Uncovering the Important Aspects of Health Insurance Policies
The world is changing faster; health issues are also changing from their regular form. But there is always a need for the best treatment for any health issue. In this speedy world, getting treatment for health problems has become costly in many cases. The cost increase of the medical treatments may lead to an unexpected financial burden for many people. The health issues or medical emergencies that are not expected may put an individual under sudden stress. Here is why health insurance is needed: it protects an individual from the financial burden of medical emergencies. 30 Lakh Health Insurance serves as one of the comprehensive coverages that offer many benefits.
Health insurance is an essential safety net through which the insured can protect their health and finances by paying premiums on an individual or a family floater basis. Individuals can get higher coverage at an affordable price with the help of health insurance plans in India from Star Health.
In this article, let’s discuss: what is the meaning of health insurance? Its types, benefits, inclusions, exclusions, and more.
What is Health Insurance?
Health insurance is a monetary contract between an individual and an insurance company, meant to cover medical expenses in case of sickness, accidents, or preventive treatment. In return for a steady premium, the insurer will cover all or a portion of the insured’s medical expenses, subject to the policy terms. Further, health insurance includes coverage that extends to hospitalisation, surgeries, visits to the doctor, diagnostic procedures, and even post-hospital recovery, depending on the selected plan.
The main function of health insurance is to safeguard individuals and families against the financial stress of unforeseen medical exigencies. As healthcare expenses continue to grow, even basic treatments can put personal finances under pressure. Health insurance guarantees you appropriate time and quality treatment without looking at the cost. Policies usually include advantages such as cashless hospitalisation, where the insurance company itself pays the network hospitals, and reimbursement for treatments availed outside the network. Therefore, having health insurance knowledge is significant to select a personalised plan as per the individual’s requirements.
There are numerous types of health insurance policies, such as individual policies, family floater plans, senior citizen plans, critical illness covers, and top-up plans. Each caters to different requirements and phases of life. Some also provide wellness benefits, health check-ups every year, and tax deductions under Section 80D of the Income Tax Act.
Health insurance plans are a safety net through which the insured can safeguard their health and finances by paying premiums on an individual or a family floater basis. One can get higher coverage at an affordable cost if they have detailed health insurance information. It could include waiting periods for pre-existing ailments, sub-limits on room charges or on a particular treatment, and co-payment provisions. Thus, it’s really important to go through the policy document thoroughly and select a plan that best suits your health requirements and financial objectives.
In essence, when people want to know ‘what is health insurance?’, it’s not merely a safety net-it’s an actively forward-thinking measure toward financial security and well-being. Whether you’re a career professional, parent, or retiree, the right health insurance plan ensures peace of mind and helps you receive quality care.
Why is a Health Insurance Policy Important for an Individual?
All individuals seek to acquire health insurance because it serves to provide security and financial support towards treatment when sickness strikes unexpectedly. The importance of health insurance can be analysed by different aspects, which include:
- Impairment of high medical expenses: Medical services may be very expensive, especially when it comes to cases of chronic diseases or even when one has to undergo surgery or is hospitalised. In the absence of health coverage, individuals may have to self-finance these expenses, which may lead to financial constraints or even bankruptcy. Health insurance assists in the settling of medical expenses and offers burden relief to families and individuals.
- Access to medical care promptly: Health insurance covers the cost of medical services, including outpatient and inpatient care, diagnostic services and therapies, and also preventive and promotive services that consist of routine health check-ups and assessments. This enables individuals to seek health care even when the problems are not advanced and helps to address the potential for more complex and expensive health care.
- Encouragement of preventive measures: In most cases, the insurance company provides members with services that enable them to carry out vaccinations, immunisations, physical examinations, and wellness check-ups. Precautionary measures are very effective since they can help in identifying any health issues before they get complicated. It increases the chances of improving the health status and cuts down on future health costs.
- Protection from health-related risks: Health problems and accidents are unpredictable; however, health insurance serves to lower the risk of being financially disrupted due to unprepared circumstances. Be it losing control of a vehicle, suffering from a long-term condition, or falling ill unexpectedly, health insurance assures that treatment will be provided.
- Increased access to a network of healthcare providers: Almost all health insurance policies come with a network of healthcare centres and hospital providers. Hence, it saves you paperwork hassles as your insurer will settle the medical bills with the hospital.
Advantages Of Health Insurance Plans
There are several advantages of health insurance plans that make them apt for your health insurance needs. Here are some of the benefits of health insurance.
- Your Convenience: You have many choices from the comfort of your home, so that you can save a large effort and time.
- Cashless Hospitalisation: One can benefit from cashless hospitalisation. The cashless hospitalisation feature allows insurance companies to settle medical expenses and bills directly with network hospitals.
- Cost savings: You can find out the best values for your health requirements and choose the medical insurance plan that suits your financial estimate(budget), depending on your health insurance premium.
- Easy Access to Network Hospitals: During a medical emergency, there may be difficulty in finding a hospital. A health insurance plan may help to break this difficulty.
- Cumulative Bonus Advantages: In some plans, you can get a cumulative bonus of between a few per cent on the sum insured, based on the plan that you choose. However, this feature is available only for some plans.
- Flexible Plan Options: You can choose a health insurance policy based on your needs. You may choose individual, floater, or family plans depending on your needs.
- Tax Deduction: Under Section 80D of the Income Tax Act, the premiums that you pay to maintain most health insurance policies are exempt from taxes. With some of the health insurance policies, you can claim an additional deduction per year.
However, note that these tax benefits are subject to changes in income tax laws. - Online Options: Instead of standing in long queues to buy or renew health insurance, you could opt for the online process. You could buy or renew policies online.
- Reduction of Financial Burden: Whenever you are stuck with a medical emergency where you need to pay a huge amount, it may stress you financially. At that time, health insurance may serve as a financial stress reducer for you.
- Pre & Post-Hospitalisation Coverage: Health insurance benefits for hospitalisation cover costs incurred during the hospital stay, such as room rent, doctor fees, medical procedures, surgery fees, and nursing care. It also includes pre- and post-hospitalisation expenses such as diagnostic tests and follow-up consultations.
- Coverage for Critical Illnesses: Some policies provide coverage for life-threatening health complications such as cancer, stroke, heart disease, etc. The plan offers lump sum coverage that takes care of the expensive treatment bills of the critical illnesses covered under the policy.
Some basic health insurance information needs to be known before you buy health insurance.
What must be included in your Health Insurance Plans?
Choose health insurance plans wisely by seeing what they include as per their terms and conditions. Besides, knowing health insurance’s rules and regulations is significant to avoid misunderstanding of the concerned policy. Many medical insurance plans include some necessary things. Here are the main inclusions in many health insurance policies.
- Many medical insurance plans offer coverage for the hospitalisation expenses, like room rents, ICU charges, surgery expenses, doctor consultations, incurred on illness, injury, or accidents.
- Many health insurance policies provide coverage for the pre- and post-hospitalisation expenses related to inpatient hospitalisation.
- It is wise to buy health insurance that covers daycare treatments and procedures. Day Care Treatment costs are included based on the plan.
- A few health insurance policies offer coverage for the domiciliary treatments taken at home on the advice of the medical practitioner.
- Some health insurance policies include coverage for the organ harvesting and transplantation expenses if the insured person is the recipient.
- Many mediclaim plans offer coverage for inpatient hospitalisationsdue to road traffic accidents.
- Many plans are available with the AYUSH Coverages, like coverage for the alternative systems of medicine like Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homoeopathy.
- The expenses incurred for Health check-ups are covered by many health insurance policies.
- Automatic Restoration options are when your medical expenses exceed your Sum Insured. This option is available only in some medical insurance plans.
Hence, Medical insurance is crucial to cover your medical expenses during a health emergency.
What are the Exclusions in the Health Insurance Plans?
There are a few health insurance rules that most health insurance plans exclude. They are:
- The coverage for any form of self-inflicted injuries will not be covered under medical insurance policies.
- Many health insurance plans will not offer coverage for the expenses of the treatment of obesity or weight control.
- Most medical insurance policies will not provide coverage for expenses incurred in treatment for cosmetic or plastic surgeries.
- Expenses incurred because of health risks for indulging in hazardous or adventure sports will not be covered by the Health Insurance policies.
- Dental treatment or surgery, unless necessitated because of accidental injuries and requiring hospitalisation, will not be covered by the Health Insurance Plans.
- Medical aid costs, like the cost of spectacles, hearing aids, wheelchairs, walkers, and crutches, and other similar aids, will not be covered by the health insurance plans.
Steps to Renew Health Insurance Online
Renewing your Health Insurance Online requires only a few steps. Here are the steps to renew Health Insurance Online.
- First, click on the Renew tab on the official website.
- Next, type your policy number and your date of birth.
- Now, select your plan type and the preferred Sum Insured. Then choose the option Calculate & Proceed.
- Finally, select your preferred payment method and complete the transaction process.
How to claim Health Insurance?
How one can claim on their health insurance is explained here. Below are the steps to claim health insurance :
- Choose a network hospital from the insurance provider’s network list.
- Notify your insurance company about your hospitalisation as soon as possible.
- Get a pre-authorisation form from the hospital’s TPA desk or your health insurance company.
- Fill out the form by providing any required documentation and then submitting it to the hospital’s TPA desk.
- Receive treatment at the hospital and pay any hospital bills at discharge.
- Gather all necessary documents, bills, prescriptions, and discharge summaries.
- Submit the claim form and supporting documents to your health insurance company as soon as possible.
- Wait for a decision from your insurance company to review your claim request and either approve or deny it.
