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What is Health Insurance?
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Top Reasons to Buy a Health Insurance Plan
Ensure Peace of Mind : By relieving you of the burden of paying expensive hospital costs, it enables you to receive medical treatment with confidence.
Protect Your Savings : It enables you to safeguard your savings by paying for your medical costs so that you can receive the necessary care without worrying about money.
Combat Medical Inflation : Despite the escalating prices of healthcare, health insurance coverage can assist you in paying your medical expenditures, including pre-and post- hospitalization costs.
Avail Cashless Hospitalization Facility : This option enables you to request a cashless hospitalization facility at any of your insurance provider's network hospitals by filing a cashless claim.
Afford High-Quality Medical Care : This enables you to afford the greatest possible medical care, allowing you to concentrate solely on healing.
Fight Lifestyle Diseases : It enables you to cover the cost of chronic treatment for diseases associated with a lifestyle, such as cancer, heart attacks, etc., which have been on the rise due to changing lifestyles.
Receive Tax Benefits : This allows for better financial planning by allowing you to deduct the cost of your health insurance premium from your taxable income under section 80D of the Income Tax Act.
Key Benefits of Health Insurance Plans in India
1) Hospitalization Costs
Medical costs associated with hospital admissions lasting longer than 24
hours are often covered by health insurance. It includes things like hotel rent, physician fees,
drug costs, diagnostic test costs, etc.
2) Pre & Post Hospitalization Expenses
This insurance pays for any medical costs you may have
incurred for a condition before being admitted to the hospital as well as any further treatment
costs after being released. The policy document specifies a maximum number of days for which
pre- and post-hospitalization costs are paid.
3) ICU fees
While hospitalized, receiving care in an ICU is also covered by a health insurance plan
4) Ambulance Cost
It pays for the cost of using an ambulance to get to the closest hospital in case
of an emergency.
5) Cashless Treatments
In India, all health insurance companies give cashless treatment options
at the hospitals in their network. If you are hospitalized at a network hospital, you won't need to
worry about finding the money to pay your hospital expenses because your insurance will take
care of that under a system known as cashless claims.
6) Day Care Procedures
This insurance also pays for day care procedures that don't require a full
day in the hospital.
7) Pre-existing Conditions
After the waiting time, the top health insurance plans cover conditions
that already exist. Pre-existing conditions are typically covered after a 2- to 4-year waiting
period. Certain insurers also waive the pre-existing waiting period with the help of riders.
8) Treatment under the AYUSH system of medicine, which encompasses Ayurveda, Unani, Homeopathy, Siddha, and Yoga, is covered by this insurance.
9) Medical Check-ups
Depending on the terms and conditions of the policy, the majority of health
insurance firms in India provide free preventive health check-up services to the insured at
regular intervals.
Special features of Health Insurance plans
Auto Restoration : The restoration benefit enables your health insurance policy's sum insured to be restored to its full level as soon as it is depleted following a claim. This benefit is provided under several family and individual health insurance plans. It is also available as an add-on insurance to your current policy and is frequently referred to as the refill benefit, reset benefit or recharge benefit. It is useful in the event of a subsequent hospitalization within a single policy year. Think of it as your fallback strategy.
NCB protector : A no claim bonus is a lucrative benefit offered to the insured person in their health insurance plan. It is a modest method by which the insurance provider pays the policyholder for completing a claim-free year; it is sometimes referred to as NCB. If no claims were made during the prior insurance period, the insured will receive a financial benefit under this rider. The no claim bonus is therefore amongst the most important variables to take into account when buying a health insurance policy in India.
Non-deductions of consumables : A health insurance policy's "consumable coverage" refers to the financial safeguarding of all single-use surgical instruments. All medical devices that can be thrown away after usage are included. When these supplies are used as an essential part of the patient's care while they are in the hospital, the cost of those supplies is directly subtracted from the hospital bill. However, by adding an additional charge to their medical insurance plans, some insurance companies may include coverage for these consumables.
Hospital Cash : A simple insurance policy add-on known as "Hospital Cash Insurance" offers a specific sum insured for each day of hospitalization lasting more than 24 hours. The policyholder receives a set daily allowance to cover other costs while they are being treated in the hospital e.g. – conveyance fee for the patient’s family to visit him in the hospital.
Maternity coverage : Health insurance that covers all costs associated with pregnancy, including those associated with Normal and C-section deliveries is known as maternity insurance. Some insurance providers offer maternity insurance policies that cover pregnancies along with pre and postnatal costs as well as newborn baby costs.
OPD benefit : The term "OPD cover" refers to a type of health insurance that covers the cost of outpatient treatment. It guarantees that the health insurance company will cover the insured's out-of-pocket medical costs. OPD coverage is typically provided as an add-on because a majority of health insurance policies do not include it.
Air Ambulance : In an emergency, air ambulances are specially outfitted aircraft that fly patients to their destination safely and in time for treatment. These aircraft are well-stocked with medical supplies and professional tools including ventilators and ECG machines. The primary objective of these aircraft is to transport patients from a distant or far-off location to a hospital with specialized healthcare resources.
What is Covered in a Health Insurance Plan?
In-patient Hospitalization Expenses : As long as the hospitalization lasts for more than 24 hours, the hospitalization costs incurred during the treatment of an illness or accident are reimbursed.
Pre-existing Diseases or Conditions : Following the expiration of the waiting period, you may submit a claim for the costs associated with treating any pre-existing disease or condition.
Pre- and Post-Hospitalization Expenses : The insurance provider covers medical costs for blood tests, x-rays, and other checks necessary before being admitted to the hospital.
In a similar vein, the cost of medications and preventive health exams performed to evaluate your health after hospital discharge are covered by the health insurance plan.
Ambulance Fees : Although the level of coverage varies from insurer to insurer, emergency ambulance fees are typically covered by medical insurance plans.
Maternity Coverage: Includes coverage for both newborn baby costs and medical costs incurred during pregnancy and delivery.
reventive Health Check-ups : Some health insurance plans in India also include regular health check-up services.
Daycare Procedures :Daycare procedures that don't require hospitalization for longer than 24 hours are covered. As stated in your coverage paperwork, it includes procedures like eye surgery, dialysis, and other typical childcare procedures.
Home Treatment Cover : On a doctor's recommendation, it also covers the costs associated with receiving medical care at home.
Reimbursement : Up to a certain amount, health insurance plans also cover the costs of Ayurveda, Unani, Siddha, or homeopathy treatments.
Mental Healthcare Cover : Health plans in India provide coverage for mental diseases in accordance with the 2017 Mental Healthcare Act. By October 31, 2022, IRDAI has ordered all insurers to update their health insurance plans to include treatment for mental diseases such as acute depression, bipolar disorder, schizophrenia, etc.
Special Purpose Policies
1) Heart Care / Cardiac Care
In India, the prevalence of cardiac conditions has been rising alarmingly. The cost of treating heart conditions might be high. Many people have come to understand the value of health insurance for conditions associated to the heart as a result of the continuous epidemic and the rising costs of the healthcare system. Therefore, it's critical to have a financial protection strategy for the possibility of heart diseases. The Cardiac Care health insurance plan is designed specifically for people who have had heart surgery, a bypass, or stenting. One of a kind in the market, cardiac care insurance provides full coverage for both cardiac and non- cardiac therapies.
It ensures that all of the cardiovascular demands of heart patients are covered by health insurance. Cardiovascular and common hospitalization requirements are combined. This offers enough expense coverage and lessens the financial load on those who must repeatedly treat heart conditions. Additionally, this policy provides coverage for a variety of heart diseases. However, the amount insured applies to these claims. The benefits of a cardiac care insurance policy include coverage for contemporary treatments, outpatient care, and personal accident insurance for accidental death. It also covers surgical and non-surgical treatments
2) Diabetic Care
One of the most common illnesses in recent years is the chronic condition diabetes. It is impossible to know for sure if someone will get diabetes because it depends on a variety of factors, including age, weight, genetic composition, family history, and—most importantly—lifestyle choices. However, adopting healthy behaviors and altering dietary habits can be done as preventative measures to avoid this chronic illness. It is crucial to choose diabetes health insurance plans so that your finances and health are protected because diabetes can even develop into a hazardous and life-threatening disease. Additionally, it can be considered as an investment because unforeseen events might happen at any time and plunge you and your family into a dire financial situation. Diabetes sufferers can obtain health insurance without as much difficulty as they might think. However, there is just one circumstance that typically applies: If you have diabetes and you acquired your health insurance coverage earlier, you will be able to file claims after a 30- to 4-year waiting period. However, you have three months from the purchase date of the policy to file claims if you do not have diabetes at the time of purchasing health insurance. Make sure your policy offers the option for lifelong renewability because health insurance companies have age restrictions that prevent you from keeping your current coverage.
3) Policy for declined risk
Usually, insurance companies do not cover risk regarding pre-existing health conditions. Such people can apply for specific policies where those pre-existing conditions are excluded and the policy is issued to cover any other health risks.
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What does Health Insurance Cover?
- Hospitalization expenses
- Medical expenses
- Pre and post-hospitalization expenses
- Ambulance charges
- Daycare procedures
- Maternity expenses
- Critical illness cover
- Optional add-ons