’s network or outside of the network. There are over 400 procedures covered by insurer’s today in the event of hospitalization.
    • Pre and Post Hospitalization expenses – Charges incurred on diagnosis and the reports and medication required for the treatment for which the insured would need hospitalization
    • Procedures such as kidney stone removal and cataract treatment are covered, even if 24 hour hospitalization is not required (Other OPD treatments are not covered)
    • Expenses incurred as a result of an injury due to an accident – this is an active inclusion as soon as the health insurance policy is issued

    Under the heads mentioned above, the insured can expect cover as below:
    • Ambulance expenses
    • Pre-existing disease cover
    • Maternity expenses and expenses for the new born
    • Donor expenses in the case of organ transplants
    • Ayush treatment expenses
    • Expenses for treatment done at home
    • Cash allowances to meet daily expenses during hospitalization
    • Yearly health checks

    The insured must however, read insurance documents well and check with their insurance provider with regard to the ‘cover’ they can expect.

    #Key Advantages and Features of Health Policies
    We always feel that tragedy will not strike us; that bad things happen to others. However disease, infirmity and ailment can strike anyone, at any time. Even when everyone in the family is fit and completely healthy there is no telling when disaster may strike. Opting for health insurance is one way to ensure that the family is protected if, there be an illness or need for hospitalization. Remember medical expenses can drain family resources- leaving people destitute and in huge debt.

    Advantages of health policies
    In India, health insurance is a growing segment. Very few people currently have health insurance. According to one report, as many as 80% people in India bear their own medical expenses. Less than about 20% people have medical insurance. There is a choice between individual and family cover; however the general benefits of health insurance are:

    • In the event of hospitalization for disease, illness or requirement for surgery, medical insurance cover will either reimburse the policy holder or pay to the hospital directly (as in the case of cashless policies).
    • Costs of hospital charges, doctor's fees, room rent, lab tests and surgery costs are covered by health insurance. The procedures, medications and surgeries covered could vary in accordance with the policy terms and the insurance provider.
    • Cashless policies give you access to treatment at partner hospitals (a list of such hospitals and diagnostic centers is provided along with the insurance policy) without upfront payment that would have to be made in the event of not having insurance.
    • Typically hospital stay is a requirement for making an insurance claim; however in some cases, policies may also pay for home or domiciliary expenses when treatment was unable to be carried out in hospital and had to be conducted at home.
    • Pre and post hospitalization expenses are also covered by health insurance – usually 30 days before and 60 days post discharge.
    • Health insurance policies may also offer critical illness (life threatening illnesses) insurance cover. Usually cancer, heart disease and stroke are described as critical illnesses. Depending upon the terms of a policy, other conditions such as kidney (renal) failure, coronary bypass surgery, heart of other major organ transplant and paralysis may also be covered. Critical illness insurance provides a lump sum benefit to the policy holder who is diagnosed as having any such life threatening condition.
    • Some policies also offer certain free annual routine checkup and test packages along with the health insurance policy
    • Children, seniors, people with some preexisting conditions and entire families can be insured under various plan categories. Many insurance companies also offer women specific health insurance and personal accident health insurance (recommended for people engaged in hazardous occupations).

    Features of a health insurance policy

    The Insurance Regulatory and Development Authority (IRDA) of India, lays down certain guidelines for services that health insurance companies are bound to provide. The IRDA also offers redress for consumer complaints via its grievance all center. While individual insurance company coverage and terms may differ significantly and terms also change according to the type of policy the insurer chooses, there are certain features of a health policy that remain standard:

    Extent of coverage – This refers to the sum insured or the maximum amount of coverage up to which benefits are available under a given policy. This total amount can be used more than once but subject to the maximum amount. For instance, the insurer opts for coverage of Rs 2 Lakhs. When there is an in the family, a claim is made and expenses are in the region of Rs 50,000/- In this case, the individual can still make a claim to the tune of the remaining Rs 1.5 Lakhs for the rest of the year.

    Insurance premiums – The amount of premium will be decided by the amount of total coverage, the type of policy (individual, family, critical illness cover etc), the age of those insured and preexisting conditions (if permitted). In most cases, no-claims bonus are offered for subsequent policy purchases if no claim was made during the previous term period.

    Making part payment – This is a clause that most insurers include in their policies (most types of insurance have this, including auto insurance) to ensure that the individual does not opt for needless procedures and remains vigilant about any unnecessary inflation of total bill amount by the hospital. Under this clause, the insured person is required to pay a certain percentage of the total expenditure incurred. This is usually about 10% of the total amount, but that number can vary in some cases.

    Partner hospitals and diagnostic centers – Usually with sudden illness, especially over a holiday or weekend, it can be difficult to find large sums of money that hospitals may be require to be deposited at the time of getting admitted or emergency surgery and so on. To ease this problem, insurance companies offer ‘cashless policies’. Insurance companies usually tie up with thousands of major hospitals and laboratories to offer patients the convenience of getting treatment without upfront payment. It works like this: the patient informs the company about hospitalization and the insurance company authorizes the hospital to proceed with treatment/ surgery.

    Tax benefits – To encourage more people to opt for health insurance, the government also offers tax benefits. According to the IRDA Health Insurance Handbook, section 80D of the Income Tax Act, permits annual deductions of up to Rs 60,000 for payment of health insurance premiums from taxable income. These deductions are also available when individuals pay premiums on behalf of aged parents.

    General exclusions – Again, while policies may differ significant form company to company, certain exclusions are standard: preexisting conditions (defined as any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and/or was diagnosed, received medical advice or treatment within 48 months prior to the first policy issued by the insurer), claims within 30 days from policy initiation, certain conditions during the first year (cataract, hernia, hydrocele, etc), costs of hearing or visual aids, routine dental treatments (unless needing hospitalization), pregnancy and pregnancy related treatments, naturopathy or similar alternative treatments.

    In conclusion, it is important to ensure one buys health insurance as per their requirement, age, occupation and budget; all the while carefully examining the terms of the policy and its exclusions.

    #Benefits of Health Insurance
    “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” - World Health Organization.

    Most people err on the side of carelessness when it comes to their health, and the importance of remaining healthy through regular health checks comes to the forefront when someone falls ill or needs hospitalization. These unforeseen circumstances result in expenses that could create a serious dent in one’s finances. To compound these expenditures, public healthcare facilities usually never suffice for all those that do require healthcare – meaning that most people need to rely on the exorbitant treatment from private healthcare service providers. For most people, this could mean ‘digging’ into their life’s savings, which is rarely enough to meet the expenses related to healthcare in private institutions. This would be even more daunting if the breadwinner were to fall grievously ill – the family would face debts, a lowered lifestyle, and still find it hard to afford the exorbitant treatment costs.

    In the light of the above, having a comprehensive health insurance is the only way to alleviate the financial risks and relieve the stress associated from the illness and expenses. Investing in a good health insurance plan, therefore, makes for a prudent financial decision. With the pace of life becomes speedier, changes in lifestyle and costs of everything rising sharply, illnesses have become commonplace. People are finding it harder to manage their families and expenses within the income available to them, much less arrange for huge sums of money required for treatment in hospitals.

    Merits of Health Insurance

    Irrespective of family wealth, there are some significant benefits of health insurance, which can indemnify anyone from the unexpected financial expenses associated with ill health. Given below is a list of the benefits of a comprehensive health insurance:

    • Financial protection and ‘safety blanket’ for the insured provides intense relief for the family and the person who may be ill. Knowing that the exorbitant medical expenses are covered is a huge benefit at a time of ill health
    • Given that today the insurance sector is highly competitive, all the players in this realm offer the best packages – fitting a person’s budget, specific requirements, pre-existing medical history, and a history of family illnesses can help people decide on a policy that would work best for them
    • A major benefit of a health insurance policy is that in addition to the main insured, it can be extended to cover the parents, spouse, children, and even parents in-law of the insured. This ‘insures’ peace of mind, and flexibility of the insurance cover
    • The benefits of an insurance policy can be enjoyed up to a ripe old age, by simply renewing the policy each year by timely payment of the required premium
    • The premium paid towards maintaining the health insurance not only provides benefits as mentioned above, they also help to reduce the tax liability. Tax exemption under Section 80D is a huge advantage given the ever-increasing rates of tax.

    Who can avail an insurance policy?
    Everyone needs a health insurance policy and it can be availed by anyone. However, there are some eligibility criteria:

    1. Anyone between the ages of 5 and 60 years (both ages inclusive), subject to the proposer being a major – i.e. over the age of 18 years
    2. Senior citizens too can avail the benefits of health insurance as per a directive from the IRDA, the governing body for the insurance sector. There is typically no upper age limit for entry, and some ‘insurers’ have an entry age even as late as 80 years (subject to the approval of the company’s medical underwriters). The cover is usually ‘lifetime renewability’ depending on the individual insurance company’s policy. However, it is highly advisable for people to take a comprehensive Health Insurance as early in life as possible.

    Investing in a health insurance policy, should however, not be purely from a tax savings perspective. It is a prudent investment, which saves one from rising medical expenses, inflation, and keeping our loved ones financially secure.

    # Best Health Insurance from Top Insurance Companies

    Health insurance is critical and necessary
    Let us begin with the good news first – the awareness, of the need for a good and comprehensive health insurance, is on the rise. Some recent surveys corroborate this fact. However, the not so good news is that these surveys also reveal some shocking statistics and facts. At least 48% to 50% people said that health insurance is a necessity only for those who are old, while others revealed that they were sure they did not need health insurance since they were presently fit and healthy. Some others revealed that the only reason they would buy or have bought health insurance, would be due to the tax deduction possible on the premium paid. This means that saving tax is the only guiding factor, while negating the exponential benefits of health insurance.

    What should you consider before buying a Health Insurance?
    The prime criterion should be the needs of your family. This would mean the number of members in the family, their health condition, and their respective ages would be key determining factors in deciding the most appropriate health insurance policy. Check and compare online to find the most suitable policy for yourself and your family. To start with, we offer some pointers on what a good health insurance policy must cover:

    • Medical check-ups
    • In the event of an emergency, ambulance expenses could be reimbursed by the insurer
    • All medical expenses of 30 days prior and 60 days post hospitalization
    • Completely cashless hospitalization
    • Tax benefits up to Rs.60,000 on the insurance paid, depending on the health insurance bought and the age brackets of the insured persons, if the amount of premium is paid by credit/debit card or cheque
    • There is also a provision for an extended cover – specialized policies for diabetics, heart patients, maternity, senior citizens, parents in-law, grandparents and children, and even treatment undertaken internationally

    Choosing the Best Health Insurance is not Guesswork
    Comparing policies online helps you to ascertain the most appropriate health insurance policy, while saving you money. The fact is, even if you decide to negate it, that health plans are the most effective way to protect yourself and your family from the rising medical costs and are usually unforeseen. Failure to have a comprehensive health insurance cover can prove to be a major disaster, especially for the personal and family finances. Ill health could further escalate from lack of proper medical attention owing to limited finances or lead to financial duress from having to dig into savings and or taking on high interest personal loans.

    Putting all these factors into perspective, the whole idea of a comprehensive health insurance seems extremely relevant. As a consumer today the good news is that you have several great options from a number of top brands such as MaxBupa, Bharti-AXA, Tata AIG, Apollo Munich, Star Health, ICICI Lombard, and several others. We help you compare and make an informed decision about the brand and which health insurance plan you should buy.

    The Various Types of Health Insurance
    The three major health insurance policies are as follows:
    • Medi-claim for an Individual
      This is also referred to as the Individual Mediclaim Policy and covers only the insured individual for hospitalization expenses up to a certain assured sum. The annual premium would be proportionate to the assured sum.
    • Family Floater Policy
      The next or enhanced version of the individual policy – the sum assured can be ‘floated’ among the members covered under the policy. This means that a single member, in the event of a medical exigency, may use the entire sum assured. For example if the total cover is for Rs.9 Lakhs and a sum of Rs.7 Lakhs is used for the medical treatment of one individual, the renewal of the policy will bring the sum assured back to Rs.9 Lakhs. This type of policy makes sense since each member is covered by a large sum.
    • Unit Linked Health Plan (ULHP)
      This has been recently introduced by insurance companies and combines investment with health insurance cover. A certain amount is refunded to the insured post the completion of the term of insurance – depending on the prevailing market conditions. This ‘product’ is still under development and is recommended for those who understand related products such as unit linked insurance plans (ULIPs) and unit linked pension plans (ULPPs)

    It must be understood that while health insurance is an expense, it serves as a cover and ‘blanket’ at difficult times of health duress. Under medical insurance, the insured does not receive a refund on the premium at the end of the term if there has been no claim, as with a Life Insurance policy, hence choosing the most appropriate and adequate health cover is necessary and must not be guesswork.

    List of the top 10 Health Insurance Companies in India
    • Apollo Munich Health Insurance
      The company is on the fast track – had an exceptional record of about 63.03% of Incurred Claim Ratio for the year 2014-15 (this shows the ability of a company to make payments towards claims). To top this, the company has added benefits such as lifelong renewability and portability options.
    • Star Health & Allied Insurance Company Limited
      The Incurred Claim Ratio in 2014-15 for this company was 63.96%. Their range of products include offerings for protection to people with HIV and Diabetes
    • Max Bupa Health Insurance Company Limited
      Amongst the best known insurance companies in the country, it has an Incurred Claim Ratio of 55.16% for the year 2014-15, and offers health insurance to all age groups of individuals
    • ICICI Lombard General Insurance Company Limited
      Possibly amongst the highest Incurred Claim Ratio in the year 2014-15 – 87.38%! Their top product offers comprehensive and complete coverage of all expenses that could be incurred during a medical exigency. These expenses include dental, cost of hospitalization, room rent, and ambulance charges up to a certain limit.
    • Religare Health Insurance Company Limited
      The company’s fast track growth in a very short span has been a benchmark of sorts for other insurance companies. With an Incurred Claim Ratio of 61.13%, the company is highly recommended especially by the Fortis Hospitals.
    • Cigna TTK Health Insurance Company Limited
      Despite a recent launch – in the year 2014 – this company has moved ahead with leaps and bounds, and got itself a place in the top ten players in the health insurance business. In its year of incorporation, its Incurred Claim Ratio was 64.32%
    • Bajaj Allianz General Insurance Company Limited
      This was the first company to provide captive TPA (third party administrators) services with add on benefits, and its Incurred Claim Ratio was a well-managed 73.59% for the year 2014-15. Their health products have proven to be highly beneficial for individuals of a certain age group – these products are Silver Health, Star Package, and Health Guard
    • New India Assurance Company Limited
      This company had an Incurred Claim Ratio of 98.78% in the year 2014-15. It is a fully government owned entity and has been in operation since 1919. It has been receiving huge acclaim for its medi-claim policy owing to the feature of providing different ratings for major metropolitans.
    • Oriental Insurance Company Limited
      Another fully government owned general insurance company, but with a comprehensive range of health insurance products. There is no requirement for a pre-policy medical test for individuals up to the age of 60 years – in direct contrast to all other insurance companies where a pre-policy medical test is mandatory even for persons below 45 years of age. Its Incurred Claim Ratio was 117.02% for 2014-15
    • National Insurance Company Limited
      This too is owned fully by the government, and has been in service for over 100 years, providing comprehensive health coverage. Its best product is coverage to senior citizens under the name of Varishtha Mediclaim. Its Incurred Claim Ratio for 2014-15 was 110.02%.

    Connect with us for more information and we will be happy to help you choose the best in health insurance for your family.

    #The Most Ideal Health Insurance Policy
    We have discussed previously that cost of medi-claim insurance depends on a number of factors – namely, sum assured, age of the insured, their current health, and any medical history. A higher sum insured would mean a higher premium to be paid. Given the factors it is safe to say that there really is no ‘most ideal health insurance policy’ – it must be customized to fit the needs and budget of the persons insured.

    It is advisable and prudent to read the medi-claim policies carefully, and not be drawn in by seemingly attractive ‘benefits’ such as ambulance charges, other hospitalization charges, and daily allowance. The premium amount is usually spiked to include these – so you would be paying for something that insurance companies would want you to believe is a benefit.

    Different Types of Health Insurance
    1. Employer provided health insurance
      Many companies today offer health insurance as a benefit and a means to attract employees. These policies usually cover hospitalization of the employee, spouse, children, and dependent parents. If however, you feel that the cover will not suffice, it would be advisable to take an additional plan by paying for it yourself. The fact is that insurance cover must always be adequate, and additionally, if you do change your job, the insurance cover from that particular employer would cease to be paid for by them. Some companies allow the employee to carry the insurance with them. However, it then becomes a personal policy, which the ex-employee must pay for personally. Even while employed with a particular company that offers health insurance, it is advisable to check on coverage and exclusions – the fact is that companies use insurance as an incentive, and the coverage may not suffice and or there could be some critical exclusions.
    2. Health Insurance to cover the Elderly
      For a long time, insurance companies were reluctant to extend medi-claim cover to the elderly. However, today senior citizens even above the age of 65 years can be covered, and depending on the policy and insurance company, the insurer can gain up to Rs.60000 as tax benefits. Of course, the premium payable for a policy covering the elderly is a lot higher. For those in employment, we recommend speaking with your company to ensure that the health insurance provided is extended to cover elderly parents and parents-in-law. Insurance companies are usually happy to extend such cover since they would receive a higher premium in bulk.

    Tax Benefits
    The Income Tax Act – Section 80D provides exemption / relief of tax up to a certain amount, depending upon the insurance cover. Please see the image below to gain an idea before checking with your insurance company. Of course, these slabs are subject to change depending on any new guidelines issued by the government.

    Health Insurance Policy Premium & Section 80D Tax benefits for AY 2017-18
    Scenarios
    Health Insurance premium paid for & Maximum tax deduction limits
    Self, Spouse & Dependent Children Parents (whether dependent or not)
    Total Deduction under section 80D
    No one in your family has attained 60 years of age upto Rs 25,000 upto Rs 25,000 Rs 50,000
    The eldest memeber in Your family (yourself, spouse and dependent children) is less than 60 years & Your parents (either mother of father) are above 60 years of age upto Rs 25,000 upto Rs 30,000 Rs 55,000
    The eldest memeber in Your family (yourself, spouse and dependent children) has attained 60 years & Your parents (either mother of father) are above 60 years of age upto Rs 30,000 upto Rs 30,000 Rs 60,000

    Buying the Most Ideal Health Insurance
    When you visit an online site, you will discover that it is a lot easier to buy health insurance
    • Click open the site for comparing plans from a number of insurance companies, such that you can make an informed decision
    • These comparisons make it easy to buy, minus the heaps of paperwork required
    • You would need to enter some basic details, depending on your needs and preference from a health policy
    • Based on your requirements, choose the most appropriate insurance plan – a matter of minutes to insure yourself
    • You would need to complete a short proposal form, which records some basic personal information about the insured – for future reference
    • You would need to upload the documents required and make payment towards the chosen plan, and you and your family (if so) would be covered under the health insurance plan
    • In addition, health insurance buyers that live in Tier 1 cities (or Tier 2, 3 cities) should keep in mind the varying rates of hospitalisation expenses at these locations relative to their purchasing power. This should enable them to plan their expenses in case of hospitalisation or other health emergencies. Certain health care providers offer differential rates for insurance buyers that reside in Tier 2 and Tier 3 cities. Insurance websites that compare the various rates can help insurance buyers gain an adequate picture of different rates.
    • Discretion can be exercised in the matter of buying a personal insurance policy or a family floater health insurance plan. The family floater plan covers all members of a family under a single insurance policy. Family floater health insurance plans cover the primary insured (such as spouse and children) that are dependent on the policyholder. Certain insurance providers do have a provision to cover extended family as well. We note that the family floater is a useful investment because any member of the (insured) family can utilise the full extent of insurance coverage as required. Family floater plans also entail fewer administrative procedures, lower premium rates, and bestow peace of mind on policy buyers.
    • Further, insurance buyers that operate personal modes of transportation must be strongly advised to opt for a personal accident coverage policy. These policies insure buyers in case of permanent disability and other health problems that follow an accident. Certain insurance providers offer a daily benefit (or hospital allowance) in case policy buyers are unable to attend work or fulfil their professional duties for a certain span of time in the aftermath of an accident. At the same time, some personal accident coverage policies can be designed to cover temporary disablement.
    • Certain details of a health insurance policy pertain to personal choices, such as single or shared accommodation in a hospital or healthcare facility, the use of premium level healthcare services, etc. These choices should be carefully considered by insurance buyers because the choices directly impact patients’ accommodation facilities in a hospital. Certain health insurance providers enable buyers to request upgrades to their insurance plans in line with personal choice and new options that may be available to the insured.
    • In addition, current levels of annual income should be considered before buying health insurance coverage. The thumb rule in general insurance indicates that such coverage should ideally be twice an individual’s total annual income. Insurance buyers can also consult online sources and Internet aggregators to compute the ideal levels of life cover to be taken by taking into account annual income, the number of dependents, and outstanding liabilities. Certain industry sources in health insurance indicate the total sum assured should be 6-7 times the total annual income of the insured person. That said, the total requirement of health insurance coverage can be lowered in cases when the insured owns substantial assets and investments.
    • Industry experts recommend that people that earn less than 10 Lakhs INR per annum, should buy coverage that is worth one and half times their particular income figure. This figure is subject to change when factors such as human life value, medical histories, needs analysis, the number of dependents, and income replacement methods are entered into the calculation. In addition, a higher amount of health coverage is recommended because hospitalisation costs, the costs of surgeries, cost of equipment rentals tend to rise with time. Therefore, a larger coverage helps the insured to gain the full benefits of an insurance policy at all times.

    Difference between Health Insurance and a Medi-claim Policy
    Most people use both terms interchangeably. However, this is not correct.

    HEALTH INSURANCE MEDI-CLAIM POLICY
    Offers comprehensive cover, managing pre and post hospitalization expenses Covers hospitalization expenses for pre-specified illnesses, for a specified duration, depending on the amount of sum insured
    Coverage for ambulance charges, compensation for any lost income, etc. depending on the riders and clauses associated with the policy Maximum limit for all claims is fixed at a particular sum based on the principle of indemnity - a 24-hour period of hospitalization is required
    Offer pre-existing disease cover, surgery and critical illness coverage, individual health insurance plans, senior citizens health plans, and preventive healthcare services. Those insured pay the expenses of hospitalization directly to the hospital, and Those insured pay the expenses of hospitalization directly to the hospital, and
    Provide cashless treatment, pre and post hospitalisation charges, ambulance charges, tax benefits, and no claim bonus options Offer cashless hospital treatment only in cases where a certain hospital operates within the network. Proper paperwork required to gain approval of a definite sum for hospital treatment
    The upper limit for claims is higher and offers some regular discounts over a fixed period. The tax benefits are also higher Reimbursements are activated when documents such as payment receipts, bills of medicine, original discharge cards, closing bills, and expense receipts are furnished to the service provider

    Documents Required for Medical Insurance Policy
    Anyone buying a health insurance online would be required to furnish a few documents to the insurance company.

    • Age proof - Any one of Birth Certificate, 10th or 12th mark sheet, Driving License, Passport, Voter ID, etc
    • Identity proof - Driving License, Passport, Voter ID, PAN Card, Aadhar Card, or any document which proves citizenship
    • Address proof - Electricity Bill, Telephone Bill, Ration Card, Driving License, Passport, should clearly mention the permanent address.

    In addition, some plans require:
    • A medical check-up, usually for people above the age of 45 years in order to make sure they do not suffer from any chronic illness
    • Passport Size Photo for a record of the insured person`s identity for future reference

    The fact is that every person today must have health insurance, based on the need and ability to pay yearly premium. By ‘covering’ oneself with medical insurance, you can save yourself from the financial burden, which unexpected illness and hospitalization brings, especially today as medical expenses have skyrocketed in an unprecedented manner. Without health insurance, the finances of the family can be severely affected – sometimes leading to heavy debt or even bankruptcy.

    Each one of us today is exposed to a variety of health hazards given the drastic negative changes in the environment. Medical emergencies can strike anytime, and with new technology, procedures, and developments in the health area, medical treatment has become exorbitant. Buying a good and comprehensive health insurance policy, at the right time can alleviate many of the financial problems and stress, when illness strikes.

    Are you covered or still exposed to some serious consequences?

    Questions you should ask before buying health insurance
    Ideally, health insurance should kick in and work for you when you or a family member falls sick or diagnosed with a serious condition or otherwise requires medical or surgical intervention. The aim should be adequate coverage that takes care of expenses that you will inevitably incur in the process; however, there is no point in paying higher premiums than you need to. How can you be an informed health insurance buyer? What are the important questions to ask (yourself and your insurance provider) before buying health insurance?

    1. Should you use an agent or buy directly? In the past, it was most common to buy insurance via insurance agents. While an insurance agent can explain what you need to know in detail, take care of the paperwork, and ease the process, this is no longer necessary. With easy access to online insurance purchase, availability of insurance comparison websites and all required information readily available, you can buy your own insurance, pay your premium online and in many cases you can even print out your policy in a moment.
    2. Now or later? If you are, a young, fit and generally healthy person you would think that buying health insurance is not a priority for you; that this is something that can wait. However, you must keep in mind that the younger and healthier you are the lower premiums you pay (because you represent a lower risk). Also, keep in mind that illness, disease or a health condition can strike at any time and at any age. While genetics and family history could be a crucial factor (many people are predisposed to cancer or more at risk of heart disease for instance), there are many things simply beyond our control as well.
    3. Some questions about the company – How long has the insurance provider been in the business? Does it have a proven record of accomplishment in the market and does it receive favorable reviews for claims settlements, promptness and so on? Be sure to check out the company’s claim settlement ratio. This information is available with the IRDA website or on insurance comparison websites. Is it a health insurance specialist or does it offer other types of insurance as well?
    4. What type of policy do you need? Your marital status, whether or not you have kids and /or dependent parents are some factors that will decide the sort of policy you buy. Looking at the top rated (ratings as provided by IRDA for financial year 2016-17) health insurance provider websites, you can see a variety of options available: Apollo Munich Health Insurance Company Limited, Star Health & Allied Insurance Company, Max Bupa Health Insurance Company, ICICI Lombard Health Insurance and Religare Health Insurance Company. If your employer offers a health care package, what does that include and given this, do you even need additional health insurance? For instance, military personnel may have access to comprehensive health care facilities but still choose to buy health insurance for several reasons: critical care cover, more modern medical facilities and tax benefits.
    5. How long is the policy renewable? Medical expenses tend to mount during one’s twilight years and are the time when health insurance cover could prove to be most critical. However, many policies may not be renewable beyond a certain age – it could be 80 years in many cases, for critical illnesses, such as cancer this could be 70 years, after which, the policy cannot be renewed.
    6. Hospital network – Each insurance company has a tie-up with a network of hospital and diagnostic centers, so you can usually avail cashless services from these. The rule of thumb would be; the bigger the network, the easier it is to avail services and the better it is for you. If you typically use the services or a particular hospital, check to see whether that hospital is on the network list.
    7. What about emergencies? There could be cases when an emergency means having to go to a hospital that is not on the insurance provider’s list. There could also be some cases when a claim has to be made for domiciliary medical expenses (when it was not possible or advisable to be admitted to a hospital). What is the procedure in such cases? Does this affect the claims process or the insurance payout? Do you need to inform the insurance provider? If so, when and how do you need to do this?
    8. Pan-India /international coverage - Check the network list to see whether facilities are available where you are and whether the network extends all over India (particularly important if you travel a lot). If you frequently travel abroad, you would typically need travel insurance; however, in some policies some limited healthcare expenses incurred abroad, may be covered.
    9. What is the policy limit and inclusions? Health insurance takes care of hospitalization expenses, surgical expenses, medications and diagnostic test expenses subject to a maximum amount (which also decides the amount of premium). However, there could be exceptions. Find out what these exceptions are. Also find out about the percentage of expense that you as the insured person has to undergo (usually 10% but could be more or less depending upon the service provider and policy type) and whether there is a limit to the number of claims you can make in one year.
    10. What is the waiting period and what are the policy exclusions? Usually preexisting conditions are not covered by health insurance unless expressly opted for. There are also certain conditions in respect of which you cannot make claims within the first one or two years of buying insurance. These can differ significantly from one to another insurance company.

      Generally speaking, the waiting period for general health insurance claims is 30 days, except in the case of treatment arising out of covered accidents. There is also the waiting period of 90 days in the case of new born babies or infants. Maternity benefits require a wait period of anywhere between 9 and 36 months before a claim can be made. Particular ailments (hernias, ENT problems, osteoporosis or as would be listed in the policy) require a waiting period of between one and two years. Certain pre-existing conditions may

      mandate a waiting period of up to four years before claims can be made in relation to them. In fact the policy may only be issued subject to such waiting periods, so be very clear about the preconditions of any policy that you buy.
    11. What documents are required?

      Ensure that you understand fully the procedure for buying insurance as well as making a claim. In some cases, one may have to undergo certain medical tests before buying insurance.

      Documents required while buying the Health Plan:

      For young, healthy applicants, no documents are required when buying insurance.

      For older applicants, those with pre-existing conditions and those applying for critical care cover would typically have to undergo certain medical or diagnostic tests as prescribed by the particular health insurance provider.

      However, depending on the conditions of the insurance company and the TPA, you could need to provide documents such as an ID proof at the time of submitting a claim.

      Making a Cashless Claim:

      When a claim is made under a cashless policy, the documentation is usually forwarded by the hospital directly to the insurance company. The policyholder has little to do except to ensure that all the hospital paper work is in order and dates, procedures, and figures mentioned are accurate prior to checking out from the hospital.

      Documents required while Cashless claim:

      The most obvious aspect to remember is that the treatment should have been undertaken in a network / empanelled hospital.

      Cashless claim in case of planned treatment:

      1. The insurance company must receive intimation (at least 4 days ahead of treatment) in order to avail cashless hospitalization, in the case of a planned treatment
      2. A cashless claim request form must be submitted with all the relevant details neatly and accurately filled out
      3. Once the insurance company / TPA receives this form, they would be able to provide details of eligibility to the hospital and the insured
      4. The health insurance card and confirmation letter must be carried along on the day of hospitalization
      5. Bills from the hospital will be settled directly by the hospital with the insurer or TPA

      Cashless claim in case of emergency treatment:

      1. The insured must carry the insurance card to the hospital in order to gain cashless treatment in the event of an emergency
      2. The hospital would complete the forms required and submit to the insurer or TPA, from who they would receive the approval
      3. On approval, the insurance company / TPA will pay the hospital directly
      4. In the event of a rejection, the insurance company or the TPA will provide reasons to the insured

      Making a Reimbursement Claim:

      For reimbursement claims, the Claims Acknowledgment Number (generated by the insurer when a claimant walks into a hospital and informs the insurance company about the start of treatment) is important to have. Policy holders should make it a point to ask their insurance company to provide this number at the start of the treatment.

      For reimbursement claims, the policy holder has to provide all relevant documents such as diagnostic reports, bills for medications, surgery details, discharge summary, doctor’s prescriptions and so on. Typically the policy holder would be required to fill out an electronic clearance service (ECS) form and also provide a cancelled cheque so that the insurance company can transfer the claim amount to the bank account of the policy holder.

      Usually the purchase and claims processes are a bit more detailed and cumbersome with nationalized companies and more user-friendly with private insurance providers.

      Documents required while Reimbursement claim:

      1. Complete and accurate claim form
      2. Signed form or Medical Certificate from the treating doctor
      3. Original discharge summary
      4. Original bills and receipts of expenses
      5. Original prescriptions and cash memos of medicines
      6. Investigation report
      7. In case of an accident, the original FIR or the MLC (Medico Legal Certificate) is necessary
    12. What is the procedure followed in case of a dispute? If there is a dispute with regard to a claim, what is the procedure? What is the jurisdiction that governs the dispute? The terms of the policy may say that ‘disputes are subject to X jurisdiction’ and this could have bearing later.

    The new GST rate of 18% is now applicable for all financial services effective July 1, 2017.

    By asking all the questions now, before buying a policy, you are saving yourself guesswork and aggravation when you really need all the benefits.
    #Measures to find the best health cover online
    Insurance is a subject that most of us find confusing and difficult to understand. As an informed consumer, it is your duty to yourself and to your family to find and buy the kind of health insurance that offers the best protection and also the best value for money. Thankfully, help is at hand.

    We now have the tools to help us compare and contrast policy features, read user reviews and make suitable, cost effective and informed choices. We look at how to go about comparing health insurance options and ways in which you can find the best health policies for your requirements.

    How to compare health insurance policies
    Many types of health insurance are offered in India – group or employee insurance schemes individual and family plans, critical illness plans, senior citizen plans, maternity health insurance, personal accident insurance and preventive health insurance plans. Deciding on the type of plan you need is a good place to start. Consider your family size, age, overall health and budget to narrow things down.

    You can also narrow down your options based on the service provider or company you wish you use. Prior experiences, recommendations of people around as well as the company’s reputation in the market, are good indicators. Some of the top insurance providers in India in terms of quality of service and reliability are HDFC Ergo Health Insurance, ICICI Lombard Health Insurance, Apollo Munich Health Insurance, Cigna TTK Health Insurance, Bharti AXA Health Insurance, Bajaj Allianz Health Insurance, Future Generali Health Insurance and Cholamandalam MS Health Insurance. These are established companies that have been around for a significant length of time and have been rooted in the health insurance field for long enough to offer quality service and support.

    You should examine some important policy features and parameters such as:

    • Check coverage vis-à-vis premium charged. Opt for policy cover that is adequate to cover for unforeseen illness, hospitalization, surgery costs. Pick a policy based on the number of people in the family, their age and health; however pick one that doesn’t charge exorbitant premiums. Ideally there should be a balance between the premium charged and the amount assured. Very high premiums may be unaffordable. On the other hand very low premiums could mean more exclusions and a lot of fine print that could cost you more when it is time to make a claim.
    • Waiting period – health policies do not permit certain claims to be made within specified periods after policy initiation. After the specified waiting period (usually between 2 and 4 years), policies will consider claims made for conditions such as hypertension, diabetes, heart disease, cancer etc.
    • Renewability – Many health care policies have an age limit after which the insurer may not renew them. Since it is during old age that one is most likely to fall ill, or develop a problem requiring hospital treatment, ensure that the policy is renewable even in your old age. Some insurance companies offer guaranteed lifelong renewal while some cease to offer protection after the age of 80.
    • Network of hospitals and diagnostic centers for cashless services – Look at not just the number but the quality and reputation of these hospitals and diagnostic centers to make a fair assessment
    • Check which policy offers the best no-claims bonus for subsequent years of policy purchase. Many companies offer an increase in the total assured amount for subsequent years when there was no claim made during the current year. For instance, if the total sum assured was Rs 3 Lakhs in the years 2016-17 and no insurance claim was made during that term, the policy holder would automatically receive increased coverage for the years 2017-18. Reputed companies may offer a 10% increase, which is significant since it can boost your sum insured upto 150%-200% (depends on Insurer to Insurer offerings).
    • There may be other features such as free yearly medical checkups, inclusion of ambulance fees and other incentives that could make one health policy more attractive than the other.
    • Health insurance portability is another factor to examine. This permits the insurance buyer to move from one insurance provider to another without losing continuity advantages. Ensure that the policy you want doesn’t have any fine print relating to a minimum lock in period, a similar limiting feature or a list of preconditions for portability.
    • Find out about caps and sub-limits (there could be a maximum room rent cap or sub-limits set for various medical procedures) and features that enable or prohibit co-payment (by employers, relatives and so on). It is best to opt for policies that not have such caps, sub-limits or prohibitions.
    • Read up about emergency provisions, domiciliary expenses or day care procedures. What if you need to be admitted to a non-network hospital in an emergency? What if you cannot be transferred or have been advised against being transferred to a hospital? What about procedures and treatments that could be quite expensive but which do not require a hospital stay of 24 hours or more?
    • The company’s claim settlement record (settlement ratio) is another feature to examine. How fast are claims settled on average? How positive is the experience the insured person had with the insurance company when making a claim? Were claims wrongly withheld or needlessly delayed?

    Personal parameters that will help you decide
    Doing your own research will also help narrow down your choices and help you opt for the right health insurance policy:

    Speak to your family physician – This is a person you trust and also someone who knows your family’s health history. A physician is also likely to have had a good amount of experience with insurance companies and types of policies. Speaking to your physician about the type of health insurance your family needs, the companies that offer the best and most comprehensive care and asking for their recommendations is a good place to start.

    Ask around, read reviews – Ask family and friends about their experiences with companies in general and policies and plans in particular. You well wishers are bound to offer sage advice. Well informed colleagues are also a good source of accurate information. Make sure that you also read online reviews about the company and their products. The official Facebook or Twitter page of the company would likely have comments, complaints and opinions; you will find those helpful in making up your mind. Also check online consumer forums to see which companies have the most number of health insurance complaints pending and unresolved against their name.

    Make a personal assessment –
    Are you in good overall health? Do you or someone in your family have illnesses such as diabetes, obesity, hypertension, and so on? Do you have a family history of cancer, heart disease or stroke? Go over your accounts and check how much you have spent on health care over the past few years and check if there is an uptick in costs or any particular ailment that appears to have cost more and put a drain on family resources.

    Conduct research and due diligence – ensure that you make the best choice for you and your family’s health so that when unforeseen problems do occur, you are fully prepared!

    #What expenses do best health insurance plans cover?
    Health insurance is a developing field in India. More players are entering into the market and competition between insurance providers ensures that customers are able to get the sort of coverage they need along with good quality service. New products are constantly being offered and existing plans being refined and improved. Specialized health policies could cater specifically to older people, people with certain medical conditions or to mothers to be (as in the case of maternity insurance plans).

    For the purposes the average Indian householder looking to protect his family from unexpected illness and hospitalization, let us take a look at a general health insurance policy most commonly purchased for the family. While various health insurance policies do have different features, inclusions and exclusions, the expenses that such a policy should take care of and the features you as a policy buyer should look out for are these:

    Pre and post hospitalization expenses – Usually we do not rush to be admitted to a hospital the minute we fall ill. We consult a doctor, undergo certain diagnostic investigations and tests and then if required and advised by a medical expert, hospitalization would follow. Such expenses incurred within 30 days before hospitalization are covered by a health insurance policy. There is also treatment that can extend beyond one's discharge from hospital: follow up consultations, continuing medications, and tests or checkups to ensure that recovery is proceeding as expected would be needed for several weeks following hospital stays. Health insurance policies also cover such expenses that may be incurred up to 60 days after hospital discharge. Usually these expenses are reimbursed to the policy holder (these transactions are typically not cashless) after the settlement of hospital claims.

    Room rent – The daily expense of simply occupying a hospital room – the boarding, lodging, nurse or attendants services – is covered under health insurance. Some policies have a cap on the maximum amount assured per day towards the room rent. Ideally you may look for a policy that does not have such a cap so that you can get the best type of room. You don’t want to have to compromise here simply because your health policy has a room rent cap.

    When illness strikes you want to have the assurance that the required level of treatment is available. At such times, the comfort and privacy accorded by a private or at least semi-private room, a room that permits a family member to stay on at night, and one that has other in-room facilities such as TV, sofa etc, can be very valuable. Typically room rent expenses are defrayed on a cashless basis as far as they relate to a hospital that is on the insurance provider's tie-up or network list and within limit of the total amount assured.

    Other hospital expenses – Hospital stays usually have many other expenses: consultations with specialists or super-specialists, Operation Theater and other surgery expenses, the expenses of an anesthetist, blood or oxygen requirements, medicines, drugs, diagnostic procedures, x-ray etc. These are also covered by your health insurance policy and will be paid on cashless basis directly by the insurance company to the hospital. A hospital not on the company network will require the policy holder to pay first and receive reimbursement later.

    Generally speaking, expenses for procedures such as artificial limbs, pacemaker, dialysis, radiotherapy would also be covered subject to these being within the maximum amount assured under the policy. So if these expenses go over the total amount assured, the policy holder is liable to pay for these of his own account. Some policies have no sub-limits on hospital expenses, specific diseases and doctor fees while some may.

    Free checkups – Many health insurance policies now have attractive free incentives built into the terms and conditions. These usually consist of certain free services to each individual covered under the policy: lipid profile, blood sugar, blood pressure, urine tests, hemoglobin, body weight and overall health are some parameters examined usually. This gives the insured person an idea about lifestyle changes, if any; that need to be made to get healthier so that illness and disease can be avoided. Regular checkups are also a good idea because they help detect medical conditions while they are still easily treatable and before they become difficult to manage. Again these incentives would vary from service provider to service provider. Some offer these annually; others every two or three years. So if regular checkups are something that is important to you, be sure to pick a policy that offers you this peace of mind.

    Day care procedures – Usually hospital stays are a prerequisite for making a health insurance claim. However, there are certain day care procedures that do not require an overnight stay in hospital, such as cataract, certain keyhole or laparoscopic treatments, dialysis, angiography, radiotherapy, tonsillectomy and so on. In some cases, the policy will state expressly whether day care procedures are excluded; in the alternative the policy or will list day care procedures that are included and that the policy holder can claim. If such day care procedures are planned in advance and in consultation with the insurance company, it may be possible to arrange for cashless services here as well.

    Domiciliary treatments – There are several scenarios in which hospitalization is not advisable or not possible. It could be difficult to move the patient out of their home at into a hospital because of health or logistical reasons. Unavailability of hospital beds could be another reason why in-home treatments are sometimes required. The medical expenses incurred for such domiciliary (at-home) expenses under the supervision of a medical practitioner are also covered by health insurance, unless expressly excluded by the policy. However, these are generally subject to terms and conditions: that under other circumstance, hospitalization would have been required and there are specific reasons why this was not possible. Conditions such as asthma, diarrhea, psychiatric disorders, gout, rheumatism, respiratory infections, and conditions arising from diabetes are usually not considered for reimbursement by insurance companies.

    Dental treatments – Since there are few good standalone dental care policies available in India, some dental treatments are usually covered under comprehensive health insurance policies. There are many variations however. Some plans will pay for dental if treatment was required because of an accident (as in the case of travel health insurance), while some will pay only if hospitalization was required. Some preventive health care policies cover routine checkups and dental consultations. Certain critical illness and surgery policies also cover and pay for specified dental procedures.

    Expenses that general policies may not cover
    • Usually, health insurance concerns itself with Allopathic medicine and does not pay for alternative treatments such as naturopathy and so on.
    • Emergency or other medical expenses incurred when abroad are also not covered by your health insurance policy unless you are a frequent traveler and have bought a policy that specifically covers such cases.
    • Maternity expenses are not covered though separate maternity policies can be purchased.
    • Outpatient treatments and second opinion consultations are also usually excluded.
    • First year vaccinations for an infant and new born cover in general are not paid for by the insurance company
    • The family policy may be subject to a certain maximum number of children – 2 to 4 usually and may not apply to larger family sizes.

    It is most important to read policy terms and conditions before buying health insurance. You should also factor in your set of circumstances and personal requirements as well as your lifestyle to ensure maximum benefit from the health insurance that you buy.

    What health plans don’t cover
    To pick a health insurance plan that suits your requirements, it is important to understand what conditions and expenses are covered under the policy that you buy. While knowing about the inclusions is important, knowing about the exclusions – what a health plan will not cover or reimburse you for – is probably even more important. You may assume that certain conditions may be covered when in fact they may not be; in such cases you could get a very nasty shock when disaster, in the form of an uncovered illness or condition strikes!

    Exclusions are specifically set out in the terms and conditions of the policy which every person should read thoroughly prior to buying health insurance. General health insurance policies typically do not cover conditions for which there are separate policies issued. For instance, critical illnesses and maternity expenses are not covered by general health insurance policies; however you can buy separate policies for this.

    Some of the major exclusions of a health insurance plan are:
    • Critical illnesses such as cancers or malignant tumors, coronary disease are excluded from general health insurance policies. Cover for critical illness can be purchased separately or as an add-on to a general health policy. Many service providers offer optional add-ons such as hospital day cash, convalescence benefits, critical illness cover and donor expenses that can added to a general policy
    • All health insurance policies have a waiting period for specified treatments and illnesses. If claims are made within that waiting period (anywhere between one and four years depending upon the type of illness) the insurance company will not pay for this
    • Alternative or complementary treatments such as magnetic therapy, acupuncture or acupressure, reflexology, naturopathy, homeopathy and ayurveda are usually excluded. Health plans typically cover and pay only for allopathic treatments
    • Pregnancy and childbirth related expenses and hospital stays, neonatal care; infant vaccines are not covered under a general health insurance policy. Even a maternal plan will usually have a waiting period of between one and two years before benefits will accrue
    • No health policy will pay for treatment arising from criminal acts; either directly or indirectly
    • If the insured person chooses to undergo any experimental treatments or procedures that are unproven and not offered mainstream practitioners, the insurance company will refuse to pay for these
    • When an illness occurs or hospitalization is needed while the insured person is outside India, the medical insurance provider will not pay for the expenses incurred towards this.

      However, if you're planning a trip abroad or are a person who travels frequently on business you can always opt for travel insurance cover for such unforeseen expenses
    • Eyeglasses, prescription lenses, or contact lenses, hearing aids, treatments to correct refractive errors or hearing impairments will not be covered under your health insurance policy
    • Usually health insurance policies do not cover at-home hospitalization or domiciliary treatment expenses, unless these are expressly included in the terms of the policy and it is possible to prove that there were genuine reasons why hospitalization was either not possible or unadvisable
    • Cosmetic surgery or plastic surgery procedures are not paid for by medical insurance. Cosmetic procedures are those that have no medical requirement; which people opt for; for purely aesthetic reasons. The most common cosmetic procedures are augmentations, reductions, lift procedures, Rhino-plasty (nose reshaping), liposuction, tightening procedures and so on. However, health insurance companies do pay for some types of cosmetic surgery, mostly of the reconstructive type or that which may be needed to prevent disfiguring; if such requirement is the result of injury, accident or as a result of a covered disease
    • Dental treatments are not covered under health plans unless they result from an accident; for instance if one loses or breaks their teeth in a road accident. Some policies will pay for dental treatments if they require hospital stays
    • Sexually transmitted diseases, HIV, AIDS, venereal disease are not covered. Sexual dysfunction, sterility or impotence and assisted reproduction will also not be covered or reimbursed under a general health insurance policy
    • Sex change procedures or procedures such as circumcisions will not be paid for by health insurance companies
    • Health policies will also not pay for hospitalizations that are mainly for diagnostic or investigative (not treatment related) purposes
    • If treatment is required from self-inflicted harm, such as because of a suicide attempt, resulting from substance abuse (drugs, alcohol, banned substances, deliberate overdose of medication etc) the insurance company will not pay for it
    • Injuries or procedures arising out of war or civil war are not covered
    • Injuries occurring from engaging in hazardous sports is also not covered. If you are into activities such as surfing, dirt bike racing, mountain climbing, bungee jumping etc, you may want to pay particular attention. While add-on adventure sports cover is offered along with some personal accident plans, very few insurers actually offer this coverage in India. However, even when this cover is offered, it is the duty of the policy holder to ensure all requisite safeguards are in place and that the activities are professionally supervised. Insurance it is only in respect of leisure pursuits; not for professionals
    • If there are claims that arise out of preexisting conditions that the policyholder intentionally concealed from the insurance provider, the insurance company may not pay. If the policy holder withholds or misrepresents certain pertinent information from the insurance provider and there is some evidence of fraud, the insurance company may decline to settle a claim or part of a claim made by such a policy holder
    • Common psychiatric illnesses are outside the purview of most Indian health insurance policies. Mental illnesses such as schizophrenia, bipolar disorder, depression, acute psychotic disorder and obsessive compulsive disorder and problems arising out of these are not covered
    • Some service providers provide incentives in the form of certain value added services – online consultation with nutritionists, periodical free health check-ups, e-consultations with specialists or online chats with medical practitioners and so on. These are not standard inclusions and will typically vary significantly from one to another insurance provider

    It is advisable to check the terms and conditions of the health insurance policy you're considering buying, do your own due diligence and only then make your purchase.
    #Health Insurance eligibility criteria
    Buying health insurance is a prudent investment for a householder who wishes to protect against the resource drain that a medical emergency or an illness would inevitably cause for the family. Health insurance obviates the difficulties of raising large sums of cash quickly or the necessity of liquidating savings when medical expenses crop up.

    Currently insurance penetration is not very high in India (less than 15% according to some estimates), hence the number of people opting for health insurance in particular is only set to rise. With medical inflation rising at the rate of nearly 20%, more and more people are seeing the wisdom of buying health insurance. Clearly, buying health insurance is advisable and prudent; but the question remains: who can buy health insurance in India? We look at eligibility criteria for buying health insurance in India.

    Age criteria
    In theory anyone in India, who is above the age of 18 can buy health insurance. Experts advise insurance buyers to get health cover early in life to protect their family. The fact is that illness and medical problems can occur at any time in life and they strike without warning. Even healthy people could contract illness; even children could develop serious conditions requiring expensive treatments. Secondly, the younger the age of the health insurance policy purchaser, the lower are the premiums.

    The ability of any Indian citizen to buy health insurance is subject to certain terms and conditions that individual health insurance providers may impose. While some health insurance products guarantee lifetime renewals, some cease to offer insurance after a certain age; which is at 80 years or in some cases at lower ages. The health insurance of the elderly also carries a co-payment clause which requires the policy holder to pay some percentage (anywhere between 10% and 40% based on perceived risk) of the medical expenses incurred for dependent seniors. Higher co-payment percentages mean lower annual premiums but bigger payments when claims are made.

    The other question that needs answering is, can senior citizens buy health insurance if they have not done so before? Can persons around the age of 60 years buy health insurance and are insurance companies bound to sell them health policies? What is the maximum entry age? According to directives issued by the Insurance Regulatory and Development Authority (IRDA) of India, companies are required to sell general health insurance policies to citizens up to the age of 65 unless the company is able to furnish just reasons for refusing to do so. The company cannot refuse to insure a person based merely on their age, nor can they arbitrarily load extra premiums; they have to offer a valid and reasonable reason for doing so.

    Medical test requirement
    Most companies offering health insurance do not require people under the age of 45 to undergo medical tests prior to buying health insurance. At this age, the chance of infirmity or disease is perceived to be lower and the health insurance company makes the presumption of sound health in customers below this age. However, this is subject to an assumption of good faith. In other words it is up to the policy buyer to make a declaration of good health and to ensure that this declaration is true to the best of his knowledge.

    If the policy buyer or anyone that he seeks to insurer has a pre-existing condition, then such a declaration is required to be made. The insurance company will then recalculate the insurance premium payable based on the perceived risk of the policy holder or anyone in their family. Take a scenario where, for instance the policy buyer or one of the family members of among those sought to be insured under a policy – aged below 45 – has a condition such as HIV or AIDS. In spite of having this information, the policy buyer neglected to inform or actively hid this information from the health insurance company. It the policy holder then makes a claim for medical expenses based on this pre-existing condition soon after buying the policy, the insurance company is within its rights to refuse the claim.

    The question then follows, as to who will pay for the medical tests that policy buyer above 45 are required to undergo? Is it the insurance company or the insurance buyer? The confusion is laid to rest by an amendment made to the IRDA Act. According to this amendment, if after the tests, the company does issue a policy, the insurance company pays half the amount of expense incurred towards such tests.

    Residential /non-residential status
    Can non resident Indians (NRIs) buy health insurance in India? There is no law that prohibits NRIs from buying health insurance in India; however the NRI has to consider whether this is a worthwhile investment/ expenditure. The fact that medical tourism is a very real phenomenon in India can be taken into account. Citizens of other countries travel to India for top notch medical procedures at a fraction of the price they may be charged elsewhere. So if foreign nationals take advantage of medical facilities in India, it certainly makes sense for NRIs to do the same.

    If the NRI has parents or other family in India whom they wish to insure, they can buy health insurance in India. If they plan to return to India in the near future, it can make sense to buy health insurance before the planned return; in anticipation so to speak. If a person has business interests in India and spends significant lengths of time in the country, it makes a lot of sense to buy health insurance from an Indian service provider.

    Actions that render one ineligible for health insurance cover
    According to the government policyholder website, a health insurance policy holder becomes ineligible to have their policy renewed in certain circumstances. In the event that a policy holder perpetrates a willful fraud upon the insurance company, the company can refuse to renew the policy. If the policy holder appears to have bought a policy for the express purpose of making a false claim, the company is free to refuse renewal. If the policy was obtained by some misrepresentation, the company is not bound to renew the policy.

    Keeping in mind the above health insurance eligibility criteria, ensure that you buy health insurance at the right stage in your life to protect your wellbeing and that of your family.
    Are there any specific disease plans available in Health Insurance
    There are many medical emergencies and eventualities that a health insurance plan will cover. However, there are also several medical conditions and situations that a general health insurance policy will not pay for. In fact, as the buyer of a health insurance policy, it would seem there are more exclusions than inclusions. A health insurance policy will not settle claims relating to preexisting conditions for the first couple of years; or offer critical illness cover under a regular policy. In the event, how does one insure oneself and their family against such specific diseases?

    General limitations / exclusions of health insurance plans
    Why do health insurance companies offer separate critical illness covers or offer such coverage as optional add-ons to a regular health plan? This is because hospitalization and other expenses incurred towards critical illnesses such as cancer, organ transplant, stroke, paralysis and so on are not covered by a regular health plan.

    Furthermore, most health plans require the covered patient to undergo hospitalization for a minimum of 24 hours in order for a successful policy claim (whether on cashless or reimbursement basis). In the event, procedures such as cataract surgery, several types of keyhole surgeries or laparoscopic procedures, which do not require 24+ hospitalizations, would be outside the purview of a regular health policy. Regular health policies would also not pay for outpatient doctor’s visits, which also do not fulfill the hospitalization criteria.

    Health insurance policies usually require a waiting period of two years (sometimes three or four) before a policyholder can make a claim for pre-existing conditions. A pre-existing condition is a medical condition that exists at the time of purchasing a policy. Hence, if a person who already has, say, diabetes buys insurance, they will not be able to make a claim for hospitalizations arising from that disease for a particular duration after the policy purchase.

    Age is also a limitation with health plans. Though the IRDA mandates that insurance companies are required to issue policies even to senior citizens up to the age of 65; the premiums payable could be very high at this stage.

    Maternity expenses and cover for newborn babies is also generally excluded from a general health insurance policy. The policyholder would typically need to buy a separate policy for this or opt for policy add-ons to cover these medical eventualities.

    Health insurance is generally offered in respect of allopathic treatments. Alternative therapies or complementary procedures are outside the purview of most health insurance plans unless expressly stated and opted.

    Another aspect of healthcare insurance that a policyholder needs to know about is personal accident insurance; the term ‘accident’ as defined under the IRDA Guidelines on Standardization in Health Insurance. If one has health insurance, why is this additional requirement an issue at all? While health insurance will pay for hospitalization and other expenses after an accident, it will not take care of income loss or other eventualities that stem from a partial or permanent disability that an accident could have caused. Accident insurance pays for death or disability – partial, complete, temporary or permanent – that could be the result of an accident.

    Specific disease plans offered by Indian health insurance companies
    Over time, health insurance policies have become comprehensive, and offer policyholders the opportunity to add features and customize their policies in accordance with their requirements. Varied policies are now available to ensure that policyholders can buy the sort of coverage they and their families need; including coverage for specific diseases, elder care, day care procedures and shorter waiting periods for preexisting conditions. Some examples of health care policies covering specific diseases currently offered by Indian health insurance companies are as follows:

    Star Unique Health Insurance Policy – This health care policy offers coverage for claims relating to preexisting diseases and conditions after just 11 months waiting period up to the limits specified. The policy term is two years and premium is payable in two installments. The policy also offers standard features and inclusions such as pre and post hospitalization expenses, ambulance charges for emergency transportation and waiver of pre-acceptance medical tests.

    HDFC Ergo Critical Care – This plan pays for critical illness care, recuperation as well as post treatment aids if any that may be required. It provides for income loss that occurs as a result of the illness decreasing the policyholder's ability to earn. If lifestyle changes are require, the policy also contemplates paying for those. The lump sum amount payout will offer financial support for costs and debt incurred.

    Critical Illness And Accident Insurance from Religare - Policyholders can opt for coverage of between Rs.5 Lakhs and up to Rs.1crore to cover expenses related to 20 critical illnesses. These are such as cancer, multiple sclerosis, major organ transplant, brain tumor, Alzheimer’s Disease before the age of 50, several major heart related procedures, motor neuron disorder, major burns, coma, infections such as bacterial meningitis and even disorders such as aplastic anemia. Health checkups and free second opinion features are part of the policy. The accidental insurance policy that the company offers pays a lump sum amount in the event of death or disability.

    ICICI Prudential's Crisis Cover - This plan protects against as many as 34 critical illnesses. Attractive features include a fixed premium rate for the entire term (premiums do no rise with age), protection against untimely death (lump sum benefit for terminal illness or death), disability stemming from an accident and lump sum benefit for critical illness regardless of actual billing to prove hospitalization, diagnosis confirmation and so on. The policyholder may be able to avail tax benefits of up to Rs 54,075 (for the highest slab rate) for this policy.

    Star Wedding Gift Insurance is a unique plan that offers cover for maternity and delivery expenses (including caesarean section deliveries), regular hospitalizations, cover for new born babies and other features.

    Royal Sundaram Master Product – Total Health Plus – This is a comprehensive plan that offers several features in addition to standard health insurance. The Elite Option covers maternity care expenses of up to two deliveries and also pays for standard vaccines for the first year of a baby's Royal Sundaram Master Product – Total Health Plus – This is a comprehensive plan that offers several features in addition to standard health insurance. The Elite Option covers maternity care expenses of up to two deliveries and also pays for standard vaccines for the first year of a baby's life. Policyholders can also opt for emergency hospital expenses for 11 critical illnesses while abroad under the Elite plan.

    Star Health Family Health Optima Insurance Plan – this is a single policy for the entire family with several unique features. The plan covers all daycare procedures as well as domiciliary hospitalization expenses for treatments that extend beyond three days. The policy offers cover for new born babies from the 16th day onwards. The policy also offers cover for assisted reproductive treatment (for couples who have trouble conceiving naturally). Health checkups are offered for every claim free year of the plan.

    Max Bupa Heartbeat Plan – This plan is designed for the Indian joint family and covers families with up to 19 members (individual plans are also available). This plan covers all day care treatments as well as organ transplant expenses. It also offers maternity benefits and new born baby cover and also offers coverage for some alternative (non-allopathic) treatments. Features of the policy include domiciliary hospitalization expenses, health checkups, hospital cash facility and emergency ambulance expenses. There is a 2 year policy tenure option and the policy offers assured renewals for life as well as tax benefits.

    ICIC Lombard Complete Health Insurance – This is another comprehensive floater health plan that covers the family including parents, children, brothers and sisters, offers lifelong renewability, automatic increase of sum assured, wellness program and other benefits. This policy also covers day care procedures. The policyholder can also opt for additional critical illness cover.

    Star Health Red Carpet – This is a policy designed especially for senior citizens between the ages of 60 and 75 years; helping to deal with the difficulty of finding health insurance for older people with their specific ailments and infirmities relating to advanced years. It covers preexisting diseases from the second year onwards and offers insurance coverage up to Rs 10 Lakhs. Also very importantly, the policy offers guaranteed lifetime renewals and requires no tedious pre-insurance medical examinations.

    Aditya Birla Active Health – This policy has two variants – ‘Essential’ which is the affordable and economical plan and ‘Enhanced’ which offers comprehensive coverage with no sub limits. Some highlights of the policy are bonus of up to 30% and Day 1 cover for conditions such as diabetes, asthma, high cholesterol, high blood pressure. The Essential plan offers free health checkup and flexibility in terms of room choice and treatment zone. The Enhanced plan offers coverage of up to Rs 2 crores and also a worldwide emergency assistance service.

    Royal Sundaram Lifeline Classic – This health plan is devised to offer protection for specific disease and critical health situations. The unique futures of the policy includes expenses such as animal bite vaccine, all day care procedures, health and wellness checkups, organ donor treatment expenses, domiciliary hospitalization expenses, AYUSH treatments and 100% reload of sum insured in the event of total exhaustion of sum ensured.

    Aviva Heart Care – It makes sense to get special coverage for heart disease, which is the no. 1 killer worldwide. In fact heart disease and stroke are responsible for as many as one third of deaths and for those with a family history of heart problems this plan dedicated to the heart may be particularly important. Under this plan, policyholders can get up to Rs 20 Lakhs coverage starting at just Rs 7.2 per day. The plan offers protection for 19 heart conditions and a fixed payout irrespective of the cost of treatment. Multiple claims are possible under a single policy.

    HDFC Cancer Care – Cancer can be a destructive disease for the sufferer, the family and family resources. Cancer can be a terrible drain on one’s resources so it is prudent to guard against this. Here as well, family history could be a guiding factor for deciding whether or not to buy this type of insurance. Hence specific cancer care products can help mitigate the situation. The plan provides protection for all stages of cancer, offers three different plan options and up to Rs 20 Lakhs cover for as little as Rs 4 a day.

    Aegon Life’s iCancer Insurance Plan - is another policy that offers care specifically for cancer sufferers. The policy covers all types of cancer and offers stage based benefit payment. About 150% of sum assured is paid at the critical stage. Premium waiver benefit and availability of tax benefits are some other policy features.

    In addition, plans such as ICICI Prudential Heart Protect and PNB Metlife Mera Heart also offer coverage specifically for heart disease. Maxlife Cancer Insurance Plan is yet another cancer care policy that one may want to check out.

    As a policy-buyer, it is important to assess one's family structure and age as well as general health of members as well as lifestyle circumstances before buying a health insurance plan. The link to the product brochure is usually available on the company website; it is prudent to read the complete terms and conditions before making a purchase. Be fully informed and then decide whether to buy separate policies for specific diseases or to opt for comprehensive plans with add-on features.

    #Is it safe to buy health Insurance online
    In earlier times, buying insurance was a long process of contacting an insurance broker who would ask for documents, then fill out some long and tedious forms and then have a policy issued in due course. Today, buying insurance, particularly health insurance is a simple matter of choosing a suitable plan, filling out a simple online form and making instant online payment…a matter of a few minutes rather than the several days it would take earlier. However, there are those among us who question the safety of buying health insurance online. We look at the benefits of buying health insurance online and also some of the precautions to take when doing so:

    Benefits of buying health insurance online
    • You can shop around and compare plans – You can view several different types of policies from various service providers, compare terms and features and then check premiums to see affordability and value for money offered. You can choose the policy that suits your budget, lifestyle and family requirement. You can also check and compare the hospital network that each service provider offers. You don’t have to depend upon the recommendations of a broker (who may be thinking about their commission or lack therefore) but can make up your own mind. You can also check out the actual terms, conditions and exclusions of a policy before you buy it, so there are no nasty surprises at the time of making a claim. You can opt for an individual or a family floater plan as required; choose between a basic policy or one with add-on covers for critical illnesses, maternity care or other riders that may be relevant for you.
    • The ease of cashless claims - Earlier, the whole process of making a claim under an insurance policy was a complicated and tedious one, now policyholders enjoy the convenience of cashless claims where the hospital bills are directly settled by the insurance company. The policyholder does not have to make out of pocket expenses or undergo the hassle or making a claim for reimbursement.
    • Encryption and safe payment gateways – Most health insurance websites have the “https” prefix rather than the “http” prefix. The ‘s’ stands for secure which indicates an extra layer of security and a site which encrypts the information that passes between you and the website. All information that you enter into a form or other communication with the company as well as the financial information such as bank account or credit card number remains secure. There is no apprehension that such information will be intercepted, misused or misdirected in any way. So you can buy your policy and renew it online quickly and conveniently knowing that your financial and personal details are safe.
    • No brokers – Since the go-between element is removed, there is no brokerage required to be paid either by the company or policy buyer. This scales down costs and the benefit ultimately passes to the policyholder who may benefit in various ways: lower premiums, higher no-claims bonuses, automatic increase in sum assured, or other add-on incentives.
    • You can always have your queries answered – If you have any questions about a policy or its terms and conditions you can always find answers to those directly from the insurance company. A majority of health insurance websites have an instant chat feature that prospective buyers can use to clear doubts and questions. Even for those who consider themselves technically challenged, the process of online purchase is fairly simple and streamlined these day
    • Mobile app – Several health insurance companies now have mobile apps to put all functionalities at your fingertips. For instance Star Health’s mobile app on Google Play and on iTunes is a convenient way to buy health insurance, renew a policy, get help initiating a claim and keep track of a claim made. You can get in touch with customer care, request a call back or use the Office Locater feature to find a branch close to you.
    • E policies – The IRDA Guidelines on Insurance repositories and electronic issuance of insurance policies envisions de-mat policies that are issued and stored in electronic form. This would potentially prevent the hassle of safeguarding policy documents and inconvenience and cost of having duplicates issued. The idea is to maintain, store and retrieve the policy document and contents easily, make changes or modifications conveniently and increase transparency and efficiency. This would also help lower costs of printing and issuing paper policies, their notary charges and so on.

    Things to watch out for when buying insurance online
    With a bit of vigilance you can remain safe when buying insurance online. There are some things to watch out for and guard against:

    • Read the policy thoroughly – You should read not only the benefits and coverage of the policy, but also the exclusions and other terms and conditions. The fine print of an insurance company is every important because it is this fine print that the insurance company will quote in the event that the company refuses to honor a claim. Read all riders and annexure documents as well.
    • Seniors and first timers should be especially careful – There is much that a first time insurance buyer may not be aware of. As such a first timer ought to be doubly careful in what they choose and what they are paying for. For senior citizens buying health insurance, choices are more limited, there may be more conditions and premiums may be significantly higher. Here as well, it is important to do one's due diligence before making a purchase.
    • Some specific plans and larger covers may not be available online – It is fairly easy to buy a standard policy with average amount of coverage. However finding specific plans; such as for obscure illness covers or plans with over Rs 10 Lakhs coverage is more difficult. Some riders and add-on features may also not be readily available online.
    • Beware of frauds – It is important to beware of bogus websites masquerading as insurance sellers or brokers. At times, some suspicious communications or emails could find their way to you; beware of these and of so called phishing emails.

    Clearly there are many benefits of buying health insurance – choice, convenience and ease of purchase. However, like everything else, there are a few limitations here as well; which as a judicious policy buyer, you should be aware of.
    #Most effective ways to avoid your claim rejection by Insurers
    The reason one buys an insurance policy is so that when there is an illness, accident of other unforeseen, unfortunate occurrence, one is protected financially. It is so that one's savings and resources for the future are not depleted and wiped out. Yet we do hear of insurance claims being rejected by companies and about policyholders not receiving compensation in spite of premium payment. How and under what circumstances can companies reject insurance claims? What can you as a policyholder do to ensure that your health insurance claim is not denied?

    When can an insurance company deny a claim?
    Insurance companies will pay for those claims which are legitimate and which are covered under the terms and conditions of insurance policy document: events, incidents, and procedures that will trigger the policy coming into force.

    An insurance policy is like a contract between the individual policy buyer and the service provider insurance company and the terms and conditions of that contract are binding on both parties. It is the job of the policyholder to pay their premiums; in return the insurance company offers protection when disaster strikes.

    However, when there is any perceived infringement of contract terms (such as nonpayment or late payment of premiums), insurance companies are entitled to dishonor claims. If the policyholder allows their policy to lapse, the insurance company will not pay for a claim made under such a lapsed policy.

    When there appears to be fraud or deliberate withholding of material information on part of the policyholder; or when the policyholder appears to be engaged in illegal or criminal acts as well, a claim can be denied.

    When the claim is unnecessarily delayed or appears to fall short in material aspects, a company can withhold payment either temporarily or refuse to honor it altogether. If the claim is made as a result of what appears to be neglect, misstatement or perceived fraud on part of a policyholder, the company may reject the claim.

    Top tips to avoid claim rejection by the insurance company
    1. Choose the right policy for your requirements – Should you buy individual policies or family floater plans? Should you buy multiple policies for difference contingencies or one comprehensive plan that covers several different eventualities and offers several optional add-ons to choose from? Remember a comprehensive policy will cost more but will cover many more events and medical problems that would otherwise be excluded. Think long and hard about whether you require features such as critical illness cover, coverage for daycare procedures, maternity and neonatal care, daily hospital cash, accident or disability cover and so on. Also check to see whether it makes sense to buy more than one health policy for better coverage for all your needs.
    2. Read the policy document carefully – Understand exactly what the policy covers: in a health policy, one should know the total coverage limit, included and excluded procedures and all relevant conditions. Some policies have a co-payment clause. Understand what this means and opt for another policy if you would rather avoid this clause. Read the fine print and ask for clarifications if some wording or conditions seem confusing. Ask questions about definitions of certain terms, claim procedures and technical details of the policy so there are no last minute shocks. You should know beforehand what the procedure for a cashless claim is and also be familiar with the insurance provider’s hospital network; contact details and so on.
    3. Make full disclosure, cooperate fully – Provide all relevant information to the insurance company and make full disclosure of any material details such as preexisting conditions or pertinent medical history. Do not withhold any relevant information since this would be just grounds for a company to reject a claim based on willful withholding of information or misrepresentation. If required to, undergo medical tests or investigations and cooperate fully with the insurance company’s requirements so that they cannot claim any inadequacy or shortfall at a later stage.
    4. Ensure all details are accurate and up to date – Make sure that the name of the policyholder, covered person(s) and the nominees and all their personal details are accurate and up to date. If there are any accuracies or updates required, point this out to the insurance company and make sure rectification is carried out.
    5. Pay premiums on time – Ensure that premiums are paid on time and in full. Do not permit a policy to lapse as this not only leaves you vulnerable and without coverage, but could also lose you the benefits and bonuses accrued for holding a policy over an extended period of time. Though companies do offer a grace period of two weeks or so for premium payment, remember that the company is not liable to make good any claims that could arise within the period for which premium is not paid.
    6. Hold up your part of the contract – Not only should you pay your premiums as required, fulfill any other conditions to show good faith. There are usually several clauses in the insurance document that list circumstances and events that could void the contract and give the insurance company a reason not to pay. Make sure that there is no negligence on your part or no action that could be construed as fraud / illegal activity.
    7. Don’t make frivolous, inflated or unnecessary claims – Know what is covered under the policy and do not make claims for excluded procedures. For instance if you plan to undergo a daycare procedure, ensure that your policy covers these. Also ensure that the claim is not deliberately or inadvertently inflated. The insurance company may know what a certain type of surgery will cost under regular circumstances. If however the claim appears to be higher, they would be within their rights to question why this is so and refuse to pay or pay only a part of the claim. If it appears that the insured person has undergone any unnecessary procedures the company would be within its rights to refuse the claim either partially or fully.
    8. Follow the claims procedure – For health insurance policies, policyholders are required to inform the company about any emergency hospitalization within 24 hours. For planned hospital stays, notice is required to be given in advance. Such information may have to be given to the company directly or to the TPA (third party administrator) as specified. The company may have certain procedural requirements and could require the policyholder to furnish proof of their identity, the original policy documents or other relevant papers.

      Keep all relevant documents safe and produce as and when required to do so without any delay. Follow the prescribed procedure for giving notice and making a claim to ensure that the company has no reason to reject a claim or to delay it.
    9. Remember prevention is better than cure – When it comes to health insurance, it is better not to have to make a claim at all, isn't it? It is better not to fall ill, contract disease or need hospitalization /surgery even if you do have health insurance that will pay for such eventualities. Try to adopt a healthy lifestyle by maintaining the recommended weight, giving up smoking, drinking only in moderation and taking sufficient exercise. This is in your interests and those of your family…who wants the stress and worry of ill-health and medical interventions!

    That said; take care to exercise prudence when buying an insurance policy and vigilance when making a claim under that policy. Make sure that you get the best returns on the amount paid when you really need it!
    Myths of health Insurance
    To ensure a better future for your family, it is very important for you to choose a beneficial, yet low cost health insurance policy. These policies are very helpful, if you want any kind of financial aid during any medical emergency. These days, you will find a whole plethora of companies providing health insurance policies. To ensure that you choose the perfect health insurance policy for your family, you need to be sure about all terms and conditions of health insurance policies shortlisted by you.

    The question is, are you sure that you are fully aware of all the terms and conditions of the health insurance policy chosen by you? There are many myths of health insurance policies that you should be fully conversant about. As you decide to compare health insurance plans, it is important that you know about all these myths related to health insurance policies. In this post, we will be discussing some common myths and facts that you should know about your health insurance policy:

    My corporate Health Scheme will help me always?
    It has always been one of the common myths of health insurance because mostly working class has this option of taking the benefits of corporate health schemes offered by their Companies.

    • If you too have this notion that your employee’s health scheme will be sufficient for you, you should think one more time about it. Even if you have some corporate medical insurance plans,
    • it is important that you buy any individual health insurance policy. Your company’s health policy may have different terms and conditions, but from third party insurance policies,
    • you’ll be able to choose the desired features and benefits that you think would be helpful in emergency medical situations.

    Smokers will not get health covers:
    It is another very common myth that people have and moreover, they think that if they smoke or consume alcohol on a regular basis, they will be denied from buying a health insurance policy. However, the myths of health insurance that you need to know is that mostly insurance companies provide complete health benefits in their medical insurance policies and plans even to regular smokers and alcohol consumers.

    • You can choose the best medical insurance plan having high premium cost and you will have to go through some medical examinations.
    • Upon passing those examinations successfully, you are always applicable to buy such policies even if you are a regular smoker or drinker.

    I am fit and do not need any health policy:
    Nothing sounds bad in taking care of your health, but thinking that you are totally fit and don’t want any health insurance policy should not be done at all. There can be many several circumstances when you might need such health insurance policies. It could be a road accident or any disease like dengue and malaria, where you may need emergency medical help anytime. Therefore, it is very important for everyone to get a health insurance policy and stay free from the worries of expenses in emergency situations.

    • You can choose a perfect policy, according to your requirements, but for that you’ll have to compare medical insurance plans and do an in-depth study of their costs and features.

    Pregnancy will not be covered:
    Till a few years back, some companies were not covering pregnancy and related medical situations in their health policies. But now, there are no such issues and you’ll not have to worry as the entire tenure of pregnancy is covered by most of the companies. However, you will definitely find some terms and conditions in every health policy, therefore careful assessment of this pointer in their terms and conditions is strictly mandatory. This can be done as you go through the entire terms and conditions before deciding about a particular plan and by going through medical insurance plans quotes online.

    You should buy a policy only from known agents:
    These are yet other very common myths of health insurance that you should only buy a policy from a known agent. When it comes to getting a new health insurance policy, you can choose any licensed agent as per your convenience and location. It is not mandatory that only a known agent will provide you the right information about the terms and conditions of the policy and quote the best price.

    • If you want to find a new online health insurance plan, it is important to read all the terms and conditions carefully before applying for the most suitable and budget-friendly health insurance plan.

    The medical claim terms will always remain the same:
    Most people think that once they have bought a health insurance policy, the terms and conditions for making medical claims will always remain same. It is a complete myth and therefore, you need to stay updated with new terms and conditions of your insurance service provider at your end.

    • When you buy a health insurance policy, make sure that the insurance company notifies you and keeps you updated with new terms and conditions through regular text messages or emails. This brings us to a fact that it is a complete rumour and you do not need to believe it.

    If you are also looking to get new health insurance policy, you should overlook all these myths and choose the best online health insurance plans according to your budget and family requirements.

    #Help in Finding a Right Sum Assured Health Insurance Cover
    Everyone wants to ensure complete safety of family health by getting the best insurance plan or policy. When it comes to ensuring the health of your family, you will find various insurance companies ready to offer their products and services at very nominal rates. You’ll just have to find the right company to get health insurance services and with this, you will make sure total safety and security of your family’s health. It is not easy to choose a perfect health insurance policy because of so much variety in the Health Insurance Plan present in the markets. But at the same time, it is important that you choose the right sum assured life or health insurance cover for your family.

    When you are looking for the best health insurance policy for your family, you should be careful and find the right insurance policy. If you are able to choose the right sum assured health insurance, you will avail some top health benefits and medical claims during medical emergencies. Most people do not consider it important to compare a list of health insurance plans offered by different companies, but you should be aware that it is very important as you choose a health insurance policy. It will always be beneficial for you if you can compare online health insurance plans and take a decision following that comparison.

    Get help in choosing the best health insurance policy:
    These days, you will find several companies providing health insurance services to the people.

    • When it comes to finding the right sum assured health insurance cover for your family, it is important to find the best health insurance plan according to your health claim requirements and needs.
    • You should also assess as to how much cover you will need for your personal health or for the health of your family members covered in the plan.
    • If you are living in a metro city, you will need a bigger amount for total health cover. You should check the average cost of medical services in your area and based on this, you can choose a suitable sum assured health insurance cover plan.

    Get top-up benefits in your policy:
    Health situations can fluctuate any time and you may need to enhance your health insurance policy cover. When you comes to buying health insurance, it is very important that you can get top up benefits with the chosen health insurance policy. In low cost policies, you will find the option of enhancing its cover by getting a top up plan. These days, you can easily find top up plans with most of the life insurance companies operating in the markets, therefore you should get these top up plans for your family and to get the best benefits according to the situation.

    Get the services of a company having a higher claim settlement ratio:
    When you choose any sum assured health insurance policy, it is always important that you choose the best company for it. It will be better to get several complete health insurance of various companies and then, check that which company is having easy, but higher claim settlement ratio.

    • The companies having a higher claim settlement ratio will always provide better consistency and capability to pay the claim made by you during any emergency health situation.
    • If you want to get help during any emergency situation with your life insurance and health insurance policy, it is very important that you compare the claim settlement ratio of various insurance companies before choosing the services of any one company.

    Choose a perfect sum assured health cover by comparing:
    These days, you will find a wide range of life insurance and health insurance plans from various companies operating in the industry. When it comes to getting the services of the best company, you do not need to stay confused with various plans.

    • Whenever you want to pick the right sum assured health insurance cover for your family, it is always the best option to choose the best health insurance plan at online portals.
    • These days, you will find many online websites to compare the services of various health insurance companies as well as different sum assured health insurance covers for your family.
    • This way, you’ll be able to choose the best plan when you want to pick a perfect sum assured health insurance cover.

    The Importance of a perfect sum assured health insurance cover:
    Whether you are an individual or you want to safeguard your family health, it is always important to choose a perfect sum assured health insurance cover. If you are able to get the best online health insurance plans for your family, you will stay assured about tackling any emergency medical situation with full confidence. In such sum assured health insurance covers, you always have the full information about your requirements and your family’s related to medical emergencies. You just need to get a claim of your life insurance policy in such conditions and you will feel completely safe from any medical situation by getting them. Whenever you want to find any insurance policy, it is very important to know about all terms and conditions offered by the insurance company.

    #What if hospital near your home doesn’t fall under the list of network hospital of your health policy?
    These days, everyone wants to ensure complete safety of your family’s health by getting a health insurance policy. Health insurance policies are a very reliable option, whenever you face any medical emergency, as you can easily get a claim of your health insurance policy, whenever you need it. If you want to search for the best policy to ensure complete safety of your health, it is very important to pick the right plan from health insurance network hospitals available on the Internet.

    To find a perfect life insurance policy, you need to consider all the necessary factors and conditions. The reason is that every insurance company has different terms and conditions and thus, it is very important that you get every detail related to the terms and conditions as you decide to buy a life insurance policy. By getting an ideal health insurance policy that suits your requirement, you can get the benefits of claim during any medical emergency situations. Every insurance policy has a network of hundreds of hospitals, where you can get medical services during medical emergencies. But many people face a situation, where hospitals near their home don’t fall under the list of network of hospitals covered by their chosen health insurance company.

    • This can be a very critical situation as you are denied the claim of your health insurance policy in some certain hospital near your home. There are some chances that your nearest hospital is not in the list of hospitals covered under your health insurance policy. When you are choosing one of the best investment plans available on the Internet, it is important to know about the network of hospitals covered by the company.

    Checking the network of hospitals when you choose any policy:
    Whenever you are choosing any health insurance policy, you should always use this option of checking the list of the network of hospitals covered by the service provider. Every insurance company has tie-ups with various hospitals all around the country. It is not possible to provide these linking services with every hospital of the country.

    • When you are choosing an insurance policy, it is very important that you check the complete list of the network of hospitals as you visit the website of the insurance company to check the online medical insurance Policy.
    • In this list, you will find an option to check all available linked hospitals of your city and you can choose the services of the most perfect insurance company to get medical insurance services at your nearest hospital.
    • If your nearest hospital is in list of network hospitals of your health insurance service provider company, you will be able to use cashless services in that hospital during medical emergency situations. It is a very beneficial option of using cashless services and it can be very helpful during emergency medical situations.
    • Every policyholder wants to get these benefits and you can also search for them when you are choosing private health insurance.
    • As you face an emergency medical situation, it is very crucial that you can inform your insurance company and they will authorize that hospital to not charge you for any medical treatment.

    Contact your Insurance Company to get Insurance claim:
    There are two options when you face such a situation that your nearest hospital is not in the list of the network of hospitals of your health policy provider company. You should check if any other hospital of your city is linked with your health policy. It will be very beneficial if you choose a hospital where you can get cashless services and find all the benefits of your health insurance policy. Another option is that you can find hospital cash policy in your health insurance plan. When you compare online health insurance plans on the Internet, you can check if they are giving the health cash policy option. With such policy, they will help you in decreasing the financial burden during any medical emergency situations in the hospital.

    If you are able to pay your medical expenses during any medical emergency, you can get the complete bill of all medical expenses from that hospital and make a claim from your health insurance company later. There can be various kinds of expenses and your health insurance policy will have to pay all those claims to the policyholder. So, it is very beneficial that you can choose the best health insurance plan of an all-inclusive health insurance company.

    These days, you will find it very easy to search for various life and health care provider to compare health insurance plans and pick the one according to your budget. You just need to visit the website of your insurance company and there, you will find the option to check the list of covered network of hospitals. You can check the network in every state and city. It will be better, if you can choose the services of Health Insurance Company that provide services in your nearest hospitals. You should also check the claim settlement ratio of insurance company, so that you can get the financial help whenever you need it during any medical emergencies.

    #Useful TIPs to buy health Insurance
    According to estimates, the cost of medical treatments and health care in general rise by about 15% each year in the country. It is a fact that illness or an accident can occur at any time and to any person in the family, requiring costly hospitalization and treatments. Such expenses could deplete savings and hamper the aspirations of a family. For these and other reasons, financial experts recommend the purchase of health insurance as prudent and as a matter of course. However, with the wide choice in health insurance, how can you decide what sort of health policy you should buy? These useful tips to buy health insurance will help:

    1. Individual or family floater plan – It makes sense to opt for an individual plan if one is single and has no dependent parents. However a person with a spouse and child (ren) and/or dependent parents would be well advised to buy a family floater plan to cover every member of the family under one plan while paying just one premium. Since it is more likely that any one member of the family could become seriously ill at any given time, rather than everyone in the family becoming ill at once, this type of policy is a better bet than buying individual policies for each member of the family.
    2. Features and inclusions – One of the most useful tips to buy health insurance is to carefully consider what your policy covers and what you as a policyholder are paying for. A general health plan will cover hospitalization treatments/ surgeries and pre and post hospitalization expenses. However a comprehensive health plan could have many more features: domiciliary treatments, maternity expenses cover, critical illness cover, day one coverage for preexisting diseases, daily hospital cash, specific coverage for accidents, coverage for daycare procedures (see below) and so on.

      A general plan costs less and a comprehensive plan costs much more, obviously. You could need to assess your circumstances and realistic requirements to decide whether the higher cost of a comprehensive policy is worth the extra expense or whether a general policy would suffice. The waiting period for making a claim for preexisting illnesses (usually 2 years; however some policies offer protection from Day 1) is another aspect to consider among the tips to buy health insurance.
    3. The maximum sum assured – What should be the maximum sum assured under your health plan? A policyholder would want to ensure that the coverage is high enough to cover all eventualities. Although a higher sum assured could sound like better protection, it obviously also raises your premiums. One useful tip to buy health insurance is to consider the following aspects before choosing the maximum sum assured:

      1. The sum assured may not be fully used up even if one opts for treatment at high-end hospitals and premium facilities; the high premium paid may therefore not be justified.
      2. High value policies could have a co-pay clause (the policyholder could be called upon to bear between 5% and 20% of total expenses) to prevent policyholders opting for unnecessary or premium services or when seeking treatment for seniors insured under the policy.
      3. Remember, a high assured sum is not the same as having a comprehensive policy with additional features. It merely means that total amount payable will be higher. Features of a policy and the treatments it covers may be limited in number even if the total sum assured is high.
      4. High value policies also tend to revise (read increase) their premiums more frequently than other plans.
      5. A high value plan may also offer other attractive sounding add-ons such as a ‘dedicated relationship manager’ or ‘global treatment’ which may not be of much use when disaster strikes. The so called global treatment option may be available only if similar treatment is not available within India.
      6. In some cases it may offer better protection be to buy two separate policies with diverse coverage rather than just one expensive policy.
    4. Customize your policy – One of the most useful tips to buy health insurance you will read today is that you should customize your policy by opting for health policy riders. Riders are add-on features over and above general coverage. Choose whether you need daily hospital cash, whether you want additional accident cover, accidental death or disability cover, maternity treatments, income benefit feature or coverage for critical illnesses. Assess this based upon the age and overall health of each person that you health plan covers. You could also opt for possible riders that cover international treatments or a waiver of premium rider. All of these are riders or voluntary add-on features of a policy that you can pick and choose as per requirements. They will add to the total premium payable, but you can choose what you need and pay only for those.
    5. Daycare procedures – General health policies pay for procedures that require more than 24 hours of hospitalization. Minor surgeries and minimally invasive procedures that don’t require hospital stays are outside their purview. A daycare treatment rider or a separate policy to cover these may therefore be desirable. When making a choice, do not be swayed by numbers; policies that offer X or Y number of specific procedures. Instead, look for a policy or rider that covers “all day care procedures” or which covers several broad categorizations of daycare treatments since these are more comprehensive and cover a wider array of procedures.
    6. Hospital network – Another useful tip to buy health insurance is to look at the insurance company’s hospital network (where the insurance provider has tied up to enable cashless treatment). A bigger network including more hospitals and diagnostic labs may be desirable. You may also want to look at the sort of hospitals they are: the location, reputation, whether or not multi-specialty treatment is offered, and the quality of doctors and treatment offered, are other aspects to look into.
    7. Buy health insurance on time – Experts advise not wait until you are older and starting to experience ill health to buy health insurance. Buying health insurance early in life (before age 40) means lower premiums, more bonuses for each no-claims year of the policy and the option of adding more features to your policy later in life. Buying health insurance is more difficult and costly later in life. Be sure to look for the “guaranteed lifetime renewal” feature when you buy health insurance so that you ensure coverage later in life when illness is most likely to occur.
    8. Avoid claim loading – This is one of the useful tips to buy health insurance that many do not take into account. Claim loading is an increase in premiums payable subsequent to the year in which a claim was made. For instance, if a policyholder made a claim in 2016, the premium payable for 2017 will increase proportionately. Hence it is important to ask 8.questions about claim loading and to read the policy document thoroughly about any mention of it. One can also opt for a policy that expressly promises a claim loading waiver or ensures no increase in premiums for a certain number of years.
    9. Look out for caps and sub-limits – Health insurance policies may have one overall limit as well as several other sub-limits. There could be a cap on the amount payable per day by way of room rent, the amount payable for emergency ambulance and so on. If privacy and personal comfort are important when in hospital, you may want to look for a policy without these caps.
    10. Check company reputation and claims settlement ratio – Apart from the other useful tips to buy health insurance it is also important to check an insurance company’s reputation in the market. Read user reviews online to know about the ease of dealing the company, the speed of claim settlement and redressal of any grievance. If you come across online consumer complaints filed against one company more than others, this should be a red flag to look out for. Check the claims settlement ratio, which is the number of claims settled by the company vis-à-vis the total number of claims filed by policyholders.

    What is Health Insurance Portability?
    As someone who has purchased health insurance for the peace of mind and protection that it accords, you should be aware of the rights that you have vis-à-vis your insurance service provider. Health insurance portability is the right of insurance policy holder to choose a different health insurance service provider and to transfer the accrued credits of an existing policy to a new one. In other words, if one health insurance provider’s service should in anyway be deficient or if another service provider offers better care, the insured person is free to port their policy as they deem fit.

    For several years now, it has been possible for health insurance policy owners in India to port their health insurance to a different service provider. There are difficulties and limitations here, since an insurance company would naturally be interested in retaining existing customers and preventing them from opting for a different service provider. Moving from one to another insurer is still difficult, particularly for people with preexisting conditions or for older customers. We look at the rules regarding portability and the difficulties that still exist.

    Who can port their health insurance policy and when?
    Anyone can port their policy for any number of reasons. The most typical reasons include:
    • Insurance companies come out with better, more attractive products from time to time. For instance, a newer product may have no cap on hospital room rent whereas the older policy may, and may offer free yearly health checkups and similar attractive features.
    • There could be wider inclusions, better facilities or more extensive hospital networks offered along with such newer products.
    • Newer products may also be more suitable for people with specific health issues; the old policy may be lacking in this sense.
    • In the case of one company providing poor service, unsatisfactory or delayed claim redressal as well, the policyholder may choose to look elsewhere for their health insurance needs.
    • One's existing insurance policy could have hidden terms and conditions and may not be transparent in the way it deals with customers.

    Policyholders could be unsatisfied with their policy or policy provider for these and other reasons. In any such case, one is free to opt for such newer, improved insurance products and the policyholder is free to take their business elsewhere. Where earlier one would hesitate to change their service provider because of the apprehension of losing the benefits accrued on their policy, since October 2011, health insurance portability has accorded extra protections to the consumer.

    Know your rights as a policyholder
    • According to experts, portability is good for all concerned and that it would lead to policyholders being able to enjoy better products and services. Industry insiders also feel that this leads to overall improvement in customer service levels and promotes innovation and improved delivery mechanisms. Portability would ensure that healthy competition in the market for customer retention would lead to better value for money products and better service.
    • According to the IRDA’s consumer education website, health insurance policyholders can shift their policy from a general insurance company to a specialized health insurance company. Both family and individual policies are permitted to be ported. The new insurance provider is bound to offer insurance cover to the extent of the sum assured under the previous policy and is liable to give the purchaser credit accrued via the previous policy.
    • Hence, the policyholder does not lose the benefit of the waiting period for covering "Pre-existing Diseases" or any bonus that may have accrued by virtue of making the change to another service provider. The two insurance companies are bound to complete porting as prescribed by the regulations and guidelines issued by the IRDA for the protection of the policy holder’s interests.
    • According to the circular from the competent authority on health insurance portability, the insurance company is required to respond to and acknowledge portability applications within three working days of their receipt.

    Health insurance portability conditions
    The health insurance policyholder is free to port their policy upon renewal and not during pendency of the policy. If the policy is for the duration of one year, as health policies usually are, the policyholder can purchase a new policy from a new service provider at the juncture of renewal.

    All the benefits of the old policy would carry over to the new policy provided the previous policy is maintained without break. Not paying premiums on time and delaying renewal beyond the 30-day grace period (which is permitted when the policyholder opts for porting) would constitute such a break. There could be certain terms and conditions applicable to the new policy which the customer should familiarize themselves with.

    The policyholder has to inform the existing insurance provider of the intended shift 45 days before the policy is due for renewal. The policyholder has to inform the existing insurer which company they will be porting their policy to.

    Common problems with health insurance portability
    While healthy, younger policyholders typically have few to no problems with portability; it is more difficult for people with diseases or those above the age of 45. In the latter case, the policyholder may have to undergo medical checkups or answer lengthy questionnaires about their health. This is reasonable because it increases the new insurer’s liability and the possibility of the policyholder making a claim.

    For this reason, the new insurer will undertake thorough investigation before permitting portability. Conditions such as an additional waiting period or specific exclusions maybe imposed and in some cases, there could a rejection of the proposal for porting. Much will depend upon the present health condition of those insured, the severity of the illness and their claims history. Though in theory, the bonuses earned by a policyholder vide his older policy will carry on to the new policy, there could be limitations to this as well. There may also be cases when the bonus carried over to the new policy becomes chargeable.

    In conclusion, policyholders have to remember that the ability to portability one’s health insurance is an important right conferred upon insurance policy buyers. However, the right is not absolute and is subject to certain limitations and conditions that service providers may impose.
    #Health Insurance Claims procedure
    It is easy to buy health insurance online. There are many attractive looking offers and blandishments offered by insurance companies keen to sell policies. Before you buy a policy, the company sales rep will call you repeatedly, answer all questions and be approachable. However, as any insurance policy holder knows, the claims process is an altogether different matter. We look at the procedure you would need to follow to make a health insurance claim to that you encounter the least amount of hindrance when you make a claim.

    A valid claim under a current policy
    The first thing that a policyholder has to check is that the claim being made is under a valid and current policy. The claim has to be made only for treatment undergone during the period of the year (or two years as the case may be) for which the policy is valid. If a claim event falls within two Policy periods (i.e. treatment is still on when one policy period ends and another begins) it will still be a valid claim so long as the insurance premium is paid on time.

    The claim should be related to covered ailments and diseases and should not arise out of any of the exclusions that are listed in the health insurance policy terms and conditions.

    Intimation to insurance company for cashless claims
    When a cashless claim is to be made, it can only be made with respect to treatment at a network hospital. It is therefore advisable for the policy holder to check the list of hospitals and diagnostic centers that the insurance company partners with to provide cashless services beforehand so that they are familiar with such medical facilities in the area and know where to go when illness or emergency strikes.

    The list of network providers is typically available on the website of the insurance company. It is also advisable to read the insurance policy as well as the terms and conditions relating to claims thoroughly so when an unfortunate event occurs giving rise to a claim, you know exactly what to do.

    Before checking into a network hospital or medical facility or taking any treatment there, the policyholder has to get in touch with the insurance company’s In House Claims Processing Team. For this as well, it is advisable to have all the relevant phone numbers and other information at hand. It may be a good idea to feed in the health insurance company’s toll free numbers into your mobile phone's phone book and to have details about the policy, its number and other details stored in your phone for ready referral at any time. This can come in very handy in case of an emergency.

    The policy holder has to give particulars such as the policy number, the name of the patient as well as their relationship to the policy holder, the type of illness or injury, location or patient, the name of the hospital or medical practitioner and all other relevant information to the claims processing team representative. This is known as pre-authorization, which is typically required to be done within 24 hours of hospitalization in an emergency. In the event of a planned or scheduled hospital procedure, the pre-authorization should be done in advance. Usually, companies need the policyholder to inform them of such scheduled hospitalization at least 48 hours in advance of hospital check in.

    Procedure in case of reimbursement claims
    For a reimbursement claim (other than cashless claim), all the relevant information about the policy, policy holder and treatment should be relayed to the insurance company within a time as may be specified by the terms and conditions of the policy (usually 10 days or less from initial hospitalization). Since is this not a cashless service, the policy holder has to make all payments to the hospital and other medical practitioners and then claim reimbursement for those under their health insurance policy. Hence, the policyholder must make all requisite payments in full upon checkout. The policyholder must also ensure that reasonable care is taken to minimize the medical expenses incurred at the hospital. If the insurance company has reason to believe that expenses were inflated, this could be grounds for dishonoring a claim.

    All original documents relating to the check-in to hospital, treatment, consultations, diagnostic tests, surgery, prescriptions, case papers, referral letters and checkout documents are required to be submitted to the insurance company. Original documents have to be submitted so that the policyholder doesn’t try to make more than one claim for the same treatment. In some cases, the patient may be asked to undergo a medical examination by the company nominated medical practitioner. This could be a requirement if there is some doubt as to the authenticity of billing, illness or medical condition, or about the treatment given.

    Procedure to be followed at the hospital
    When a policyholder approaches a hospital or medical facility listed on the insurance company network list, the policyholder should ask to be guided to the insurance desk of the hospital. There, the policyholder must offer some proof of identification and inform the hospital about the existing insurance policy under which the treatment is to be initiated. The policyholder must ideally ensure that the pre-authorization is forwarded by the hospital to the insurance company so that the requisite procedures can be initiated at the company’s end.

    These are the general procedures health insurance companies expect policyholders to follow there could be variations to the procedures followed by different service providers. It is therefore very important that the policyholder read the policy and become fully familiar with the claims procedure in advance - not to wait until the last moment to do so.
    #List of Government Health Insurance Schemes
    The good health of people and easy access to healthcare is one of the most significant indicators of well-being of a populace. As such, successive governments of India have created health related schemes to benefit various strata of society through nationalized insurance companies as well as via government programs created under the aegis of departments such as Insurance, Health, Agriculture, Rural Development, Financial Inclusion, Pension, Child Care and so on. We look at some of the government backed healthcare and insurance schemes that Indian citizens can avail:

    Public sector insurance company health care
    Four nationalized insurance companies that provide health insurance policies for buyers to choose from. Several of these policies offer features that are quite similar to products from private players such as HDFC, ICICI, Max Bupa and so on.

    Oriental Insurance Healthcare Products – Various healthcare policies are created for individuals, groups, seniors as well as for overseas requirements:

    • Mediclaim Policy (Individual)
    • Group Mediclaim Policy
    • Health of Privileged Elder (HOPE)
    • Happy Family Floater Policy 2015
    • Overseas Mediclaim Policy (B&H)
    • Overseas Mediclaim Policy (E&S)
    • OBC-Oriental Bank Mediclaim Policy
    • PNB-Oriental Royal Mediclaim Insurance Policy
    • Pravasi Bhartiya Bima Yojana Policy
    • Jan Arogya Bima Policy
    • Oriental Happy Cash Policy

    All particulars of the policies are available on the insurance company website. The policy document including the terms and conditions of the policy, the prospectus and other information connected to the respective policies can be accessed to read and to print as that policy buyers can read all particulars before making a purchase.

    The New India Assurance Company Limited – Apart from other insurance products like householder's policy, motor insurance products, shopkeeper's policy and fire & machinery policies, the government owned company also offers health insurance. The Mediclaim policy offers protection for unforeseen hospitalization expenses subject to standard exclusions. The policy covers treatments in India and compensation is offered for healthcare facilities located applicable zones (as specified) of that policyholder.

    The company also offers the Overseas Mediclaim policy which is designed with frequent corporate travelers in mind and covers expenses incurred towards illness, injury or other treatments required when aboard. Premiums are payable in Indian currency and claims can be settled in foreign currency abroad. Various sector plans are available.

    "United India Insurance Company Ltd. – Presenting an array of insurance products, this public sector company also offers health insurance policies for individuals and families. People with preexisting conditions, disability or deformity are required to visit the nearest office, while others can buy their health insurance policy online by choosing policy period, type of policy and other details. Buyers can choose between family floater cover and individual family cover, choose the policy amount (between Rs 2 and 10 Lakhs) and indicate whether daily cash allowance and ambulance compensation is required to get an instant quote.

    National Insurance Company Ltd – Anyone between the ages of 18 and 65 can apply for one or two year health insurance policies. Policy options include the National Vairishtha Mediclaim policy for Senior Citizens, Critical Illness cover, Family Floater plans such as the Parivar Mediclaim policy, individual policies and group Mediclaim policies.

    Other national health programs and insurance schemes
    Apart from health insurance products that are offered via public sector /government owned companies that offer products quite similar to private insurance companies; there are other government schemes that offer health protection to Indian citizens.

    Rashtiya Swasthiya Bima Yojana (RSBY) – This scheme is for the benefit of people below poverty line. This program from Ministry of Labour and Employment, is meant to provide poor families health care for any conditions that require hospitalization. There is no age limit and preexisting conditions are covered for a family of up to five people (spouses plus up to three children). Treatment is available at government hospitals as well as private hospitals across India; at centers that are empanelled under the RSBY scheme. Rs 30 by way of registration fees, is required to be paid to avail the benefit of the scheme.

    Employment State Insurance Scheme (ESIS) – Designed as a social security system for workers and their families, this scheme provides protection for workers who fall ill, suffer permanent disability and loss of earning. The policy is meant to protect workers against hazardous occupations and work related injuries and is applicable to non-seasonal factories that employ ten or more people. Factories, hotels, shops, cinemas, transport undertakings and newspaper establishments as well as certain educational institutions and private medical facilities fall within the ambit of this scheme.

    Central Government Health Scheme (CGHS) – This scheme is designed for central government employees as well as pensioners and is operational in major cities across India. Comprehensive health care is provided to beneficiaries through allopathic CGHS dispensaries and wellness centers as well as polyclinics that provide alternative or complementary treatments under homeopathy, ayurveda, unani and other systems. X ray and lab exams, hospitalization are also covered under the scheme.

    Aam Aadmi Bima Yojana (AABY) – This scheme is designed with rural landless laborers in mind. The scheme offers compensation in case of death under natural circumstances or due to accident, for permanent disability or partial permanent disability. Free add on benefit to children in the form of scholarships is also available under the program.

    Janashree Bima Yojana (JBY) – Under this scheme, 45 identified occupational groups are covered. Beedi workers, carpenters, power look workers, textile workers, cobblers, fishermen, people engaged in food manufacturing, handicraft artisans, weavers, tailors, agriculturists, rickshaw workers, milk producers, forest workers, toddy tappers and many others are covered.

    Universal Health Insurance Scheme (UHIS) – This is another scheme meant for families below poverty line and is designed to reimburse medical expenses for the entire family as well as cover for accident of the earning head of the family. This is a subsidized scheme is implemented by the four nationalized insurance companies listed above and is meant to help poor family access health care. Families of up to seven members can utilize the benefits under the program.

    While individuals can buy health insurance for their families and dependent seniors from any of the nationalized company products listed above, manufacturers and business owners can familiarize themselves with the government health insurance schemes offered by various state and health departments that would help protect their employees, their health and that of their families.
    #Difference between Medicalim and Health Insurance
    Insurance is a subject that most of us find confusing; the terms health insurance and mediclaim can be especially confusing. The conditions of each policy, the terms used in those policies can be difficult to understand as well. When it comes to health insurance, these terms and conditions are especially important to understand so that as a policyholder, there are no unwanted shocks when it is time to make a claim under the policy.

    Are mediclaim and health insurance the same thing?
    The terms mediclaim and health insurance are more or less synonymous as understood in common parlance. Health insurance policies and mediclaim policies also offer practically the same tax deductions and benefits to policy holders. Mediclaim and health insurance are also similar in that they both offer cashless as well as reimbursement facilities. In fact, many people use the two terms interchangeably; however it is important to understand the specificity of each term:

    What is Mediclaim?
    ‘Mediclaim’ is a portmanteau of the words ‘medical’ and ‘claim’ and the term is often used as a brand or product name in India as well as aboard. Sometimes the word is used to indicate government programs relating to health insurance. For instance, the government owned insurance company; New India Assurance offers health insurance products called Family Floater Mediclaim Policy, the Janata Mediclaim policy and so on.

    According to the website of HDFC Life, one of India's most trusted insurance providers, the term Mediclaim refers to one limited type of health insurance which offers some features of health insurance. According to the explanation offered, mediclaim policies cover some but not all expenses of health care and would typically pay for hospitalization and treatment towards accident and pre-specified illnesses for a specific sum up to an assured limit.

    What is health insurance?
    As most commonly understood, health insurance is more of an umbrella term used to describe all types of medical related insurance and reimbursements by an insurance provider including mediclaim policies. While mediclaim could be limited in nature, health insurance policies could be of various different types and offer additional features. Depending upon the type of policy, it could offer cover for critical illnesses, outpatient or day care procedures and features such as discount on premium, possible premium reduction or reduction of sum assured as well.

    Common terms used by mediclaim and health insurance policies and what they mean
    The Insurance Regulatory & Development Authority (IRDA) of India frames laws and regulations regarding the functioning of the insurance sector in India. This is to ensure that policyholders are protected and functioning is standardized so that the consumer knows their rights and what to expect from insurance providers. The IRDA also issues circulars from time to time, to make certain clarifications and issue guidelines, such as the Guidelines on Standardization in Health Insurance which provides definitions of terms that are commonly used in both health insurance as well as mediclaim:

    Accident – defined as a sudden, unforeseen and involuntary event caused by external and visible means. In insurance terms this could refer to falls, vehicular accidents and other accidental injuries.

    Co-Payment – When buying a health insurance policy, the policyholder has to know about the concept of co-payment that requires some part of the expenses incurred to be borne by them, while the insurance company pays the rest. Co-payment is defined as cost-sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible costs.

    Day care treatment – Usually, health insurance claims become payable only in the event of hospitalizations; more particularly hospital stays of at least 24 hours. However, there are many health policies that also pay for procedures that do not require such hospitalization. These are known as ‘day care procedures’ and are defined as medical treatment, and/or surgical procedure which is undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because o f technological advancement. In other words, this refers to procedures that would earlier have required hospitalization but don’t now because of medical advancements. For instance laparoscopic procedures have replaced many open surgeries now and minimally invasive treatments now no longer require long hospital stays.

    Grace Period – Insurance companies require prompt renewal of health care policies for the policyholder to get certain benefits and provide ongoing protection to the policyholder. Hence the policyholder is required to renew their policy as soon as it is due to lapse (one or two years from the start of the policy depending upon the type of policy opted for). Companies do provide some grace period, which is defined as specified time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as waiting periods and coverage o f preexisting diseases. The regulations specify that the policyholder is not entitled to coverage for the period for which no premium is received.

    Hospital & Medical Practitioner – These terms cannot be used loosely. A hospital has to meet certain criteria: having at least 10 beds, with qualified round the clock nursing staff and medical practitioner, fully equipped operating theatre, etc. A medical practitioner has to be registered with any Indian state medical council and licensed to practice as such. Insurance companies may also stipulate that such a practitioner shouldn’t be the policyholder’s close family member.

    Medically necessary – The treatments, medications and hospital stays should be necessary for the type of injury of illness in respect of which a claim is made. They should be prescribed and should conform to professional standards. In other words, the policyholder cannot opt for unnecessary or extra procedures and then expect the insurance company to pay for them.

    Pre-existing disease – This is excluded or requires a waiting period before any claim can be made and is defined as any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and/ or were diagnosed, and /or received medical advice/ treatment within 48 months to prior to the first policy issued by the insurer.

    Critical illness – Unless specifically included in the health policy, purchased separately or as an add-on, critical illnesses are not covered by a general health policy. Annexure II of the regulations lists and describes critical illnesses in detail; all inclusions and exclusions are also specified. They include

    1. Cancer of a specified severity
    2. First heart attack of specified severity
    3. Open Chest CABG (coronary artery bypass graft)
    4. Open heart replacement or repair of heart valves
    5. Coma or specified severity
    6. Kidney failure requiring regular dialysis
    7. Stroke resulting in permanent symptoms
    8. Major organ or bone marrow transplant
    9. Permanent paralysis of the limbs
    10. Motor neuron disease with permanent symptoms
    11. Multiple Sclerosis with persisting symptoms

    Getting accurate and proper information is the first step towards buying health insurance to protect your health; to being an informed, responsible consumer.

    #Can a senior citizen buy the insurance Policy
    It is common knowledge that health insurance is cheaper for younger policyholders and that the premiums tend to get higher with age. This is because we are all more and more likely to fall ill and develop health issues as we age; hence, the perceived risk for health insurance companies increases as well. The issue, about whether it is possible for senior citizens to buy health insurance or not, requires more clarity. Can a health insurance company refuse to sell a policy to senior citizens? How can seniors go about insuring their health in the twilight of their life; when they are most likely to incur healthcare costs?

    Insurance companies cannot refuse to insure seniors up to age 65
    To ensure that senior citizens can buy health insurance and continue to receive protection later in life, the Insurance Regulatory Development Authority (IRDA) of India issued certain mandatory directions. There was the apprehension that insurance companies would try to lower their risk by avoiding issuing policies to seniors, who are seen as a higher risk.

    Certain protections for senior citizens are prescribed according to the IRDA Health Insurance Regulations 2012. Health insurance policies are bound to provide entry up to age 65 years (under regulation 3.1). So in other words, the insurance company is supposed to issue general insurance policies for senior citizens aged 65 and less. The company cannot refuse to do so unless it can furnish genuine and reasonable grounds for such refusal.

    The regulations also provide that there should be no exit age for renewal of the policies once the proposal is accepted; provided the policy is continuously renewed without break. Further, the insurance provider cannot load extra premiums on the policy without just reason; based only on the policyholder’s age.

    Under the same regulations – regulation 3.10 also provides clarifications vis-à-vis the pre-insurance health checkups. Since customers aged 45 and above have to undergo certain medical tests to determine fitness and to fix premium rate based on the policyholder's state of health, the regulation makes certain clarifications. If the policy is issued by the company, 50% of costs incurred towards pre-insurance health checkups shall be borne by the health insurance company and 50% is to be borne by the policyholder.

    Seniors are liable to receive medical benefits such as hospital expenses (including room rent, doctor’s consultation, nursing charges, prescription medications etc), day care cost incurred for specific procedures, medical expenses for existing diseases, ambulance charges as well as pre and post hospitalization expenses as the terms of the policy may stipulate. Senior citizens would also avail tax benefits up to Rs.30,000/- for holding health insurance.

    Senior health insurance plans to choose from
    Senior Citizen Red Carpet Health Insurance from Star Health – Especially for seniors aged 60 to 75 years of age; this policy requires no pre-insurance medical tests and covers preexisting diseases from the second year onwards. Coverage is offered for higher sums of up to Rs.10 Lakhs and seniors, receive benefit of outpatient medical consultations at network hospitals.

    Senior Silver Health Policies from Bajaj Allianz – Senior health policies cover 130 day-care procedures (for which hospital stays of over 24 hours are not required), offer cover for preexisting illnesses from the second year onwards and offer cashless settlement of claims at up to 5000+ network hospitals. The company provides innovative packages to cover seniors and their spouses. Cumulative bonus up to 10%, family discount of 5% and waiver of co-payment is available.

    Apollo Munich Optima Senior – The plan offers protection for medical treatments relating to illness and accidents, 140-day care procedures, treatment expenses at the time of organ transplant and so on. Policy features include optional second opinion (e-opinion in case of critical illness), domiciliary cover, cumulative bonus and enhancement of sum insured subject to certain conditions.

    Tata AIG MediSenior – This is a comprehensive senior medical plan that offers all the usual benefits plus the assurance of portability, quick settlement of claims, the option of lifetime renewal and no-claims discount of 5% for subsequent policy renewals. The policy wordings, customer information sheet & premium table are available on the website for instant download so that interested buyers can quickly compare and contrast the terms and conditions of different policies.

    The New India Assurance Company Senior Citizen Mediclaim Policy – Since this is a government owned company and not a private insurance company, the terms and conditions are slightly different. With this policy, anyone between the ages of 60 and 80 can buy the policy, which can be renewed (if continuously held) up to age of 90 years. Apart from other standard coverage, the policy also offers limited cover for hospitalizations in government hospitals and registered Ayurvedic, Unani or Homeopathic hospitals. High blood pressure and diabetes are covered after 18 months upon payment of additional premium. Certain discounts and special features are also offered.

    Remember, health insurance for seniors is important not just because of increased risk of illness and chronic medical conditions, but also because of increased risk of falls and accidents in one's advanced years. Hence, you should make an informed, judicious choice to safeguard your health and that of loved ones in later years of life.
    Do I have to undergo Medicals while buying health Insurance
    Health insurance providers need to assess their risk while issuing a policy. They want to be sure that the insured person(s) has reasonably good health and is not likely to make expensive claims on their health insurance policy in the near future. Health insurance companies do require the insured person(s) to undergo health check-ups in some circumstances to make such a risk assessment. So if you're wondering – “do I have to undergo medical tests while buying health insurance” the following should clarify matters:

    What you should know about pre-policy medical screening
    • What are pre-insurance tests - Pre insurance medical tests could include procedures such as ECG, lipid profile, blood sugar, blood pressure and other optional tests for testing kidney and other organ functioning. Many insurance companies waive medical test requirements to make the insurance buying process quick, smooth and hassle free. This is done to incentivize policy purchase.
    • Do health insurance companies insist on tests? This depends upon the insurance company and the type of plan chosen. However even if such tests are waived and are not a precondition to buying insurance, those applying for a health insurance policy are required to state that they are in good health. Such a declaration implies that the applicant does not suffer from or has not in the past suffered from any major medical condition that could impact risk..
    • Should you undergo medicals while buying health insurance even if it is not compulsory? In some cases it is advisable to undergo such tests even if there is no express requirement for it from the insurance company. It is a way to demonstrate good faith and present medical proof of sound health of it to the company. Remember, if the insurance company has reason to believe that the medical history of any covered person is withheld deliberately, this is grounds for refusing a claim at a later date. If however one chooses to undergo medicals while buying health insurance, the chance of a claim being withheld on such grounds of nondisclosure is far lower. Hence undergoing tests prior to policy purchase improves chance of a claim being honored.
    • Who pays for the tests that you undergo while buying health insurance? The insurance company will pay half the amount for such pre-policy medical tests if the company decides to issue a policy. This is an IRDA requirement. The other half has to be borne by the policy buyer. If however the insurance company decides not to issue a policy (it may do so if the perceived risk is deemed too high), the company is not bound to pay for pre-insurance tests.

    Who needs to undergo medical tests when buying insurance?
    While some companies and health plans require pre-insurance medical tests, others do not. However, it is advisable to undergo tests in the following circumstances:

    • People over 45 – When buying insurance cover for persons lower than 18 or between the ages of 18 and 45, there is usually no requirement for undergoing medical tests or pre-insurance screening of any kind. Experts also do not advise this unless there is a specific family history of certain diseases. Perceived risk to insurance companies is low and most service providers waive this requirement in lieu of a declaration of sound health from the insurance buyer.
    • Some insurance companies waive checks even for older applicants -Some insurance companies such as Star Health do not require medical tests for regular health insurance policies up to the age of 50. Their Senior Citizen Red Carpet policy is specially designed for seniors up the age of 75 and does not require one to undergo medicals while buying health insurance. The family floater plan from the nationalized insurance company Oriental Insurance also does not require medical tests for insurance persons of up to 60 years of age.
    • People with preexisting conditions – Even if the insurance company does not make it compulsory to undergo pre-insurance screening, it is advisable to do so if one has preexisting conditions such as hypertension, diabetes, a heart ailment or if one is obese. Since these conditions increase the risk of complications and hospitalizations it is best to undergo medicals while buying health insurance so that the insurance company has the true picture and can fix premiums and issue a policy accordingly.
    • Applicants over 45 years of age – It is also advisable for applicants over the age of 45 to undergo pre-insurance screening since the risk of chronic diseases increases after this age. A certificate of good health from a hospital or diagnostic agency could, in some cases help to lower health insurance premiums as well.
    • Other reasons to undergo medicals while buying health insurance – Experts advise general health checkups at regular intervals after a certain age; and especially when buying health insurance. This could help to reveal health conditions before they show symptoms, so that the problem can be controlled before it becomes acute. Though this could alter premiums and impact policy exclusions, it helps maintain good health with the help of timely intervention; something that is vital for the health and wellbeing of the entire family.

    What If I Do Not Claim During the Entire Policy Tenure?
    A health insurance policy is generally issued for a period of one or two years. At the end of this policy period, it is required to be renewed. The term ‘policy tenure’ usually means the uninterrupted length of time for which a policy has been in force and not just the one or two years that for which it has been issued. For instance, a policy bought in the year 2014 and renewed each subsequent year by timely premium payments; the policy continues to be valid till date. We look at what happens if there is no claim made during the entire policy tenure:

    • Many types of insurance offer returns on investment in case there is no claim made during the policy tenure. However, health insurance is not the same. It is not a tool for investment and there are no maturation payouts or returns, if you do not claim during the entire policy tenure.
    • Making a claim under your policy will not attract any penalty such as claim loading. Claim loading is the increase of premium, after a claim is made by the policyholder. There is an IRDA notification stating that claim loading by insurance companies is not permissible.
    • However if you do not make a claim during the policy tenure –– the insurance company may offer some rewards. This is to incentivize policyholders not to make a claim unless necessary and to bear the cost of inexpensive treatments on their own. Rewards could be in the form of a NO-claim bonus, which increases the maximum sum assured under a policy by 5% or 10% without proportionate increase of the premium or a free top-up of the policy, which offers a discounted premium for the subsequent year(s). Some insurance companies could also offer free riders (value added services) or extra coverage when the policyholder makes no claim during the entire policy tenure.

    #What are the post sales services after buying health Insurance
    One could be buying a car, a gadget or a financial product – the sales team typically shows itself to be enthusiastic, informative and responsive before the purchase. The story after completion of the sale tends to be rather different. In fact, it is the post sales service offered that tends to set the apart the outstanding product or service from the rest; an aspect one ought to consider when buying health insurance as well. What are the post sales services after buying health insurance? What are you entitled to, and what can you expect?

    Post sales services after buying health insurance
    At the time that one is consumed with worry about an illness or accident in the family, the last thing one wants is to be caught up in tedious paper work and technical nitty-gritty. For a policyholder, it is most important for them that when dealing with the customer service department of an insurance company, they receive streamlined and hassle free service. For a positive experience with your health insurance company, you are within your rights to expect certain post sales services from your health insurance company:

    • User-friendly customer service – The customer service team of the insurance company should be adequately trained and equipped to handle any queries from policyholders, promptly. Ideally, the customer should have access to a 24-hour helpline manned by trained, courteous and knowledgeable staff or the option of communicating to with the company via email or even post. Senior citizens or policyholders in remote areas should have the option of being able to communicate via any means of their choice.
    • Prompt changes and redressal of any grievance – If there is any factual or material error in the policy document with regard to names, age or any other details of the covered individual(s) such error should be brought to the attention of the company in a prescribed manner. The company is bound to correct the error within a reasonable period and issue a new or amended document. Ideally, the company should make it easy for policyholders to apply online for minor changes such as fund switches, name or address change, update of contact details, payment frequency alterations, change of nominee and so on.
    • Ease of obtaining a duplicate or e-policy – Most insurance companies make it easy for customers to buy health insurance online and expedite the issuance of the policy document. Many insurance providers now issue e-policies that can be downloaded and printed easily by the policyholder at home without having to wait for the same to be couriered to them. The IRDA’s guidelines with regard to Insurance Repository and E-Issuance of Policies may be useful to refer to in this regard.

      However, in the case of hard copy policies, documents do get damaged, lost, mislaid or inadvertently destroyed in cases. The process of having a duplicate policy document issued should be simple and free of tedious applications, costs other than administrative expenses or any penalties. However, it is important to find out more about this, since some companies may require proper written applications, the publishing or advertisements and the issuance of indemnity bonds in some cases.
    • Ease of making a claim – Probably the most important of post sales services after buying health insurance is the claims process. Ideally, the claims process should be accompanied by ease of making contact with the insurance company or the TPA (Third Party Administrator handling claims and providing ambulance services etc.). It should be easy for a policyholder to obtain information and guidance and fulfill procedural requirements and documentation. At a time when one is burdened by worry, one should not have to waste time on this, so requirements should be minimal.
    • Dedicated relationship manager – Some high value policies or premium policies offer special customer service value add-ons such as a dedicated relationship manager, personal advisor or simplified claims procedures. This could mean that the premiums go up slightly, however. It is up to the policyholder to decide whether the extra cost is worth the service offered.

    Remedy if post sales services after buying health insurance are deficient
    In the event that a policyholder finds customer service or other aspects of their health policy to be deficient in any way, the option of policy portability is available to the policyholder. The policyholder can port their policy to another service provider/ insurance company without loss of continuity benefits if that company offers better policy terms or customer service. Remember, it is your right to expect a certain degree of care and a certain quality of post sales services after buying health insurance.
    #Who can help and guide to claim health insurance amount
    If you are looking for help and guidance to claim your health insurance amount, you are in the right place. It is our endeavor to offer you useful, accurate and up to date information about health insurance products and processes. Read on to know more about claims processes, TPAs and other information about who can help and guide to claim health insurance amounts.
    As soon as you buy a health policy and before the need for a claim arises, familiarize yourself with the following:

    • The list of network hospitals and diagnostic centers where cashless claims can be made under the health policy you have bought.
    • Read policy document thoroughly to understand inclusions and exclusions.
    • Ensure that the policy document and health insurance card are complete and accurate in all respects. Correct and incorporate any inconsistencies or mistakes by following the set online or offline procedure.
    • Always keep handy the health insurance card issued by the health insurance company. Not only is this necessary at the time of making a claim, it would also typically have all requisite contact information such as the company toll free number, email address, fax number and registered address for ready reference.
    • The card would also display the policy number, name and other details of the policyholder or individual covered under the policy, which would act as identity proof at the time of being admitted to a hospital for a cashless claim.
    • If a health card is lost or damaged, immediately apply for a new one or make an online request to generate one.

    Procedure for initiating a health insurance claim
    There are two types of claims that can be made under a health insurance policy:

    1. A cashless claim – this type of claim can be made at any network hospital or diagnostic center which has a tie up with the insurance company; where payment is made directly by the insurance company to the hospital or medical facility. The policyholder would need to show their health insurance card and fill up a pre-authorization form (similar to this Tata AIG claim form) at the hospital’s front desk at the time of being admitted.

      In most cases, the approval from the insurance company would be forthcoming within a few hours; usually 6 hours however, several insurance providers offer assurances of approvals within 4 hours. If there is some amount of urgency and it is not possible to wait for insurance company approval, the policyholder may be required to make an upfront deposit of some amount which can later be reimbursed by the insurance provider.
    2. Reimbursement claim – Such a claim may be made at a non-network medical facility, for which the policyholder would typically make upfront payment and then apply for reimbursement by presenting all original documents and requisite applications /forms. It is important to keep track of all documents such as admission papers, prescriptions, bills, OT papers, lab reports and discharge summary, since all originals would have to be presented to the insurance company. Reimbursement claims are sometimes subject to co-payment where the policyholder has to bear some proportion of the total expenditure.

    There are two ways to claim health insurance amounts:

    1. Emergency hospitalization claims – where sudden illness or injury requires urgent hospitalization. For such claims there is a standard requirement for the policyholder to inform the insurance company with 24 hours about such hospitalization in the manner prescribed by the company. Usually, emergency claims can be processed and initiated within 4 to 6 hours of admission into the hospital.
    2. Scheduled hospitalization claims - These are claims made for scheduled hospitalizations that are planned in advance for any surgical or diagnostic or daycare procedure that is covered by the policy. The insurance company would usually have to be given advance notice of such planned hospitalization. A pre-authorization form would typically need to be filled by the policyholder as well as the attending physician/ surgeon based on which the insurance company would approve and authorize the claim.

    What are TPAs?
    The term TPA is one that often crops up in health insurance nomenclature. TPA stands for Third Party Administrators. These are like agents or go-betweens that help policyholders make claims. These are agencies apart from the insurance company who can help and guide the policyholder to make claim health insurance amounts due under a policy.

    Some health insurance companies need the policyholder to contact the specified TPA for initiation of a claim; whereas some companies may not require TPA interventions. In recent times the role of TPAs has declined since companies increasingly settle their claims in house; cutting out the need for such agent participation.

    Different companies have different claims procedures. For instance, ICICI Lombard has a specific claims process for reimbursement as well as cashless claims – both scheduled as well as emergency. Claims under Apollo Munich policies can be initiated directly as well as via a TPA. Max BUPA claims to process cashless claims within 30 minutes and has its own claims process to follow.

    It is important to be familiar with the claims to process prescribed by your chosen service provider and policy in advance, so that when disaster strikes, you know exactly how to claim your health insurance amount.

    #Is health insurance from govt company better than private insurers
    In India we tend to associate government owned or nationalized companies with slow or poor service and with generally lower levels of competence and accountability. It is therefore a valid question to ask: it is advisable to buy health insurance from government companies or from private insurers? With such a wide array of health insurance products to choose from, making this decision becomes doubly difficult. We look at the pros and cons of buying health insurance from government owned companies as well as private players.

    Why some people prefer to buy health insurance from government companies
    • Nationalized insurance companies are large in terms of capital as well as network and have been around literally for decades. They are well established and easily accessible no matter where you are in India. There is no apprehension that such an established entity could go out of business; particularly since there is always the assurance that the government itself will bail the company out in the event of a financial crisis.
    • With a newly established company or one that depends upon foreign collaboration, there could be such apprehensions, however. If one is wondering whether to buy health insurance from government companies or from private insurers financial stability of the insurance provider is a significant issue.
    • Another issue is the network of offices, which could be wider in case of nationalized entities. For people in remote areas or those without access to the internet, this is important to keep in mind.
    • Many of the newer companies may not have long-term proven track record. Even though the company may be offering some very attractive looking products, the question has to be asked whether the company has the capital and the market experience to follow through. The safety of one’s investment could be a significant factor to consider.

    Why many prefer to buy health insurance from private players
    • Privately owned insurance companies tend to offer a wider range of diverse products and policy riders and more options to customize a policy as required. There could be less red tape and tedious documentation in case of policies issued by private insurance companies. Hence the process of buying a policy as well as claim settlements could be quicker, more streamlined and relatively painless.
    • The customer service offered by private players tends to be better and more responsive on the whole. For sheer ease of buying a policy, many prefer to go with private companies. There is also the fact that private companies tend to sensitize their employees more. Hence getting information about products is easier and the process of settling claims tends to be handled with more sympathy for the policyholder. The process of dispute redressal may also be more tedious with nationalized companies.
    • Many private insurance companies are well established in the market; with proven and reliable track records. There may be no real apprehension that the company could go bankrupt or that the foreign investor could pull out of the joint venture. Further, since the IRDA regulates the functioning of all insurance companies and requires them to maintain a certain solvency margin, policyholders need not worry that a claim will be dishonored due to insufficiency of funds.
    • Nationalized companies tend to have co-payment clauses for some of their products. This would mean that the policyholder has to pay a portion of the total expenses incurred in medical treatment. Fewer private players have such a requirement and usually have this requirement only in health policies for senior citizens.
    • Some private players also tend to offer some attractive features such as waiving of waiting period of 30 days from the date of purchase of policy for making a claim as well as the waiving of two years waiting to make a claim for a pre-existing disease.
    • Those that need policies with higher coverage or coverage for large families may find that private insurance providers offer more flexible terms.
    • Hospital networks of nationalized companies are sometimes divided into zones and policyholders may be required to use only zonal medical facilities to avoid co-payment.
    • The type of no-claims bonuses offered may also vary between private and public company products. Some private companies also offer other attractive features such as free yearly health checkups for family members insured under a family floater, automatic enhancement of the sum assured for a claim free year and so on.

    Should you buy health insurance from government companies or from private insurers?
    It is important to remember while private and government companies do differ, there are other aspects to keep in mind: check out the company’s claim settlement ratio. This indicates how many payouts were made by the company vis-à-vis claims made by policyholders. Also check what user reviews say about the ease of doing business with the company and their overall experience. If you come across several pending online consumer complaints against a particular company, this should give you pause for thought.

    In conclusion, remember, the individual policy features, inclusions and exclusions may be more important than whether you decide to buy health insurance from a government company or a private insurer.

    #Most effective ways to reduce the premium of health insurance
    As an insurance buyer, one would presume that health insurance premiums are not negotiable and that there is no way to pay lower premiums than the amount quoted by the company. While this is largely true and it is unlikely that an insurance company will negotiate with a policy purchaser to lower premiums, there are other ways to make your health policy cost effective. We look at the most effective ways to reduce health insurance premiums:

    • Buy insurance early in life – Insurance companies like to encourage people to buy insurance early in life; so the younger the policyholder, the lower the premiums are. Since younger people present lower risk of medical and because buying insurance early means more number of premiums paid, premiums are lower for younger people.
    • Examine loading features – Some health policies increase premiums when the policyholder makes a claim in the previous policy tenure. However there are service providers who assure reloading of 100% of the assured sum. Alternatively, look for health policies that guarantee no increase in premium amounts for a certain number of years.
    • Buy a family floater plan rather than individual plans – Family floater plans cover all specified members of the family under a single plan; for the payment of one premium. Any and all of the covered individuals receive benefit and under a floater plan. A family plan can include children, aged parents and in some cases other relatives as well. This can significantly reduce health insurance premiums vis-à-vis buying multiple policies. It can make more sense to buy one high value policy for the entire family because it is quite unlikely that the entire sum assured by a high limit policy will be consumed by a single person (under an individual plan).
    • Choose longer policy tenures – Though health insurance policies are generally issued for one year, many service providers do issue two year policies as well. Opting for a two year plan could help to reduce premiums as well.
    • Opt for co-pay – Some health policies have a co-payment clause that requires the policyholder to pay a certain amount of the total claim while the rest is paid by the insurance company. For instance a 10% co-pay clause in a health insurance policy would mean that if there is claim made for Rs 1 Lakhs, Rs 90,000 would be paid by the insurance company while Rs 10,000 would have to be borne by the policyholder. A co-pay clause could help lower premiums.
    • Increase your voluntary deductible - A voluntary deductible is the portion of claim not covered by the policy. A policyholder could opt for a deductible such as this: if a claim is made to the tune of, say, Rs 50,000 under a policy, the insurance company does not pay. If the claim is higher, the policy is triggered and the insurance company pays. So co-pay features and higher voluntary deductibles could be some effective ways to reduce health insurance premiums.
    • Opt for policy top-ups – A top-up can be used to increase the assured limit under a chosen plan. It can be used to supplement an existing employee health benefit plan. A policyholder can also opt for a regular plan with a higher deductible limit; where if the claim is above the deductible limit, the insurance company becomes liable increase the total sum assured by a fixed amount.
    • Opt only for necessary riders – Optional add-on features or riders of a policy do help to increase coverage and provide protection for a wider range of medical problems. However these can also increase your premiums. Several riders may look attractive but may be unnecessary for your requirements. Ensure that you pay only for the riders that you envisage you will need to keep your health premiums low.
    • Look out for policies with attractive no-claims benefits – Insurance companies reward policyholders and encourage them not to register and make claims by offering various no-claims benefits. These benefits could be in the form of an automatic increase in the total sum assured by a certain percentage without the premium being hiked to the same extent. Some service providers may also offer a discount in premiums if no claims were made for a specified duration. At times, low value claims may also mean that the no-claims bonus still applies. Such no claim benefits can also help to reduce your health insurance premiums.
    • Keep yourself in good health – It goes without saying that you should try and keep yourself and your family healthy so that you lower the chances of falling ill and having to make a claim under your health policy. Some health policies offer value added services as part of the policy, that can also help one stay healthy; take advantage of these features. For instance, the Aditya Birla Activ Health Essential plan offers a Chronic Management Program to control chronic ailments, a wellness coach facility to keep policyholders healthy. Many insurance programs also offer free yearly health checkups which can help to detect disorders or disease early.

    Organize your insurance purchases and tweak your policy in a way that best suits your requirements and reduces health insurance premiums to the extent possible.

    #Does a cheaper premium a guarantee of best health Insurance Plan
    Everyone wants to be assured about the health and safety of family so in such cases and therefore these health insurance plans have emerged as a perfect option for the people. In the markets, you will find various kinds of health insurance plans and also the opportunity to choose one from these plans according to your family health and safety requirements. It is very important to choose the desired benefits for a safe future of your loved ones. It is very important that you consider your requirements and financial position to choose the best health insurance plan.

    When it comes to choosing one of the best health insurance plans, most people prefer the plans that come with extremely low premiums. If you are also looking to invest in the best health insurance plans, you should avoid the idea of picking one of those having cheaper premiums. There are many more factors that you should consider to get the best benefits in any emergency situation with your health insurance plan. If you are also looking to choose the best health insurance plan, here are some tips that you can use to get the best benefits and to invest with perfect premium in these plans:

    • Your health and medical requirements in the future:
      When you are going to choose any health insurance plan, it is very important to consider your health and medical requirements in future. If you are choosing the health insurance plan that has cheaper premium than your requirements, then this health plan will not be beneficial for you and will not guarantee your health and medical requirement satisfaction in the future. If you are able to buy best health insurance considering your future medical requirements, you will find the perfect premium for your plan depending upon your requirements.
    • Claim settlement record of company:
      You should not only choose the health insurance plan with a justified premium, but also consider the insurance plan with a highly reputable insurance company. If you want to choose the best company to buy a health insurance plan, it will be a better if you could check the claim settlement record of the insurance companies. By assessing the company’s claim settlement record, you will be able to know if the company is worth investing your hard-earned money or not. It is a good option to choose the services of a company having higher claim settlement record, but it should not be too high because in that case, it might symbolise a loss that company will face in the future.
    • Ability to pay premium:
      If you are able to pay high premiums for your health insurance plan, you should not go with an insurance plan with cheaper premium. By choosing a health insurance plan with high premium according to your financial ability, you will be able to find the perfect benefits in cases of any medical emergency with the help of your health insurance plan. If you are not able to pay high premiums of your health insurance plan, it will be a good option to consider health insurance plans that come with cheaper premium options.
    • Feature of add-on in your health insurance plan:
      If you are going to choose the health insurance plan having lower premium rate, then you should always make sure that you are getting the facility of add-on in your cheap health insurance plans. By getting this feature of add-on, you will be able to extend your premiums in your medical insurance plans, whenever you realise that you need more cover during any medical emergency situation.
    • The cost of medical services in your city:
      In every city, you will find medical services at different costs. Therefore, it is very important that you consider the cost of medical services in your city 10-15 years down the line and then, choose the perfect health insurance plan with proper premium according to your medical service requirements in the future. If you think that you’ll medical services at higher cost in your city in future, it will be a good option that you avoid those health insurance plans that come with cheaper premium option. In that cse, you should choose the best health insurance plans having higher premium to ensure your complete medical safety in future.
    • Always get health insurance plan with future prospective:
      When you are going to choose any health insurance plan, it is always important that you can keep the future prospective on the top of your mind. You may need any medical emergency situation in future and it will be better to choose the perfect health insurance plan that can cover your medical situations arising in the future as you grow old. You can also choose combo plans for your complete family as top health insurance plans with the best health benefits.

    You should not only go with cheaper premium health insurance plans, but also see the overall benefits of your health plan. If you need better cover with your health insurance plan in the future, it will be a big mistake to choose health insurance plan with cheaper premium. If you are not able to pay high premiums in your health insurance plans, then you should choose the perfect health insurance plans having cheaper premium according to your requirements.

    #Are Pre & Post hospitalization expenses covered in Health Insurance Policy?
    Are you searching for best insurance plan to get health benefits in any emergency situation or medical situation? When it comes to choosing a perfect health insurance plan, everyone wants to get an all-inclusive medical cover and several benefits with such plans. You will find the option of choosing from many health insurance plans offered by different health insurance companies. Every health insurance company has different terms and conditions and you will find different benefits in the plans of every company.

    When you are going to choose any health insurance plan, it is very important that you know about all the health benefits and emergency benefits of the plan. With every health insurance plan, the company will provide complete expenses related to hospitalization of the patient. If you are choosing any health Insurance Policy, you always want to be assured that it covers your pre and post hospitalization expenses other than several other things. It is one of the most common questions that whether pre and post hospitalization expenses are covered in a particular health insurance policy or not? If this question comes in your mind too, here are some facts that you should know about your health insurance plan.

    • Choose perfect health insurance plan according to your premium ability:
      When you want to choose a health insurance plan, you will find an option to choose from various health insurance plans that have different benefits. If you want to get the best health benefits during emergency medical situation, it is very important to choose a perfect health insurance plan to get the desired insurance cover with low coat premium. With health insurance policies, you should also know about the premium ability because you will need to choose the health insurance policy with different premium options. If you can pay higher premium for your shortlisted policy, you should not choose the premium plans with cheap premiums to ensure your health benefits.
    • Know about pre and post hospitalization expenses in your insurance plan:
      If you do not want to face any problem during any medical emergency situation, it is very important to know if your health insurance plan covers the pre and post hospitalization expenses according to your needs. It is not necessary that every health insurance plan will provide the facility of paying all your pre and post hospitalization expenses so you should choose a plan in which you can find these facilities. While choosing any insurance plan, you should ask the agent about the cover of pre and post hospitalization expenses in your health insurance plan.

      There are several pre and post hospitalization expenses that would like the insurance company to cover in its health insurance plans. In pre hospitalization, most of the companies include diagnostic charges, doctor’s fees, and medicine costs during 30 days before admitting to the hospital. For post hospitalization, they include charges of investigation tests, doctor’s fees, and medicine costs for up to 30/60 days from discharging date.

      Most of the people do not consider this factor when choosing an insurance plan, but according to the experts, it is very important to consider this factor to ensure your satisfaction with the insurance plan. The reason is these expenses can be very high with different diagnostic tests and very expensive medicines. So, it is very important that you can confirm if your health insurance plan have the cover for pre and post hospitalization expenses.
    • Claim settlement percentage of company:
      f you want to know how to choose the best health insurance policy, it is very important to get the services of a company having higher claim settlement percentage. If you do not want to face the situation of facing claim rejection during any emergency medical situation, it is very important that you know about the claim settlement record of the insurance company before getting the services of the health insurance. If you are choosing the services of a company having high claim settlement record, make sure that they also provide the clause of handling your pre and post hospitalization expenses completely in your selected health insurance plan.
    • Read all the terms regarding pre and post hospitalization expenses:
      It is seen that mostly insurance agents will not clear all the terms and conditions about the pre and post hospitalization expenses in your health insurance plan. If you want to be assured about these expenses in your health insurance plan, it is very important to read all the terms and condition regarding pre and post hospitalization expenses policies of your insurance plan. You can also confirm by asking the insurance agent when choosing any health insurance plan, if they are providing the option of pre and post hospitalization expenses in the plan or not.

    These are different points that you should consider while choosing any health insurance plan. It is very important that you choose the best health insurance plan having all kinds of pre and post hospitalization expenses covered in it. These days, you will find that pre and post hospitalization expenses are more expensive than the medical charges during hospitalization. So it is very important that you can choose the perfect insurance plan according to your requirements and your needs.

    If you want to search for the best health insurance plans, it is a perfect option that you can get online services to compare best health insurance policies. You can also see all the additional benefits like pre and post hospitalization expenses in different health insurance plans of different health insurance policies by comparing them online.

    #Is it compulsary to get admitted in the hospital to take claim nay type of health insurance Claim?
    Everyone wants to choose a perfect health insurance plan to ensure complete claim settlement in any medical emergency. Are you sure you will be able to claim your health insurance in every situation related to medical emergency? There are different terms and conditions of every insurance company that you should know when you are going to choose any health insurance plan. If you want to get complete benefits of your health insurance plan, it is important that you choose an insurance plan that has all the benefits according to your present and future requirements.

    Everyone has different requirements and needs during medical emergency. With the help of your medical insurance plan, you will be able to get help during any medical needs. It is very important to know about the steps to file health insurance claim and to know about the terms and conditions to comply with for health insurance claim. There are many people, want to know whether they will be able to claim their health insurance when the patient is not hospitalized during any medical condition. Here are some facts that will help you to claim your health insurance during medical emergency:

    • It is not mandatory to hospitalize the patient:
      It is one of the most common and biggest myths about health insurance plans that it is compulsory to hospitalize the patient to claim the health insurance reimbursement. If you are looking to get any medical service from any individual doctor and you are not going to any hospital for it, you will still get the benefits from your health insurance plan. Most of the insurance companies and agents will not tell you without you asking about this particular clause. Because of this, most of the people think that it is compulsory to hospitalize the patient to claim health insurance.
    • One day hospitalized terms:
      In the terms and conditions of many health insurance companies, you will find the option to cover health insurance, if the patient is hospitalized for the minimum of one day. Every health insurance company has different terms and conditions and it is very important that you know about these one-day hospitalization terms and conditions when you are going to choose any health insurance plan. You should also know if they are providing the health insurance claim services without any hospitalization or they have the terms of one-day hospitalization for the claim process of health insurance plan. According to a recent verdict given by a court, it is not important to hospitalize the patient for any health insurance claim.
    • The medical bills are necessary:
      When you want to claim your health insurance, it is very important that you can show your bills and medical expenses to your insurance company to claim your health insurance. In the health insurance claim process, they will always ask for the medical bills and several other medicine bills given by the hospital. If you are not hospitalized, you will need to get the proper medical bills of medical store or any clinic to claim your health insurance. If you want to claim your health insurance without any hospitalization, it is important to provide the medical bills and clinic bills to your health insurance company.
    • Always read all the terms and conditions about claim process:
      When you are going to apply for any medical insurance plan, most of the people do not take it as a serious thing to read terms and conditions given by the company. There can be different hidden terms and conditions of any investment company that you should know about the claim process. If you want to be assured about the claim process of insurance company, it is very important to read all the terms and conditions of company carefully. You can also ask the experts of insurance industry or your insurance agent about the terms and conditions of the health insurance claims.
    • Be assured about pre and post hospitalization policies:
      In your health insurance plan, you should not only know about the conditions for hospitalization. It is also important to know about all the terms and conditions related to pre and post hospitalization. You will need the insurance claim for pre and post hospitalization charges. In the charges, you will cover the expenses like all the diagnostic tests and all the medical medicine bills. It is very important that you can know about all the details of the claim process related to pre and post hospitalization when you are going to choose any insurance plan.

    These are different conditions to claim your health insurance plan during the different hospitalization conditions. If you are also looking to know about the complete benefits with your health insurance plan during hospitalization or without hospitalization, it is important to know about all these terms and conditions that your health insurance company offers to you.

    Every company has different plans and terms. When you want to choose health insurance plan with any company, it is very important to know about the hospitalization terms and claim process in different conditions. It will be helpful for you to manage with your health insurance plan during any medical emergency.
    #What are the exclusions in the health insurance policy
    Everyone wants to keep the health in perfect condition and wants to give priority to health over many other things. It is not possible to stay fit and healthy all the time, but it is definitely possible to compile plans to ensure better health by getting health insurance plans. Many health insurance companies are providing different health insurance plans and policies according to the needs of the people so that they can be assured about better medical services in the future. These health insurance plans are designed to help you cover your medical expenses and hospitalization expenses during any emergency medical situation.

    Limitations and exclusions of health plans:
    The policyholder may be assured about getting medical expense covered by getting any health insurance plan. But before that it is important to understand whether your health policy will help you cover every kind of medical expenses or not. There are some health plan limitations and exclusions and it is very important to know about all the exclusions involved with your health insurance policy. Here are some of the common things that will be excluded and you should know while buying any health insurance policy:

    • Pre-existing diseases:
      It is one of the most common omissions experienced in most of the health insurance plans offered to you. If the policyholder has any kind of disease while getting any health insurance plan, the health insurance policy will not cover the medical expenses to treat that disease. You will have to find the option of the waiting period of 2 to 4 years, but the waiting period can change according to the type of your disease and the risks associated with the disease. Therefore, it is very necessary for you to consult your health insurance agent about the inclusion of your pre-existing diseases. They might also ask for your medical certificate prior to applying for a health insurance plan.
    • Waiting clause:
      In the health insurance policy offered to you, you might also find "a waiting clause" in certain conditions. In most of the policies, the policyholder will not get the cover immediately and he may have to wait for at least 1 to 2 months to get the benefits of the purchased policy. These conditions may not be applicable to the accidents and death cases of the policyholder. So, it will be better for you to ask your health insurance agent about this "waiting clause".
    • Pregnancy related coverage limitations (waiting clause):
      Your health insurance policy providing company may refuse to pay for the pregnancy expenses. This makes it very important to consult your health insurance company representatives about pregnancy expenses coverage in the policy shortlisted by you. In most of the insurance policies, you will find waiting period of 1 to 2 years to get the benefits of your health insurance policy for pregnancy expenses.
    • Surgeries:
      Your health insurance policy may also lack the coverage of various surgeries like cosmetic surgery, dental surgery, joint replacement surgery and a few others. If you are planning to get any surgical treatment using the medical policy, it will be better to confirm from your insurance agent if your medical health insurance is covering these surgical expenses or not.
    • Alternative treatments limitations:
      When it comes to getting treatment for any disease, you will find various alternative treatment methods of medical science. These days, people are choosing these alternate treatment methods like homoeopathic, Ayurveda, and several other similar alternative treatments. All these alternative treatment methods are also one of the most common exclusions of health insurance policy. It will be better to check if your insurance provider is offering these treatment benefits or not.
    • Additional hospital costs:
      The health insurance policies are a good option to cover your expenses of treatments, but you need to understand that you will not get the coverage of your additional hospital costs in your health insurance policy. Therefore, it is important that you know about these limitations like fees of the visiting doctors, ambulance cost, rent of the room and other additional costs of the hospital during your treatment. If you are going to use your health insurance policy during any emergency, it is very important to know about all these additional exclusions of different kinds of expenses.
    • Some permanent exclusions are :
      There are some permanent exclusion as well that you will definitely find in your health insurance policy. If the policyholder is getting any injury in war or has any congenial disease like HIV or any intentional injuries, then the expenses of their treatments will not be covered in the health insurance policy. You will always find a complete list of all such permanent exclusions while getting the services of any health insurance company.

    The mentioned are some of the most common exclusions that you will find in your health insurance policy. Every health insurance company may have different conditions and terms so it is very important to know about all the terms and conditions of your health insurance company while choosing any health insurance plan.

    It is very important to know about all the health insurance policy exclusions before choosing any health insurance plan. You should always look to ensure that all your health expenses are covered by your health insurance plan and if you are not aware of these common and uncommon health insurance policy exclusions, and then you may face some unexpected problems while facing any emergency. If you are going to choose any health insurance policy through the Internet, you will always find the option of knowing about all the exclusions of the health insurance plan that you have chosen from the website of any given Health Insurance Company.

    #Difference between family floater and Individual policy
    When you plan to get any health insurance policy, you always get confused between different health insurance plans of different insurance companies. Most of them are providing health insurance policies of two types that everyone can choose according to personal requirements. It is always one of the most common confusions about choosing a perfect health insurance plan from individual and family floater policies. When it comes to getting the best health insurance plan for your family, it is always important to do some homework to get rid of this confusion between two plans. Here are some points to clear this factor of individual vs family floater health insurance plans.

    Individual health plans vs family floater plans:
    Individual health insurance plans Family Floater Health Insurance Plans
    The individual health insurance plans are made to give medical cover during any emergency situation to each member of your family separately. In the family floater health insurance plan, only one health plan can cover all medical expenses of your family members. In this health insurance plan, you do not need to get a separate plan for each member of your family.
    In individual health insurance plan, the premium will have to be paid according to the age of every individual person of your family. The age factor will be different in different individual health plans for different members of your family. The age factor is always important when you want to compare individual versus family floater policy for members of your family. In family floater insurance plans, the premium will be calculated according to the age of the oldest member of your family. The family having young-aged members will get more benefits than the family having older members in these family floater insurance plans. If there are people over 50 years of age in your family, it will be better option for you to choose a separate plan for them and family floater plan for rest of your family.
    If you are choosing individual health plans for your family members, everyone will have different premium policies. You will find that individual health plans have more premiums for people having older people. In family floater insurance plans, only one plan will be applicable to members of your family. You will find these plans more beneficial because you will need to pay a lower premium as compared to the premium in these individual health insurance plans.
    You can apply for individual health insurance plans for any member of your family. It can be easily applicable to a wide spectrum of relationships in your family. It is applicable for everyone because every policyholder will have a different health insurance plan and will follow different terms and conditions according to various factors. When you want to get any family floater insurance plan for the members of your family, you always need to know about the spectrum of relationship according to terms and conditions of the insurance company. Most of the companies provide the option of covering your parents and kids as well in such plans while you can add your grandparents and in-laws in policy with some other insurance plans.
    In individual health policies, every member of your family will have a different insurance plan and can claim the plan according to the terms and conditions of the company whenever you need it. In family floater health insurance plans, if one family member will claim the insurance benefits, the insurance company will nullify the entire no claim bonus for 1 year.
    You do not need to consider the age of any children in individual plans because the health insurance companies have their own terms and conditions about age factor of the children in such plans. While choosing any family floater plan for your family, you will need to consider the age of the children in your family to be covered in your insurance plan.
    Individual health plans are considered for more freedom of every member because of a unique and separate health insurance plan for every member of your family. The family floater policy can be considered for your complete family and you will find more premium benefits with this insurance plan. It is very important to consider different terms and conditions to clarify every factor about these plans for different members of your family.

    These are different factors that you should consider when you are going to choose any plan for your family members. It is very important that you consider your needs and requirements when you are going to choose any health insurance policy for the family. Whether you want to choose any individual health insurance plan or you want to prefer any family floater plan, you can use online and offline methods for applying in any of these insurance plans. It is very important to know about all exclusions and terms about both plans to ensure your secure future.
    #Who all can be included in a family floater policy?
    When it comes to securing the future and financial condition of your family, it is always the best option to choose a good health insurance plan for your family members. With these health insurance plans, you can easily get remarkable amount of help during any emergency medical situation and you can be assured of a giving a better future to your family. When you want to search for a perfect plan for your complete family, you always need to choose between individual health insurance plans and family floater plans.

    One plan for all members of your family:
    The family health plan can be an ideal option if you want to choose one plan for all the members of your family. In these insurance plans, you will see one plan covering multiple members of your family. Any member of your family can use the coverage amount of this insurance plan within the given time and according to the terms of the insurance company. These days, most of the people prefer family floater plans to ensure the complete safety of their family. In these plans, you will also find many premium related benefits as compared to buying an individual plan for every member of the family.

    Members you can include in these family floater plans:
    The family floater plans are offered commonly by most of the health insurance companies these days. Every company has its own set of terms and conditions to follow in terms of adding more family members in your family floater plan.

    You will be able to include self, spouse, up to four kids, parents in law and even grandparents in some cases, in these plans. At the time of choosing any family floater plan, you will be offered the option of adding the following members into one family floater policy:

    • In a family floater plan, you will find the option to include your family members having the age of up to 60 years, but this has no more remained a stipulation these days.
    • If you wish to secure the future of your family, buying one such plan would be the wisest decision you would take in your entire life.
    • The policyholder will get the option of adding his/her spouse to this family floater plan.
    • Similarly, he/she can also add his/her dependent children in this insurance plan. Most of the companies provide the option to add maximum of 4 kids in a family floater plan.
    • The policyholder will also find the option of adding his/her parents in family floater plan if they are dependant and not availing any government medical reimbursement facility. In the family floater plan, the premium will be calculated based on the maximum age of the person added to the plan and they could be parents as well.
    • Some companies also provide option to add the grandparents and in-laws in these family floater plans. In case if your plan does not have this feature, you will need to choose a separate individual plan for such members of your family. You should know about conditions to include them in family floater health insurance if they are living with you as a part of your joint family.

    You will find the option of getting a separate family floater health insurance plan for these members of your family. Most of the companies do not give the option to include the family members having a relationship of a wide spectrum. If you have any family member in a wide spectrum relationship, you will need to choose a separate individual plan for that family member.

    Age factor in family floater plans:
    If you are planning to get a family floater plan to get insurance coverage during an emergency, it is very important that you know about the age factor included in a family floater medi claim policy. As said above, in these plans, the premium is often calculated according to the age of the eldest member in your family added to the family floater health insurance plan.

    For example, if you have 4 members in your family and the oldest family member is aged at 55 and others are aged below 35 years, you will need to pay the premium on the basis of age of the 55 years old member. The health insurance companies give the option of paying more premiums for the people having an older age.

    If you are going to choose any family floater plan, it will be a good option that you can exclude the oldest member from that plan and choose a separate individual plan for that left out person of your family. It will be helpful for you to save money on the premiums of the best mediclaim policy for family. It is also important to know about different terms and conditions about the age of your children and family floater plans. When you want to find a separate individual plan for your children that are above the age of 18, you should know about different terms and conditions of the insurance company about switching of the plans.

    Choosing a perfect family floater plan:
    When you want to choose one of the best health insurance policy for family, it is very important to compare various family floater plans offered by different companies active in the markets. Every health insurance company has a different set of terms and conditions to comply with and you can easily get more benefits and liberty by choosing a better family floater plan by comparing the plans presented to you by your insurance agent. You will find the option of applying for the best insurance plan online as well as offline with the help of a reliable insurance agent. It is very important to know about all the terms and limitations of the chosen insurance plan while choosing any family floater plan.

    #Do's and Dont's while buying health Insurance online
    It is always said that health is wealth and it is imperative to secure your health by getting a perfect health insurance policy. These days, people consider health insurance policies to protect the future of their family. They can give the best treatment by getting a claim in any emergency medical situation. Make sure to get a good health insurance policy with a trusted health insurance company. When you want to get any health insurance policy, you will find the option to choose from a good deal of health insurance plans with different companies. You always have the freedom to choose the perfect insurance plan according to your future needs.

    You can apply for health insurance plans using online and offline methods. Online process has become the easiest and fast options to choose any health insurance plan. You can easily pay premium and track your status online. When you apply online for any health insurance plan, remember to keep in mind some dos and don'ts for health insurance. Here you go with the standard tips that help you to choose perfect health insurance plan online:

    Dos while buying health Insurance online Don't while buying Health Insurance online.
    When you are going to choose any health insurance plan at online websites, it is vital to make some market research. You will find many options in the market, and every company will provide different benefits under different health insurance plans. It is critical to research and to choose a better plan to secure your future. Spend some time and take a decision. When you want to choose any insurance plan, never get carried away by the attractive advertisements of insurance companies. You should never pick any insurance policy based on the ads. It is important to do some research to find the best benefits of your health insurance policy.
    When you are buying health insurance plan, it is always important that you read all terms and conditions of company related to your health insurance policy. When you read terms and conditions of the company, you will be able to understand all limitations and benefits of your policy in a better way. Don’t blindly trust any insurance agent. Insurance agents may not always provide all details. Selling the policy will be the prime motive of some agents. They may not explain you the details thoroughly. You should never avoid reading the terms and conditions of the company when you want to reap benefits of health insurance policies.
    If you want to get all benefits of your health insurance policy, then consider your needs and requirements. To protect your future before picking a perfect plan that covers all your needs. While buying health insurance plan, you should never choose the plan just because someone else has chosen it. Each will have a different requirement. You must make a decision based on your family situation and need.
    It is essential to know about limitations and pre-existing conditions of your health insurance policy. If you are buying health insurance online, then it is imperative to read all terms and conditions related to pre-existing conditions and excludes of your policy. If you are unable to know about excludes and pre-existing conditions of any health insurance plan on the website of the company, then better stay away from that plan. When you feel that insurance company is hiding terms and conditions related to the excluded, then straight away reject that plan.
    If you are applying for any health insurance using online websites, then you should upload all required and genuine documents. It is also important to provide your current health certificate with all these documents. Updating them with your current illness can help you identify the right plan. You should never hide your current medical condition when you are applying for any Health Insurance plan at online websites. Don’t hide your medical history and the health certificate that has the details of your current health condition.
    When you are going to choose health insurance using online websites, it’s nice to compare the coverage details and premiums of different companies and select the plan that suits you the best. Comparing different plans will provide you more insight into the policies. If you are going to choose online health insurance plans, then you should never hesitate to ask questions to online help center of the company. If you are unable to understand any plan, then better do away with that plan

    These are the essential dos and don’ts that you must consider and know how to buy health insurance to reap the maximum health benefits according to your requirements. If you can choose the perfect health insurance plan using online websites, then you can secure the future of your family. Put some efforts one time to enjoy benefits for life time.
    #Benefits of renewing your health insurance policy on time
    If you have taken health insurance policy for your family, then you can get help during any emergency medical situation. You can secure the future of your family with health insurance plan. Make sure to renew your health insurance policy to get the complete health benefits and coverage during any emergency. Most of the people understand the importance of premiums, benefits, and coverage of insurance policy, but they fail to renew the health insurance plan on time.

    Everyone wants to get all the advantages of health insurance policies at the time of claiming for any medical emergency. When you renew your health insurance plan on time, the insurance company will give you following benefits with your health insurance policy:

    • Related to waiting period:
      When you choose any health insurance coverage, the company will provide you with a waiting period between 30 and 90 days for the coverage benefits. If you are not renewing your health insurance policy within the given time, then you may need to go through the waiting time again. You will not be able to get coverage benefits during the waiting period. If you do not want to face waiting time again, then from next time you can also pay your premium by choosing to renew health insurance online.
    • Get no-claim bonus:
      If you are not claiming your health insurance, then Health Insurance Company will reward you with claim bonus every year. If you do not want to lose your claim bonus, then you should never ever let your health insurance policy lapse. Your bonus will be added to your sum assured, and it can be between 10 – 50 % of your sum assured. Never lose your no-claim bonus. If you religiously renew your health insurance policy on time, then you will be able to find all these bonus benefits on your sum assurance.
    • Pre-existing diseases:
      As you know, the health insurance company will not give you coverage benefits for any pre-existing condition during the waiting period. If you are not renewing your health insurance policy on time, then you will not be able to get coverage benefits for any pre-existing illness. To get health benefits for your pre-existing diseases, you should always renew health insurance policy on time and never face the waiting time again.
    • The premium of policy:
      Your age and medical history will be taken into account, and the premium amount of your policy will be calculated. With increasing age, your premiums will also rise. In such cases, the cost of your new policy will be higher than your current policy. If you do not want to pay an extra premium for your new policy, then it is important in understanding health insurance renewal benefits.
    • Benefits in claim settlement:
      If you pay all premiums on given time and renew your health insurance policy on given time, then you will be a trusted client of Health Insurance Company. It will be beneficial for you during the claim settlement process. If you pay your health insurance policy on time, then you will find it easy to claim your insurance coverage at the time of any emergency situation. This reason reminds you as to why you should renew your health insurance on time.
    • Enter in grace period:
      If you are unable to renew your health insurance policy on given time due to any emergency reason, then the company will still give you the option to renew your policy in the grace period. This grace period is given up to 30 days. If you are paying the premium during the grace period, then you may not lose any of benefits offered by your insurance company. You should always understand the importance of renewing the health insurance policy on given time. But remember, you will not be able to get coverage of hospitalization expenses during the grace period.

    These are some standard benefits of renewing health insurance policy on given time. If you are looking to choose the simplest and fastest option to renew your health insurance policy, then go for the online services. You will be able to pay and renew your health insurance policy from anywhere by using online services.

    After knowing all these reasons, you should never miss to renew your health insurance policy. By renewing your health insurance policy at a given time, it will not only be easy for you to get all the benefits of your health insurance policy, but you can also get the complete coverage. If you are unable to remember the date of renewing for your health insurance policy, then you can easily set a reminder using your phone these days. With the advancement in technology, it has become straightforward to renew your policy at the right time.

    #What are the lesser known benefits of Health insurance
    It is one of the most valuable assets to secure the health of your family. Everyone wants to protect the future of their families. When it comes to ensuring your family health, perfect option is to choose the right health insurance plan. These days, you will find various options from which you can pick the perfect health insurance plan according to your family medical requirements. Whether you are searching for an individual plan or you want to get one plan for your entire family, every plan is available on the market according to your desires.

    Benefits of choosing Health Insurance plans:
    It is impossible to stay fit for a lifetime because the health problems are increasing day by day and you will need medical treatment for all illness. There can be other emergency health concerns caused due to accidents and injuries. If you are choosing any Health Insurance, then you will be able to get claim during any medical emergency situation. You can also avail other benefits of health insurance. Apart from all these advantages, there are some more additional benefits of health Insurance which you must understand. If you also want to know about what are the lesser known benefits of health insurance policies, then here you go with the benefits of which you should be aware:

    • Lifelong renewal benefits:
      Every health insurance company has different terms and conditions related to the age of the policy holder. With most of the policies, you also get the lifelong policy renewal option. If you are using this feature of your policy, then you can use your health insurance plan even at the age of 90 years. The premium will get appraised along with your age in your health insurance policy.
    • Health Restoration benefits:
      When you choose any health insurance policy, you will find many facts about health insurance and benefits. They always provide the medical help whenever you need at any emergency situation. If you are hospitalized for more than ten days, then you will be able to make use of restoration benefits with your health insurance policy. According to these restoration benefits, the insurance company will take care of your household expenses until you get back to normal health.
    • Alternative treatment services:
      When you are looking to get information about the hidden benefits of health insurance, you should also know about the factor of alternative treatment services. Almost every company consider the alternative treatment methods like Ayurveda and homeopathy as exclusion from medical health insurance policy. But you should know that some selected companies like National Insurance have already included the alternative treatment in medical cover with a set of conditions. IRDA is going to make some changes in terms and conditions of companies for alternative treatment services.
    • Top up benefits:
      Every individual goes through many changes in life by getting married and giving birth to kids. You always want to get health cover benefits for the new members of your family. It is also available in health insurance policies: lesser-known benefits where you can use the top up benefits and add new family members in your family insurance plan. You will also find the option to get a separate plan for new members of your family, or you can add all members to your existing plan based on the terms and conditions of the company.
    • Medical concierge services:
      According to these services, you will get the personal assistance in case of any illness. In these lesser known benefits of the health insurance, they will also provide help to contact and get an appointment with the medical professionals. They will also help in different tasks like making bills and prescriptions when you face any medical condition. Saving your time and efforts is beneficial at the time of medical emergency. This benefit is getting popular across the world and yet to get implemented in India.

    These are the 5 lesser-known facts about buying health insurance that you should always know when you want to ensure the safety and security of your family with health insurance plans. Most of the people and policy holders are not aware of these facts of health insurance policies.

    When it comes to getting any health insurance policy, you will find that most of the companies have different terms and conditions for various plans and policy holders. When you spend time and read the terms and conditions of the policies, you will be able to know about all the unknown facts in any company’s insurance policy. Many companies gives importance to the sell the policies, and fail to provide the complete details regarding the hidden terms and conditions to their clients. You can know all facts and terms of your insurance policy by using online services at the website of the company.
  • Q: What is health insurance?
    A : This type of insurance offers protection against medical expenses. A policyholder pays a certain premium and the insurance provider company pays for certain covered medical expenses that may be incurred while the policy is in force.
    Q: What do health insurance policies cover?
    A : General health insurance policies cover medical expenses such as hospitalization room rent, doctor’s fees, surgical expenses, nursing charges, prescription expenses and so on. Related expenses incurred 30 days before hospitalization as well as recuperation, consultation fees, medications and other expenses incurred 60 days after discharge from hospital, known as pre and post hospitalization expenses are also covered.
    Q: What is a health insurance policy?
    A : The document issued by the health insurance company upon payment of premium is the health insurance policy. This constitutes the contract that is binding on the company as well as the policyholder and sets out all the terms, conditions, inclusions and exclusions of that contract.
    Q: What are medical expenses?
    A : These would include expenses incurred as a result of illness or accident during the policy term: hospitalization pre and post hospitalization expenses such as doctor's consultations, diagnostic or lab tests, follow-up tests and specialist consultations etc.
    Q: What is room rent?
    A : The amount payable per day of occupying a hospital bed is known as room rent. Some policies have a cap on the amount of daily room rent while others do not. A health policy may also clarify terms such as “private room”, “semi-private” or “shared ward”.
    Q: What do health insurance policies not cover?
    A : General health insurance policies do not cover critical illnesses, day care procedures and domiciliary hospitalization expenses. They will also not pay for expenses incurred in respect of preexisting diseases for a certain length of time (usually two years) after the start of the policy.
    Q: What are daycare procedures?
    A : Daycare procedures are medical procedures that do not require hospitalization for more than 24 hours such as cataract, laparoscopic procedures, keyhole surgeries and other minimally invasive procedures. General health plans do not cover these unless expressly stated or opted for as add-on.
    Q: What are domiciliary hospital expenses?
    A : At home hospitalization is referred to as domiciliary hospitalization: where treatment is to be undergone in non-hospital settings because of unavailability of a hospital bed or upon medical advice.
    Q: What is a family floater plan?
    A : A family floater plan covers all members of a family under a single plan and premium. While the most typical floater plan covers spouses and their children, plans can also cover seniors such as dependent parents. Joint family plans which provide coverage for parents, in-laws, brothers and sisters etc may also be available.
    Q: What other types of health plans are available in India?
    A : Apart from individual and family floater plans, the policyholders can opt for the following:
    • Maternity insurance plans to cover pregnancy and childbirth related expenses
    • Personal Accident plans that offer lump sum or income replacement in the event of part or permanent disability arising from an accident
    • Senior citizen plans for older people or dependent seniors
    • Top up plans to supplement an existing health insurance plan or employer provided coverage
    • Hospitalization daily cash benefit plans could be bought separately or as an add-on to an existing plan. Under such a plan, a predetermined amount is paid regardless or actual expenses incurred
    • Disease specific plans that offer care at all stages (early or advanced) for specific medical conditions such as Dengue Care plan, heart disease plan, cancer care plans etc

    Some or all of these may be available as add-on plans as well.
    Q: How are health insurance premiums calculated?
    A : Health insurance premiums are calculated based on the age of the policyholder, the number of people covered and their age, add-ons or riders opted for, overall health and health history, pre-existing diseases (if any) and any other factors that could impact perceived risk. The number of claim-free years also impact premium payable.
    Q: What is cashless treatment?
    A : Cashless treatments mean that policyholders can receive treatment without having to make upfront payment when getting admitted to a hospital. The insurance company pays directly to the hospital or medical facility.
    Q: Is cashless service available everywhere?
    A : Most health insurance companies have a network of hospitals and diagnostic centers with which they have a tie-up and where policyholders can avail cashless facilities. The hospitals and diagnostic centers and the number of such facilities in the insurance providers’ network vary from one to another service provider. These are usually private health care facilities and not government facilities such as AIIMS or TMH or Army Research and Referral.
    Q: How does a policyholder make a cashless claim?
    A : The policyholder has to inform the insurance company about emergency hospitalization within a period of 24 hours of being admitted into hospital. For planned hospitalizations, the insurance company has to be informed in advance of being admitted. Such notice must be given to the insurance company or to the TPA in the manner prescribed.
    Q: What is reimbursement?
    A : When an insured individual has to undergo treatment at a hospital or medical facility not on the network list of the insurance company, cashless treatment is not available. In such cases, the insured person would have to make all payments and then make a claim for reimbursement, along with all original treatment papers. Reimbursement claims may take time to settle and may also be subject to co-payment.
    Q: What is copayment?
    A : Some policies have a co-payment clause which requires the policyholder to bear a certain percentage of the expenses incurred towards treatment. Using a hospital or medical facility not on the insurance company’s network list, or one that is outside the zone opted for, could invoke this copayment clause. Copayment is often also applicable to health insurance for senior citizens. In India, health insurance providers such as SBI General Insurance, National Insurance and so on, often have a copayment clause.
    Q: What is classification of zone?
    A : Some health plans (typically nationalized health insurance companies) have a concept known as “Classification of Zone” (check the terms and conditions of the National Parivar Mediclaim Policy to know more) where the specific premium is to be paid in respect of the Zone opted for. The policyholder is required to avail treatment within their chosen zone and if not, the claim is subject to copayment.
    Q: What is a preexisting condition?
    A : LThe IRDA defines pre-existing diseases as “any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and/or was diagnosed, received medical advice or treatment within 48 months prior to the first policy issued by the insurer.” Health insurance policies will not pay for preexisting conditions for a specified period unless expressly covered by the policy. Usually, insurance providers will not pay for a claim made for treatment relating to a preexisting disease within 2 years of the policy initiation.
    Q: What if one already has a preexisting condition?
    A : If the person already has a medical condition such as hypertension, diabetes or heart disease at the time of buying a policy, this would count as a preexisting condition and should be disclosed to the insurance company at the time of policy purchase. Even if person has had in the past, a heart condition from which they are now fully recovered and now wants to buy a health policy, this information should be disclosed to the insurance company at the time of buying the policy. Such conditions may be analyzed by the company’s underwriters and a policy issued after assessing the risk at altered premiums.
    Q: What is critical illness insurance?
    A : Critical illnesses are generally not covered by standard health care policies. The policyholder would either have to buy a separate critical cover policy or opt for cover as an option add-on to the regular policy (with proportionate increase in premium payable). Annexure II of the IRDA Standardization Guidelines lists a number of conditions that are termed as critical illnesses: specified cancers, first heart attack, open chest coronary artery bypass graft, open heart replacement or repair of heart valves, coma of specified severity, kidney failure requiring regular dialysis, stroke resulting in permanent symptoms, major organ or bone marrow transplant, permanent paralysis, motor neuron disease with permanent symptoms and multiple sclerosis.
    Q: Do you need critical illness cover?
    A : With improved life expectancy and rising costs of health care, critical illness cover is recommended for older people and those with a family history of certain chronic conditions. Critical care cover entitles the covered individual to a lump sum payment by the insurance company upon the diagnosis of such a disease.
    Q: What is the waiting period for making claims?
    A : Usually after the initiation of a new policy, there is a 30 day waiting period before a policyholder can make a claim.
    Q: What is health insurance portability?
    A : To ensure that policyholders get the best and most cost effective health coverage, the IRDA issued a circular conferring the right of portability upon policyholders. Under this circular, policyholders are free to change their health insurance provider without losing the benefits such as no claims bonus, waiting period for preexisting conditions and so on. If as a policyholder one finds that there is a new or better product on the market that offers more features or facilities, they can port their existing policy to new service provider.
    Q: Are medical examinations necessary before buying a policy?
    A : Usually medical examinations are not necessary for policyholders under 45 years of age. Older people, those with preexisting or critical illnesses and policies with larger coverage sums may require medical exams.
    Q: Who pays for the pre-policy medical exam?
    A : The expenses of a pre-policy medical check-up or examination are usually shared. If a policy is issued by the insurance company, 50% of the expenses of such check-ups are paid by the insurance provider (usually on presentation of original bills).
    Q: How long is a health plan valid?
    A : Health plans are usually valid for one or two years, after which they have to be renewed.
    Q: What is the grace period?
    A : A grace period of 15 days after the expiry date of a policy is usually available to the policyholder to renew their policy. The policy will lapse if renewal premium is not paid within the grace period. The period for which premium is not paid is not covered by the health policy.
    Q: Is there a limit to the number of claims made during a policy period?
    A : In most cases, the policyholder can make any number of claims during the policy period (unless the policy provides a specific cap to that number). However, each time a claim is made, the total sum assured is proportionally reduced. The total amount payable by the insurance company will not exceed the maximum limit specified.
    Q: What is a lifelong renewable policy?
    A : While some policies cannot be renewed after the insured person reaches a certain age, lifelong renewable policies have no such limitation. The insurance company will renew the policy as long as the person lives. This is important so that a person has health insurance during the later years of life when disease and chronic illnesses are most common.
    Q: Who is a medical practitioner?
    A : Health insurance in India deals principally with allopathic procedures and practitioners (alternative treatments such as homeopathy, ayurveda, Unani etc treatments are excluded unless specifically included). A medical practitioner is one who holds valid registration with any state medical council of India; including general practitioners, specialists, surgeons, pediatricians and so on.
    Q: What about AYUSH treatments?
    A : Though health insurance plans typically cover only allopathic treatments, it is now possible to get coverage for AYUSH (which stands for ayurvedic, yoga, Unani, Siddha and homeopathy) treatments as well. Several insurance providers now offer such standalone policies for those who prefer holistic treatments based on traditional medical practices.
    Q: What is TPA in health insurance?
    A : TPA or Third Party Administrator are agencies or individuals who process health claims and make cashless facilities available to policyholders. The relevant TPA and their contact information are usually mentioned in the policyholder’s health insurance card or user manual.
    Q: Who needs overseas travel insurance?
    A : Certain countries require applicants to buy overseas travel insurance for visa approval. Frequent travelers or those with poor health / certain medical conditions should buy overseas health insurance considering the high cost of health care particularly in developed nations.
    Q: Is a health insurance policy required if one has employee health coverage?
    A : Corporate health coverage for employees may be limited or inadequate. It may cover only the employed person and not their family. The benefits would cease in the event of losing the job or upon superannuation (retirement) when entry into a health insurance policy could be very costly. Buying a health plan in addition to employee coverage could provide more comprehensive and affordable coverage.
    Q: What is no-claims bonus?
    A : Insurance companies reward policyholders for claim free years in different ways: the total sum assured may increase automatically, there could be a discount offered in terms of premium payable or certain free add-ons could be added to the health policy at no extra charge.
    Q: What are the tax benefits of buying health insurance?
    <>A : To encourage more people to buy health insurance, the government offers certain tax benefits to policyholders (who pay their own premium and do not have someone else making premium payments for them): for a policy that covers the policyholder, spouse and dependent children, exemptions of up to Rs 25,000/ are available if the policyholder is below 60 years of age. For policyholders above age 60, exemption of Rs 30,000/- is available. In addition to this, tax deductions of up to Rs 30,000/- are also available for premiums paid in respect of parents who are senior citizens (whether or not they are dependent on the policy holder). The highest possible tax deduction under Section 80D is Rs. 60,000/-.
    Q: What is the difference between Mediclaim and Health Insurance?
    A : The difference is mainly that of nomenclature. Mediclaim policies tend to be more specific and several health plans offered by nationalized insurance companies go by this name. Health insurance is a wider subject and offers a variety of customizable, comprehensive plans to suit different requirements.
    Q: What documents are required for buying health insurance?
    A : In most cases, there are no documents required for buying health insurance. Some insurance companies or TPAs may require ID proof such as PAN cart or AADHAR card however several insurance companies waive this to make it easier to buy health insurance and to streamline the online purchase process. However, such ID proof is typically required at the time of making a claim along with all relevant insurance documents and medical case papers.
    Q: Can Non Resident Indians buy health insurance in India?
    A : Yes, NRIs can buy health insurance. Whether one is studying or working abroad one can buy health insurance in the event one is visiting India for an extended period. NRIs often choose to buy Indian health insurance since medical facilities as well as coverage are much more affordable in India. Some NRIs also choose to buy medical insurance in India for their families or dependents who are residents even though they themselves may not be residents.
    Q: Who receives claim amount if the policyholder dies during treatment?
    A : The person named as the nominee in a health insurance policy will receive the insurance amount (in case of reimbursement and not cashless claims) in the event of the policyholder dying during treatment. If there is no nominee named in the policy, a succession certificate issued by the competent court may have to be produced before insurance company.
    Q: Can a policyholder buy more than one health insurance policy?
    A : Yes this is possible. A policyholder can choose to buy more than one policy from the same insurance company or from different service providers to get extra coverage. The policyholder can choose whether to buy separate policies or to choose add-ons for an existing policy.
    Q: How can a health insurance policy be cancelled?
    A : If one no longer wishes to have a health insurance policy, one can let an existing policy lapse by choosing not to pay the premium which would renew the existing policy. One can also cancel a current policy and in such cases, a policyholder would be entitled to such refund as the policy document may specify.
    Q: What If the Hospital Near Your Home Doesn’t Fall Under The List Of Network Hospital Of Your Health Policy?
    A : When choosing any health insurance policy, you should always use the option of checking the list of the network of hospitals covered by the service provider. Every insurance company has tie-ups with various hospitals all around the country. It is not possible to provide these linking services with every hospital of the country.
    • When you are choosing an insurance policy, it is very important that you check the complete list of the network of hospitals as you visit the website of the insurance company to check the online medical insurance Policy.
    • In this list, you will find an option to check all available linked hospitals of your city and you can choose the services of the best insurance company to get medical insurance services at your nearest hospital.
    • If your nearest hospital is in list of network hospitals of your health insurance service provider company, you will be able to use cashless services in that hospital during medical emergency. It is a very beneficial option of using cashless services and it can be very helpful during emergency medical situations.
    • Every policyholder needs these benefits and one can search for them when choosing private health insurance.
    • As you face an emergency medical situation, it is very crucial that you inform your insurance company and they will authorize cashless medical treatment.
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