2022-04-07
Understanding a Health Insurance Plan
World Health's Day
To begin with in today's time we all
have understood the importance of having health insurance to save on money
during any health emergency.That is when, a health insurance plan comes to our
rescue. A health insurance policy covers medical expenses incurred as a
result of an accident, illness, or injury. An individual can purchase such
insurance for a set period of time by paying monthly or annual
premiums. During this time, if an insured is involved in an accident or is
diagnosed with a serious illness, the insurance company will cover the costs of
treatment. Let us now look this into the detail for a better understanding -
1. Survival Period: A period
you need to survive to avail of insurance claim benefit. It’s basically used in
critical insurance plans. In order to receive claim compensation, the
policyholder must usually live for at least 30 days after the diagnosis of the
medical condition.
2. Pr-existing illnesses: The
term "per-existing illnesses" refers to illnesses or diseases
that you have before you obtain an insurance policy. Most insurance companies
do not cover per-existing conditions until the policy has been in place for
four years. If you've had your health insurance policy with the same company
for four years, the insurer might consider covering your per-existing
conditions.
3. Network Hospital: All
health insurance companies have tie-up with a few hospitals, which are
referred to as the insurer's network hospitals.
4. Waiting Period: A waiting
time is included in every health insurance policy. It's the period after which
you'll be able to use your health insurance plan's benefits. Exceptions, such
as emergency hospitalization as a result of an accident, are covered even
before the waiting time is completed. The length of the waiting period varies
by insurance provider and plan, although it is typically 30 days for standard
health insurance policies.
5. Deductible –
The portion of the cost that an insured pays to the insurance provider prior to
the start of coverage. Typically, if
an insurer pays lower premiums, the deductible for the same will be higher.
6. Coinsurance – The amount payable to a healthcare provider after the
deductible has been reached is referred to as coinsurance. Coinsurance is often calculated as a percentage of the entire
expenditure.
If the policy's co-insurance is set
at 10% and the cost is Rs.1, 00,000, the policyholder is responsible for Rs.
10,000 in co-insurance.
7. Co-pay- A co payment or copay is a specified fee paid by a patient
to the service provider before getting the service. It might be defined in an
insurance scheme and paid by the customer every time a
health care service is utilized.
8. Top up policy -
Only once the existing health insurance policy sum is depleted does a top-up
health insurance plan become active. Premiums for top ups are usually lower
than that of the actual health
insurance policy. For Example – Ms. P had a basic coverage
of Rs. 5, 00,000 (family floater) & a top-up policy of Rs. 10, 00,000
(family floater) of XYZ Ltd. On 5th jan 2021, Ms. P made got a
billof Rs. 7,
00,000 due to some sudden accident but since she had a
top-up policy, her claim was accepted. (Rs. 5,00,000 from the basic health
insurance policy & Rs. 2,00,000 from the top-up insurance policy).
Types of Health
Insurance policy
There are several health insurance
policies available in the market. You should select a policy as per your needs
and health condition. Some of the types of a health insurance policies are:-
1. Individual Health Insurance
-An individual health insurance plan is a plan that provides health insurance
coverage to individuals.
2. Family Health Insurance-
It's also known as a family floater because it covers the entire family. A family
floater plan typically covers a family of four (2 adults and 2 dependent
children). However, there are some variations, as some companies let you add
your parents and in-laws as well.
3. Critical Illness Insurance - If you have been
diagnosed with a critical illness, you should consider purchasing this policy.
4. Maternity Insurance - This health insurance plan
was created to ensure that pregnant women receive ongoing medical care. Some of
the policies under this policy cover both the mother and the baby.
5. Senior Citizen Insurance - - This health insurance
plan was created to give comprehensive health insurance coverage to anyone over
the age of 60.
Features of a Health Insurance Policy
The basic features that most health
insurance company offers are:-
1. Cashless Hospitalization - You will not be required to pay for your medical expenses
if you receive treatment at one of your insurance provider's network hospitals.
To take advantage of this benefit, simply present your health insurance
provider the card and have your treatment completed according to your policy's
coverage. If you must be admitted to a non-network hospital for any reason, you
must pay your fees out of pocket and have them reimbursed by your insurance
provider later.
2. Pre and Post Hospitalization- The
majority of health insurance offers both pre and post-hospitalization coverage.
Most health insurance companies consider 30 days of pre-hospitalization care
and 60 days of post-hospitalization care.
3. Online renewal - You can
renew your health insurance plan online at the end of the policy year. You can
accomplish the same thing by going to your insurance provider's website.
4. Grace Period - It's a
period of time granted by insurance companies following your policy's
expiration date. Policyholders are allowed a grace period to pay their premiums
in order to keep their health insurance policy active and receive claim
benefits. The majority of health insurance companies include a 15-day grace
period.
5. Day Care Treatment - Some
insurance companies will only accept your claim if you have been in the
hospital for at least 24 hours. Some plans, however, include day care
treatments and do not need you to stay at the hospital for a set number of
hours.
6. Claim Settlement - Every
insurance company has a process for settling claims, although it varies per
company. As a result, it is recommended that you familiarize yourself with your
insurance provider's claim settlement process. Make sure you have all of the
paperwork you'll need to submit a cashless claim. It is necessary to fully
comprehend the claim procedure in order to have a seamless claim approval
Recent Updates
Recent Pandemic (Covid- 19), War
like situations have increased the urge to buy a health insurance policy.
According to health insurance specialists, the current COVID-19 pandemic has
altered numerous industries in India, none more so than the health insurance
market. Experts feel that the disruption has, in some ways, allowed insurers to
be more flexible in terms of putting out unique health packages, such as
home-based COVID-19 care as well.
Lastly to conclude it is very much
important to buy health insurance as it helps you during a medical emergency.
And, on this World Health Day, Team IFA wishes you all the best of health !
- TEAM IFA