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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 !