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Health insurance

Health Insurance is an insurance policy that ensures that you get cashless treatment or expense reimbursement, in case you fall ill. A health insurance policy reimburses the insured for medical and surgical expenses arising from an illness or injury that leads to hospitalization.

The insurance company provides the insured with the facility of cashless hospitalization at a network hospital or provides a reimbursement for the incurred expenses. Furthermore, health insurance cost is subsidized to the insured in the form of tax exemption under section 80D of Income Tax Act, 1961.

Why is Health Insurance Important?

There are plenty of reasons why buying a health insurance plan is not just a good idea, but in fact, necessary. The benefits provided by such plans outweigh the cost of premiums and the exclusions that are involved. Currently, the life expectancy rate has risen substantially owing to medical advancements. But many people face financial strains or even a lack of finances when it comes to funding their treatment. This results in loans, mortgages and sale of assets just to keep the person alive. This is where a health insurance plan could be a real lifesaver as the cost of hospitalisation, surgeries, treatments, medicines and so on, have risen.

India’s total expenditure on health stood at 4.7% of the country’s GDP in 2014 according to the data released by the World Health Organization (WHO). India is also a country where medical costs are surging at the rate of 15% to 20% every year. In addition to mounting medical expenses, the increase in lifestyle diseases is also affecting the people of our country.

- Health issues can suddenly arise and catch you off guard.
- In today’s world, the chances of contracting cancer and other illnesses is high.
- If you are not rolling in dough, chances are you will need to figure out how to fund your treatment.
- Medical costs have risen substantially over the past few years.
- A health insurance plan will take care of most of the expenses associated with treatment and lighten the financial burden.
- Cashless facility offered by all insurers can help reduce out-of-pocket expenses. The patient can focus on recovering and be at peace knowing that the finances are taken care of.
- The financial burden will not fall on the family of the insured person.
- Insurance companies provides added benefits such as emergency assistance, ambulance cover, critical illness cover, hospital cash and so on.

Types of Health Insurance Policies in India

Everyone needs to secure their own and their family's health. With the increasing cost of healthcare in India, buying a health insurance policy has become almost mandatory for everyone. In today’s world of options, people have different choices when it comes to purchasing health insurance. There are various plans readily available in India to include every aspect of a medical emergency. Some popular types of policies are explained below:

1. Indivdual Health Insurance

This type of health insurance provides coverage to an individual against certain illnesses, offering advantages like cashless hospitalisation, reimbursement, coverage of pre-hospitalisation and post-discharge expenses and various add-ons. The entire sum assured is available for only one individual.

2. Family Health Plan

With family health plan, you can include your family members under the umbrella of a single health cover. Family floater mediclaim policies offer a fixed sum assured to the family members, which can be availed either by one or all members of a family for one or more claims during the tenure of the policy. Family health plans come are more expensive than an individual health plan

3. Senior Citizen Health Insurance

Senior citizen health insurance offers coverage for senior citizens aged between 60 years and 80 years. Senior citizen health insurance plan is a necessity especially when you are planning to retire and live on pension or interest income from savings. A sudden medical emergency can result in a financial crisis. To avoid this, it is prudent to take a comprehensive senior citizen mediclaim insurance policy.

4. Surgery & Critical Illness Insurance Plans:

This plan is usually brought as a standalone policy or as a rider for the treatment of various critical illnesses, such as kidney failure, paralysis, cancer, heart attack etc. As the medication of such illnesses is expensive, the imbursement related to them is also very high. A critical illness is a serious, possibly terminal, disease and is pre-defined by the provider. Most critical illness policies provide a lump-sum benefit if the insured is diagnosed with one or more of the specified terminal conditions.

5. Maternity Health Insurance:

Medical insurance companies today cover additional costs, including those incurred in both pre and post-natal care, child delivery (normal or caesarean), and sometimes include vaccination of newborn babies in a maternity plan. This insurance covers the newborn baby up to the validity of this policy. It also covers transportation fee for ferrying the mom-to-be to the nearest network hospital of her choice.

6. Personal Accident Cover:

These personal accident plans are frequently offered as riders. They include hospitalisation and bear the medical outlay in the event of an accident. These are issued as fixed benefit policies, where a specified sum is paid on the occurrence of unforeseen events, such as accidents, which can result in death or disability of the person. However, the payout is not related to the sum assured.

What is Incurred Claim Ratio?

Incurred Claim Ratio refers to the total value of all claims that the health insurance firm has paid-out in a given financial year against the total amount of premiums that they collected during the same year. The Incurred Claim Ratio is a good indication of the company’s ability/willingness to provide a payout when a claim is raised. Thus, if a company’s Incurred Claim Ratio is higher is 100%, it would indicate the company has paid-out more in claims than what it collected as premiums during the fiscal year. Whereas, if the company’s Incurred Claim Ratio is lesser than 100%, it would indicate the insurer has paid a lesser amount of money as claims in comparison to the premiums that it collected. The Insurance Regulatory and Development Authority of India (IRDAI) publishes the Incurred Claim Ratio for all health insurance firms in India, every financial year.

What is Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) of an insurance company indicates the insurer’s capacity to settle a higher number of claims per year. For instance, if the CSR of an insurance company is 95% for FY15-16, it means that the insurer has settled 95 claims out of 100 in that financial year. The formula for calculating claim settlement ratio is as follows:
Claim Settlement Ratio = (Total Claims Settled) / (Total Reported Claims + Outstanding Claims at Start of Year – Outstanding Claims at End of Year)
Claim Settlement Ratio also lets you know the claim settlement history of an insurance provider. A new insurance company may have a lower claims ratio. The CSR of an insurance company is a parameter to consider when choosing the right insurance plan.

Key Advantages & Features of Health Insurance Policies in India

The cost of healthcare in the modern days is increasing at a crazy rate while one’s earnings do not seem to match up that level. A patient looking forward to availing frequent health check-ups may no longer be able to bear the expenses associated. A comprehensive health insurance comes packed with features that can assist a person in managing expenses associated with medical emergencies and also with preventive healthcare. Understanding the following features can make purchasing a medical insurance policy easy:

Cashless Treatment:

Every medical insurance organization has tie-ups with various nursing homes and hospitals across the country called 'empanelled hospitals'. If you are admitted to one of these, you don’t need to pay anything. You only need to mention your policy number and everything else will be taken care of by the hospital and your insurer. This type of plan is preferred because there is no stress of claim reimbursement and arranging documentation. However, if your expenses go beyond the sub-limits specified by the insurance cover or marked as “not covered” by the provider, then you will have to settle it directly with the hospital. Another important thing to remember is that cashless Mediclaim is not available if one gets treatment at a hospital which is not a part of the hospital network of the insurance provider.

Coverage of Pre and Post-Hospitalization expenses:

This feature of a health insurance policy takes care of both pre and post-hospitalisation fee. It takes into account the costs incurred during a certain number of days both prior to and post hospitalization for a specified period from the date of discharge as part of the claim, provided the expenditures are related to the disease/sickness.

Ambulance Fee:

The person is free from burden of transportation fee as it is borne by the insurer. This is an add-on benefit and you should opt for it while purchasing medical insurance.

No Claim Bonus:

NCB (or No Claim Bonus) is a bonus provided to the insured if the no claim has been filed for any treatment in the previous policy year. The reward can be offered either as an increment in the sum assured or as a discount in the premium cost. You can avail this advantage on policy renewal.

Medical Check-Up:

A Medical plan entitles the insured to receive regular medical check-ups. A free check-up is provided by few insurers, provided you have a good history of no-claim bonus.

Benefits of Comparing Health Insurance Online

Due to tight and hectic schedules these days, it has become quite impossible to visit different offices or branches of different health insurance companies in order to compare various medical insurance policies.Thankfully, we Understand the dilemma of the customers and hence, has offered a platform where you can compare health insurance policies online. Which means, no more lines and no more lies. But, there is more. Enlisted below are few of the major advantages of buying a health insurance plan online:

Access to Accurate Information :

Offers an easy access to every insurance policy available in the market. It also saves the buyers from dealing with agents who are known to provide unreliable and biased information most of the times.

Time Efficient and Convenient :

By comparing health insurance plans online, the users are able to save their time as they don’t have to keep meeting with the agents to compare and choose the best plans. Additionally, several tasks, such as paying premiums, renewing the plans, etc., are also easier via online mode.

Pocket-Friendly :

The person is free from burden of transportation fee as it is borne by the insurer. This is an add-on benefit and you should opt for it while purchasing medical insuranceIf a customer buys a health plan via an online channel, he/she will be able to compare plans and opt for the one that fits in the budget. Also, no brokerage or agent fees are levied and hence, the buyer ends up saving a significant amount of money.p>

Availability of Provider/Plan Reviews :

Doing so will help you get an overall idea of an insurer’s reputation, enabling you to make an informed decision.

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