Health Insurance

Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured. Under health insurance insurer provides financial protection against the high costs of medical treatment, providing individuals with access to healthcare services without the burden of paying the full cost out of pocket. Best health insurance plans cover a range of medical services, including doctor visits & fees, hospital charges, medications, hospitalization costs, and other healthcare-related expenses.

A standard health insurance plan is a mutual contract between the insurance provider and the policyholder, in which the insurer agrees to offer financial protection to the policyholder during any medical emergency. As per the chosen plan terms, a health plan offers both cashless treatment benefits and reimbursement benefits while availing of medical treatments.

It acts as a financial safeguard and a protective shield and ensures the beneficiary avails of quality healthcare services without financial worries.

Although medical science has shown several milestone achievements in the last few years and is still growing, we have witnessed that healthcare costs are reaching new heights each day. Considering such a steep and steady inflation rate, it has become essential to invest in a competent health insurance plan.

Major reasons for purchasing best health insurance plans include:

• Savings protection: A standard health insurance plan will offer sufficient coverage to protect your savings during medical emergencies.

• Compete with medical inflation: Despite the steep and steady rise in the inflation rate in the medical industry, you can complete your treatments at quality healthcare centres without financial worries.

• Easy accessibility to quality healthcare services: Health insurance opens the doors to quality medical care facilities with network hospital benefits.

• Combat lifestyle ailments: A health plan even takes care of lifestyle ailments like diabetes , and hypertension along with issues that require long-term medical care like cancer, stroke, cardiac arrest, etc., depending on the terms of the chosen plan.

• Cashless hospital facility: You can easily access quality treatment facilities without the need for any immediate upfront payment.

• Tax benefits: The premiums paid towards health insurance qualify for tax benefits under section 80D of the Income Tax Act.

Before purchasing a best health insurance plan, you should remain aware of its principal features:

• Sum insured: The optimum amount of sum insured determines the coverage extent. You must ensure that the sum insured amount remains on the higher side. If it gets exhausted, you will have to settle the dues out of your pocket.

Tip: So, opt for a higher coverage limit right from the beginning. You can always step it up.

• Waiting period for Pre Existing Diseases: You must remain aware that when you purchase a health plan, certain ailments automatically do not get covered immediately. Those health issues get coverage after a specific waiting period has elapsed. This waiting period varies with the insurer, ailment, and the plan concerned. Read the policy document well to know the details.

Tip: Opt for a low waiting period if you have any pre-existing ailments so that you can start filing for the same.

• Sub-limits: The room rent can prove to be quite expensive during hospitalisation. It mostly remains tied to room rent and is generally limited to 1-2% of the total sum insured. It is a bit higher in the case of the ICU. Read the policy papers well before purchasing.

Tip: Ideally, opt for health insurance plans without any sub-limit, even if that is slightly more expensive. This would help you to lower your out-of-pocket expenses.

• List of network hospitals: All best health insurance plans providers maintain tie-ups with several hospitals across the country. These are called network hospitals. You must ascertain your preferred hospitals come in this list before finalising your health policy purchase. It is better to choose an insurer with a higher number of network hospitals to ensure easy accessibility and utilisation.

Tip: Opt for an insurer with a large network of hospitals so that you can avail of cashless hospitalisation benefits.

• No Claim Bonus: Similar to auto insurance, health insurance plans providers also offer a No Claim Bonus benefit for raising no claims in a year, eventually raising your total sum insured amount at no additional cost.

• Co-payment options: Here the beneficiary shares a pre-defined percentage of healthcare costs incurred. To ensure optimum liability reduction, you can choose a plan with a minimum co-payment percentage.

• Plan exclusions: No health plan offers 100% coverage under any circumstances. These exclusions may vary based on the plan terms and the insurer’s business policy. Ensure this list of exclusions beforehand for a seamless claim settlement.

• Pre- post-hospitalisation expenses: All health insurance plans cover pre- and post-hospitalisation expenses up to a specified tenure. Read the policy papers well to confirm this tenure. It is generally 30 days prior to hospitalisation and 60 days after hospital discharge the health insurance plans tend to cover. However, this may vary depending on the terms of the insurer and plan concerned.

So far it is clear that health insurance is ideally extremely helpful. Some of its most highlighting benefits include:

• Hospitalisation charges: All standard health plans cover hospitalisation costs. However, claims are settled only for those health issues that were not present during the policy purchase. Several insurance providers offer plans like critical illness plans, offering coverage for listed critical ailments, accidental coverage plans, etc.

• Zero capping on ICU charges: Several insurance providers offer plans without any room rent capping on ICU charges. The beneficiary can opt to live in a private cabin at the cost of the insurance provider. However, if it exhausts the plan terms, he/she has to settle the excess dues.

• Mental illness coverage: Health plans also cover mental illness treatment costs. This has become mandatory as per the IRDAI norms considering the steep rise in mental health issues.

• Bariatric surgery costs: Only a specific handful of health insurance plans offer coverage for obesity treatment. The premium rates are slightly higher.

• Zero room rent capping: Health plans usually cover room rents during hospitalisation. They previously disclosed the total disbursement amount in this context.

• Daycare procedures: These are those medical procedures that require less than 24 hours of hospitalisation like cataract surgery, angiogram, dialysis, etc. Most health plans cover these.

• Ambulance charges: General health plans allow road ambulance cost coverage incurred during medical contingency.

• Refilling sum insured: Under such health plans, you can make up to 2 claims per year within the specified sum insured limit, provided the health issues differ in both cases.

• Daily cash cover: Best health insurance plans also offer daily cash allowance to compensate for the income loss incurred during the term of hospitalisation.

• Zone upgrade: In terms of medical insurance, zones are classified as per the average medical expenses in the concerned city. They tend to be comparatively higher in the metro cities than towns and other smaller cities. This particular add-on allows you to consider the cost disparity costing slightly additional premium charges. However, it subsequently saves your total premium payment cost by nearly 10% to 20%.

• Domiciliary cost coverage: Certain treatments may require domiciliary treatment rather than hospitalisation as per the doctor’s advice. Some health plans even offer coverage for such treatments too.

• Organ donation costs: If any major organ like the liver or kidney requires replacement, it becomes extremely expensive. However, health plans cover organ donation costs depending on the terms of the plan.

During any medical contingency, a cashless treatment facility comes in extremely handy. Some of the major benefits of cashless treatment include:

• Easy access to fast treatment: With the help of a cashless health plan, you can easily access quality healthcare immediately without financial worries. You need to inform the authorities within 24 hours of emergency hospitalisation and 48 hours of planned hospitalisation.
• Comprehensive benefits: With the aid of a cashless treatment facility, you can utilise all the comprehensive benefits of your health plan.
• Coverage during travel: If you, unfortunately, fall sick while travelling, you can avail of a cashless treatment facility at any network hospital throughout the country.

Before purchasing best health insurance you need to consider certain crucial factors to ensure optimum coverage and smooth claim settlement:

• Inclusions and Exclusions
• Choosing Best Health Plan
• Selecting the Right Company
• Waiting Period
• Sum Insured and Premium
• Daycare Coverage
• Coverage for Specific Ailments
• Alternative Treatments
• Room Rent Limit
• New-age Treatment Coverage
• Add-Ons
• Pre- and post-hospitalisation Coverage
• Co-payment
• Network Hospitals
• Employer’s Group Health Plan
• Age Criteria
• No Claim Bonus
• Preventive Health Check-ups
• Claim Process

Read More About: The Must-See Checklist Before You Buy Health Insurance

Some of the most significant reasons to buy and maintain health insurance plans are:

• Ensure financial coverage: A health plan acts as a protective financial safeguard during medical contingencies. Having competent health insurance allows you to access quality medical care without needing any upfront payment.

• Rising inflation: The inflation rates in the medical industry are quite steep and always on the rise. Having a suitable health plan allows efficient financial management.

• Affordability: Purchasing a health plan early in life can make you go a long way keeping it affordable and allowing optimum coverage.

• Lifestyle issues: The contemporary sedentary lifestyle enhances several lifestyle diseases. If you wisely invest in best health insurance beforehand, you can enjoy its coverage protection when needed.

Several variants of health insurance plans are prevalent in India:

• Parent's Health Insurance Policies: These are specially crafted for your parents to ensure that they get medical treatment and hospitalisation coverage during emergencies.

• Children's Health Insurance Policies: These are designed to meet the unique medical requirement coverage for your child. It usually covers consultation fees, tests, medicines, and sometimes, immunisation.

• Women's Health Insurance Policies: This sort of health plan caters to the unique medical coverage exclusively required by women. Diagnosis, medication, treatment, and maternity costs, are all usually covered.

• Individual Health Insurance Policies: It covers a single beneficiary and covers treatment and hospitalisation costs.

• Family Floater Health Insurance Policies: It is a single umbrella plan that covers all the family members. It usually covers the self, spouse, children, parents, and parents-in-law. However, it may vary depending on the chosen plan.

• Senior Citizen Health Insurance Policies: These plans are specifically designed to meet the unique health requirements of people 60 years and above.

• Group Health Insurance Policies: It is provided by the employer to all its employees throughout their employment tenure.

• Maternity Health Insurance Policies: This sort of plan offers coverage for unforeseen complications due to pregnancy and childbirth. It includes coverage for both normal delivery and C-sections.

• Cancer Health Insurance Policies: It allows medical insurance coverage incurred for the treatment of cancer. You are paid a lumpsum amount on detection of the ailment which is equivalent to the expenses incurred.

• Personal Accident Health Insurance Policies: It allows financial coverage for injuries, disabilities, or death caused due to an accident. The coverage limit is usually up to INR 25 lakhs.

• Critical Illness Insurance Policies: These plans specifically provide coverage for life-threatening ailments such as cancer, kidney failure, heart attack, and more. However, it's important to note that each insurance company maintains a separate list of critical ailments. It's advisable to carefully consider and clarify the coverage details before making a purchase.

Comparing similar health insurance plans offered by different companies is very crucial for understanding the scenario well and acquiring the most suitable plan at the most affordable rate:

• Ensuring optimum coverage: There is no single plan that equally fits everyone well. Comparative analysis is essential to understand which plan suits you the best.

• Effective cost management: You must compare different plans to ensure receiving the best coverage at the most affordable rate.

• Plan terms and conditions: Once you begin your comparative study among different plans, you get a better grasp of the nature of policy terms and conditions. This aids you in making an informed decision.

• Additional benefits: Comparing different policies will help you explore different additional benefits and riders.

• Customised coverage: When you compare health insurance plans you pave the road to utilise customised coverage, a perfect plan that satisfies most of your requirements.

• Value for money: When you purchase a health plan after careful comparison, you ensure to get optimum value for money.

• Command: When you compare different health plans before purchasing, you remain in command to secure the perfect match considering your requirements.

Having a competent health insurance plan saves a lot of financial burdens and troubles. The standard coverage benefits of a health insurance plan include:

• In-patient hospitalisation coverage

• Pre-hospitalisation expenses for a pre-defined tenure

• Post-hospitalisation expenses up to a specified period

• Daycare treatment coverage

• Domiciliary treatment cost

• Organ donor costs

• Ambulance charges

• AYUSH costs

• Free health check-ups

• Restoration of the sum insured

• Maternity benefits

• OPD coverage

• No Claim Bonus, etc.

Even the best health insurance plan will also not offer 100% coverage. Although the list of exclusions varies from one insurer to another and depending on the terms of the plan, some standard exclusions include:

• PEDs are not covered before the specified waiting period has passed

• Coverage of certain specific ailments like hernia, piles, fistula, etc. does not happen in the primary year of policy commencement

• Any ailments that are contracted within 30 and 90 days right after plan purchase are generally excluded

• Any cosmetic treatments that are not medically essential

• Any dental treatment other than occurring due to an accident

• STDs

• Ailments caused as a result of war or similar allied activities

• Health issues caused due to overuse of alcohol and/or drugs

• Any unproven, experimental form of treatment

• Self-inflicted injuries

• Health issues arising due to voluntary participation in adventure and hazardous activities

• Ailments caused for participating in criminal activities, etc.

The importance of health insurance cannot be exaggerated. Some of the most significant factors that highlight the importance of health insurance especially considering the current-day scenario include:

• Competent coverage of medical expenses: Health insurance allows medical emergency coverage without any need for immediate upfront payment.

• Cashless hospitalisation facility: You can access cashless hospitalisation facilities throughout the country among network hospitals.

• Family protection: You can ensure family protection using a family floater plan.

• Combatting medical inflation: Health plans allow you to combat medical inflation most effectively, ensuring efficient finance management.

• Critical illness coverage: Some health plans even allow critical illness coverage.

• In-patient care: In-patient hospitalisation coverage is allowed under health insurance.

• No Claim bonus: Health plans allow NCB for non-claim years, eventually raising the sum insured amount at no additional cost.

• Additional riders: You can add befitting riders to enhance the coverage span.

Coverfox is a commendable name in the health insurance industry. Some of the significant reasons for purchasing best health insurance plans through Coverfox include:

• User-friendly: Coverfox maintains a simple and easy-to-understand interface for easy online health insurance purchases. You can even use their official site to renew health insurance online.

• Ample options: Coverfox offers best health insurance options considering the varied requirements of the wide customer base.

• Affordable: The health insurance options available on Coverfox are comparatively much more affordable and offer competent comprehensive coverage.

• Network hospitals: Coverfox maintains a wide network of hospitals throughout the country for easy cashless hospitalisation facilities.

You need to meet certain critical criteria for buying best health insurance:

• Insured’s age: Most health plans have specific entry age criteria which may vary depending on several factors. Always check it out before purchasing.

• Exposure risk: The risk factors vary from person to person and the premium levels too vary accordingly. The higher the risk, the higher the premium.

• PEDs: If the beneficiary possesses PED during policy purchase, the premium amount tends to rise as the risk factor is higher.

1). Documents Required for Buying

• Age proof like passport, birth certificate, etc.

• Identity proof like passport, Aadhaar Card, etc.

• Address proof like passport, DL, utility bills, etc.

2). Documents Needed for Claim

• A duly filled and signed claim form

• Recent passport-size photo

• All the hospital bills, receipts, documents, reports, prescriptions

• Pre-authorised claim form for cashless claim

• Identity proof

3). List of Documents Necessary to Claim Under Reimbursement

For reimbursement claim, you need the following documents:</b>

• Discharge summary from the hospital

• All the receipts, bills, prescriptions, reports, and documents, issued during hospitalisation

• Identity proof

1). Cashless Claim

For a smooth cashless claim settlement, follow these steps:

• Inform your insurer and contact the hospital TPA desk regarding your hospitalisation in a network hospital within 24 hours

• Duly fill in, sign, and submit the pre-authorisation form

• Once the treatment process is complete, submit all the bills, receipts, and documents issued so far along with the discharge summary

• The insurance provider will liaise with the hospital authorities and directly settle the approved claim amount

• You have to settle the remaining dues and complete the process.

2). Reimbursement Claim

In this type of claim, you need to pay for the expenses out of your own pocket and then file for the claim after discharge.

• Immediately inform your insurer regarding the development and your hospitalisation

• Once the treatment process is complete, settle the entire hospital bill out of your pocket.

• Contact your insurer at the earliest after discharge.

• Submit all the prescriptions, reports, invoices, receipts, and documents along with the discharge summary and a duly filled and signed claim form

• Once all the documents are verified to be correct, you receive the approved claim amount directly to your registered bank account.

While wrapping up, we must emphasise that health insurance has become a necessity considering the current circumstances of steep medical inflation. So, it is best to purchase one at the earliest. You can easily buy best health insurance online with a few simple clicks and taps on your computer or smartphone. However, consider all the tips and tactics mentioned here to ensure optimum coverage without burdening your pocket.