Health & Wellness Solutions

Health insurance provides for medical expenses to the insured in case of hospitalization, for more than 24 hours, caused due to illness or accident. Health insurance covers Medicare needed of individual or family for surgeries, nursing care, consultation fees, diagnostic tests, hospital accommodation etc. Health insurance also pays for regular checkups. The insured in return pays a specified amount called premium on an annual or bi-annual basis.

Why Health Insurance?

No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and offers many other important benefits.

  • Health insurance protects you from unexpected, high medical costs.
  • You pay less for covered in-network health care, even before you meet your deductible.
  • You get free preventive care, like vaccines, screenings, and check-ups, even before you meet your deductible.
  • If you have a Marketplace plan or other qualifying coverage, you don’t have to pay the fee that many people who don’t have coverage must pay.

Types of health insurance plans

Individual and Family

Also called comprehensive or major medical, individual and family coverage is likely the first type of health insurance you might think of. It covers a wide range of services.

  • Lasts 12 months or longer
  • Can be renewed (in most cases)
  • Meets the Affordable Care Act requirements and includes:
    • Emergency services, hospitalization, and preventive care
    • Maternity, newborn and pediatric care
    • Mental health care & substance abuse treatment
    • Laboratory services, prescription drugs, and disease management
    • Rehabilitative services and devices

Features to be compared while purchasing a Health Insurance Policy

1. Sub-limits on Room Rent

Room Rent is one of the major expenses you have to bear if any member of your family gets hospitalised; so some general insurance companies cap the maximum amount that they will pay under their health insurance plan. Generally such limit is to the extent of 1% of sum assured and in case of ICU (Intensive Care Unit) the maximum limit is 2% of sum assured. But there are various general insurance companies which do not have any maximum limit on room rent, so you should look for such health insurance plans.

2. Pre-Existing Diseases

Pre-Existing Diseases are those which you are suffering from before opting to buy a health insurance plan, and therefore insurance companies do not cover them from day 1 of your policy. They have a waiting period ranging from 2-4 years in which they will not be liable for any claim arising on account of your pre-existing disease. Therefore, you should look for health plans which will cover your existing disease and have the least number of years of waiting period.

3. Co-payment

Co-payment is a clause in health insurance plans that requires cost-sharing by the policyholder. Cost sharing is the specified percentage of the admissible claim amount. For instance, suppose you have a health insurance plan which has a 20% co-payment clause; so in case you are hospitalised and your claim amount is Rs. 1 lakh, then you as an insured would be liable to bear Rs. 20,000 (Rs 1,00,000 * 20%), while the rest--Rs 80,000--would be settled by the insurance company. Hence, you should look for health insurance plans which do not have any co-payment clause at any stage of your life.

4. Network Hospital

Network hospitals are those which have a direct tie up with your health insurance company; so in case of a claim you can go for cashless facility. Cashless facility saves you from settling the bill amount with the hospital as the insurer directly settles your bill. You do not have to file for reimbursement.

5. No Claim Bonus

In the years that you have not made any claim, the insurance companies also provide you with a no claim bonus. This has an effect of increasing your sum assured in the next renewal of the policy. Such a bonus can range from 10-50% for a claim-free year. Hence, you should look for a policy which provides you highest no claim bonus.

6. Exclusions

Once you buy a health insurance plan, you might feel relaxed that you have covered yourself and your family against any possible hospitalisation in future. But if you don't go through the exclusion section of your policy, then you might get surprises at the time of a claim. So before finalising on any health insurance plan go through it's exclusion and select the one which has the least number of exclusions and exclusions are clearly defined.

7. Premium

The premium you would pay is a vital aspect you should consider while buying a health insurance plan; but mind you, it shouldn't be paramount in your selection process. Just think, you buy a health plan with a very low premium without even taking into consideration the features of the policy. At the time of claim you learn that the insurance company is not liable to reimburse you as the cause for which you were hospitalized was not covered under the policy.

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Benefits of Health Insurance

With increasing risk of medical emergencies due to modern lifestyle patterns and ever increasing medical expenses, health insurance is essential so that one does not compromise on good medical treatment. Health Insurance provides protection to the insured and his family with cashless hospitalization in best hospitals.

  • Cashless treatment at the time of hospitalization.
  • Pre and post hospitalization- provides for pre and post hospitalization expenses and medical care.
  • Coverage of Ambulance charges.
  • Pre-existing disease cover - After a waiting period of 2-4 years, various policies offer a cover against the pre-existing diseases -e.g. - diabetes, hypertension etc.
  • Medical check up - Free check up is included in the policy premium paid by the insurer.
  • Tax Benefits under section 80(D) is available.
  • Critical illness cover – Mediclaim cover can be extended for critical illness or various riders depending on the age and medical history of the insured family.
Type of Health Policies available

Individual –In this type of policy individual is covered against various illnesses with cashless hospitalization and other features.

Example for Individual Plan - Religare Care, Star MediClassic

Family Floater Mediclaim - Covers family members under a single plan.

Example for Family Floater Family Health Optima , Religare Health Plan

Surgery & Critical Illness – This can be availed as a standalone plan or a rider in case of treatment against serious illnesses like- cancer, kidney failure, heart attack, paralysis etc.

Example for Critical Illness -

Senior Citizen – Provides coverage for people in their old age.

Example for Senior Citizen Plan Senior Citizen Red Carpet

Preventive Healthcare – Can be taken to cover expensive preventive care treatments which include consultation charges and other tests or x-ray fees concessions.

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