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Insurance

Health Insurance

Introduction

The one thing that most of us value most is our health. But, today's hectic work schedules and lifestyles make us prone to many illnesses and infections. A health insurance policy is the best way to protect you and your family in times of a health crisis or during hospitalisation. More so, with today's rising healthcare costs. A well-structured policy offers you the advantages of hospitalisation cover, tax benefits, cashless facility, and flexible coverage.

With the confusing array of options available today, finding a comprehensive low cost health insurance is similar to looking for a needle in a hay stack! That's where MoneyRaksha steps in! We familiarize you with health insurance terms and help you understand the options to choose the right coverage for you and your family.

Types of policies

The variety of health insurance plans seems endless today, so where do you begin to make sense of them all? First of all, you must keep in mind that there is no one-size-fits-all health insurance plan. You have to carefully consider your needs and budget before you sign on the dotted line.Ask yourself these questions: is this health insurance plan for your own health care needs? Are you caring for any dependents? Do you have an ailment that requires monthly treatment? What if you require surgery? What if you were injured in an accident? How much preventative care do you want?

Indeed, these are tough questions, but it's never a good idea to bury your head in the sand, especially where your health is concerned. If you can answer these questions, you can find that health care sweet spot, where you get the coverage you need at prices you can afford.

Health insurance

A comprehensive health insurance plan takes care of your personal health and medical cover including hospitalisation expenses and pre- and post-hospitalisation expenses.

The benefits of this policy are:

  • Instant individual coverage;
  • Minimal documentation;
  • No medical examination;
  • Income Tax benefits under section 80D of the Income Tax Act.

Coverage features

Most health insurance policies cover the following:

  • Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor/ surgeon fees, medicines, diagnostic tests, etc.;
  • Medical expenses incurred prior to and post-hospitalisation;
  • Some advanced treatments, such as cataract, eye surgery, dialysis, chemotherapy, radiotherapy, coronary angiography, etc , which do not require hospitalisation for more than 24 hours;
  • Out-patient covers such as boarding and nursing expenses; expenses related to dental treatment; surgeon, anaesthetist, medical practitioner, and specialist fees; anaesthesia, blood, oxygen, operation theatre charges, surgical consumables, medicines and drugs, diagnostic materials and X-ray, ambulance, etc.

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

What is not covered?

The family floater plan does not cover the following:

  • Any illness contracted within 30 days of the inception date of the policy, except those that are incurred as a result of an accident;
  • Treatment of diseases such as cataract, hernia, piles, arthritis, joint replacement (unless due to an accident), skin and internal tumors and cysts, including breast lumps, dialysis required for chronic renal failure, surgery on tonsils and sinuses, and gastric and duodenal ulcers;
  • Non-allopathic treatment;
  • Pregnancy and childbirth-related complications;
  • Cosmetic, aesthetic, and obesity-related treatment;
  • HIV or AIDS and related diseases;
  • Injuries arising out of alcohol or substance abuse;
  • Intentional self-injury or suicide;
  • War, riots, induced treatment.

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

Claim process

To claim your health insurance, you need to submit the claim form with documents such as the first prescription from your doctor, the hospital discharge card, the hospital bill giving detailed break up of all expense heads mentioned in the bill, laboratory and diagnostic test reports, etc.

Personal accident insurance

Sometimes, even a small accident can throw your financials out of gear. A personal accident insurance policy insures you against accidents, which may lead to a permanent physical disability or accidental death.

The benefits of this policy are:

  • No health check-up;
  • Global coverage;
  • Easy claim process with minimal documentation;
  • Flexible premium payment options.

Coverage features

Most personal accident insurance policies cover the following:

  • Accidental death;
  • Permanent disability;
  • Temporary total disablement;
  • Broken bones due to an accident;
  • Benefit towards funeral costs in case of accidental death.

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

What is not covered?

The personal accident insurance plan does not cover instances where the death, injury, or disablement of the insured person is caused by:

  • An intentional self-inflicted injury, suicide, or the direct consequence of an attempted suicide;
  • Alcohol or any other substance abuse;
  • Sports related activities;
  • Venereal diseases, AIDS, or insanity;
  • Criminal activity;
  • War, enemy hostilities, rebellion, revolution, mutiny, coup, capture, arrests, restraints, and detainment of all kinds;
  • Childbirth or pregnancy.

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

Claim process

To claim your personal accident insurance, you need to fill in the relevant claim form and attach documents such as the police panchanama, FIR, post-mortem report, disability certificate from the treating doctor, death certificate, etc.

Hospital cash policy

Hospitalisation can occur due to illness or an accident. This policy provides you with a daily cash benefit for each 24-hour period spent in the hospital. The policy covers are expenses incurred on conveyance by family members to and from the hospital, special diet expenses, expenses incurred by the family member staying with patient, etc.

The benefits of this policy:

  • No medical examination required;
  • Hospitalisation cash up to 180 days;
  • Premium paid is eligible for tax exemption under Sec 80D of the Income Tax Act;
  • Guaranteed issuance;
  • No limitation on hospitals.

Coverage features

The hospital cash policy covers:

  • Hospitalisation expenses due to sickness;
  • Incidental expenses while in hospital due to accidents;
  • Reimbursement of day-to-day medical bills due to accidental injuries

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

What is not covered?

The hospital cash policy does not cover the following:

  • Any pre-existing condition or any complication arising from it;
  • Suicide, AIDS, military service or operation;
  • Injury caused under the influence of drugs or alcohol;
  • Dangerous sports;
  • Pregnancy and resulting childbirth, miscarriage or disease of the female organs of reproduction;
  • Cosmetic or plastic surgery;
  • Routine examinations, laboratory diagnostic, or X-ray examinations where there is no objective indications or impairment in normal health, except in the course of a disability established by a physician;
  • Dental care except as a result of injury caused by accident;
  • The diagnosis and treatment of acne;
  • Any expenses incurred outside India.

Critical care coverage

Despite our age and diligent health and fitness regime, critical illnesses can affect anyone, anytime, and command expensive and specialised medical services. During these times, critical care coverage can help bring you back to good health, without causing a strain on your finances

The benefits of this policy:

  • No health check-up required for policy issuance;
  • Payment is done immediately after the first diagnosis of the covered illnesses;
  • Covers the expenses of emergency hospitalisation also;
  • Covers expenses like donor expenses in a transplant surgery, which are not covered under normal health insurance policy;
  • Global coverage.

Coverage features

Most critical care policies cover the following illnesses:

  • Cancer
  • Coronary artery bypass surgery
  • First heart attack
  • Kidney failure
  • Multiple sclerosis
  • Stroke
  • Paralysis
  • Major organ transplant
  • Major burns
  • Coma

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

What is not covered?

The critical care policy does not cover the following:

  • Any critical illness, which was manifested or contracted before or for which care, treatment, or advice was recommended before;
  • Any critical illness diagnosed within the first 90 days of the policy;
  • Death within 30 days following the diagnosis of the critical illness;
  • HIV/AIDS infection
  • Pregnancy or childbirth, including caesarean section or birth defects;
  • War, invasion, terrorism, rebellion, or revolution;

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

Claim process

To claim your critical care insurance, you need to submit documents such as the first consultation report, supporting documents to prove diagnosis, discharge summary mentioning the diagnosis, date and time of admission and discharge, past medical and surgical history, etc., along with the relevant claim form.

Family floater

A family floater policy secures your family against financial emergencies during sudden illness, surgery, or accidents. This policy lets you share the entire sum insured among your family members covered under the policy.

For example, your family of four is covered under a traditional health insurance plan, with individual policies of Rs 1 lakh for each member. In case your son is ill, and the surgery and hospitalisation charges amount to Rs 2 lakh, then the existing policy covers only Rs 1 lakh, while you have to bear the balance amount of Rs 1 lakh. But, with a family floater insurance plan, each member of the family can utilise the entire insured sum of Rs 4 lakh, which means that your son's entire medical expenses would be covered.

The benefits of this policy:

  • Cheaper than other policies;
  • No health-check-up;
  • Access to cashless facility at recognised hospitals;
  • Income tax benefit on the premium paid as per section 80-D of the Income Tax Act;
  • Minimal documentation.

Coverage features

The family floater policy covers:

  • Medical expenses incurred as an inpatient during hospitalisation for more than 24 hours, including room charges, doctor/ surgeon's fee, medicines bills, etc.;
  • Pre- and post- hospitalisation expenses;
  • Day care expenses incurred on specific advanced surgeries and procedures requiring less than 24 hours of hospitalisation (including dialysis, radiotherapy, and chemotherapy)

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

What is not covered?

The family floater plan does not cover the following:

  • Any illness contracted within 30 days of the inception date of the policy, except those that are incurred as a result of an accident;
  • Treatment of diseases such as cataract, hernia, piles, arthritis, joint replacement (unless due to an accident), skin and internal tumors and cysts, including breast lumps, dialysis required for chronic renal failure, surgery on tonsils and sinuses, and gastric and duodenal ulcers;
  • Non-allopathic treatment;
  • Pregnancy and childbirth-related complications;
  • Cosmetic, aesthetic, and obesity-related treatment;
  • HIV or AIDS and related diseases;
  • Injuries arising out of alcohol or substance abuse;
  • Intentional self-injury or suicide;
  • War, riots, induced treatment.

(Please note that these are just illustrative pointers. You must refer the specific policy for an exhaustive list.)

Claim process

To claim your family floater insurance, you need to submit the claim form with documents such as the first prescription from your doctor, the hospital discharge card, the hospital bill giving detailed break up of all expense heads mentioned in the bill, laboratory and diagnostic test reports, etc.

Cashless policy

The cashless health insurance policy spares you the travails of bill-processing and payment at the time of discharge from the hospital, as the settlement is done directly by your insurance company. However, you must get approval from your insurance company, before admission in the hospital (not applicable in case of emergencies).

The claims maybe of two types:

  • Planned claims, where you are aware of the hospitalization, 2-3 days in advance;
  • Emergency claims, where you or your covered family member meets with a sudden accident or has an illness that requires immediate hospitalization.

Health insurance FAQs