"Best Health Insurance: Coverage, Benefits and How to Choose a Plan”

As health-related problems continue to rise, the related treatment costs also place a considerable financial burden on families. Health insurance is a type of insurance that offers financial coverage for eligible hospitalisation and medical expenses of an insured person, subject to applicable terms and conditions. It is a contract between an insurance company and a policyholder, where the former provides coverage towards specified healthcare expenses up to the applicable sum insured. This may also include hospitalisation expenses, treatments, surgeries, and other eligible medical costs, depending on the plan.

How Does a Health Insurance Plan Work?

The health insurance plan provides financial coverage to fulfil eligible medical expenses against the premium paid by the policyholder. The process involves the following steps:

Step 1: Purchase of Health Insurance Plan

Select the Best Health Insurance to buy depending on coverage, premium, inclusions, and exclusions.

Step 2: Determination of Premium

The health insurance company determines the premium based on certain factors, such as the policyholder’s income, age, health profile, and coverage chosen. They may conduct medical assessments to assess health while determining the annual premium and sum assured.

Step 3: Cashless Treatment

Check whether the plan offers cashless treatment or not in case of hospitalisation. In case of cashless treatment, the Third Party Administrator (TPA) coordinates with the network hospital for processing the claim and settling the eligible expenses. In case they do not offer cashless treatment, you need to pay the hospital bills and get reimbursed afterwards.

Step 4: Hospital Cash

Some of the plans also offer a hospital cash facility along with a daily allowance to meet the additional expenses incurred during hospitalisation. It is subject to the number of days spent in the hospital to manage the incidental costs.

Step 5: Claim Process

In case the plan is not cashless, submit the required bills, discharge summary, medical reports, and other documents to the TPA, who will verify them and then file a claim with the insurance company. The insurance company will process the claim and reimburse these expenses after deducting relevant deductibles.

Step 6: No Claim Bonus

Some insurance companies offer a no-claim bonus in case claims are not raised in a policy year. Depending on the policy, the benefit may be provided as an increase in the sum insured or a discount on the premium.

Factors to Consider When Choosing Health Insurance

Choosing a health insurance plan requires considering multiple factors, which ensures that the coverage aligns well with the healthcare and financial needs.

Sum Insured

Consider a sum insured that offers an adequate financial protection against potential medical and hospitalisation expenses depending on the age, family needs and healthcare expenses.

Premium

Compare the premium payable against the coverage and benefits offered by different plans.

Network Hospitals

Check the list of network hospitals available under the plan, mainly located near your house or workplace, to understand the availability of cashless treatment available.

Waiting Periods and Exclusions

Evaluate the waiting periods for pre-existing diseases and specific treatments, along with the exclusions, before buying a health insurance plan.

Co-payment and Sub-limits

Assess whether the plan includes co-payment requirements or sub-limits on certain medical costs, as these may affect the amount payable during a claim.

Overall Health and Lifestyle

Consider the existing health requirements and lifestyle while evaluating coverage. Tools such as a BMR Calculator lets you estimate your basal metabolic rate and hence support general health and wellness planning.

Benefits of Health Insurance

A health insurance plan provides financial assistance against eligible healthcare expenses to help individuals manage medical treatment costs. Some of these include:

Financial Protection

A health insurance plan includes eligible medical and hospitalisation expenses, hence reducing the financial burden on family members.

Cashless Treatment

A policyholder can avail cashless treatment at network hospitals, where the expenses are settled directly by the insurance company, subject to applicable terms and conditions.

Hospitalisation Coverage

The health insurance plans may include hospitalisation expenses, surgical costs and other eligible medical treatments depending on the plan chosen.

Pre- and Post-Hospitalisation Coverage

Some health insurance plans also cover eligible medical costs incurred before and after hospitalisation for a certain period, subject to applicable terms and conditions.

Critical Illness Coverage

Some health insurance plans provide financial assistance towards critical illness, subject to applicable terms and conditions.

Tax Benefits

The premium paid towards the health insurance is eligible for a tax deduction under applicable Income tax provisions, subject to terms and conditions.

Conclusion:

With rising medical costs, a health insurance plan can help individuals and families manage unexpected healthcare expenses. While buying an insurance plan, it becomes essential to consider the coverage and waiting periods, benefits, sum insured, and applicable premiums. Comparing health insurance policies depending on healthcare requirements and financial needs allows an individual to choose appropriate coverage, hence making an informed decision.

FAQs

Is it allowed to change health insurance plan after buying it?

Yes, it is allowed to switch from one health insurance plan or insurance company to another through portability, subject to applicable terms, conditions and timelines.

Is it allowed to have more than one health insurance plan?

Yes, an individual can have more than one health insurance plans. However, the claim settlement will depend on the applicable terms and conditions of each plan.

What happens if the health insurance policy is not renewed on time?

Failure to renew the health insurance plan within the applicable renewal period may result in a break in coverage and could affect accumulated benefits, subject to the applicable terms and conditions.

Is it allowed to increase the sum insured of a health insurance plan?

Yes, some insurance companies may allow to increase the sum insured at renewal or through specific plan options, subject to underwriting and applicable terms.

What is the difference between a health insurance plan and a critical illness?

A health insurance generally covers eligible medical and hospitalisation costs, while a critical illness plan typically provides a fixed benefit upon diagnosis of specified critical illnesses, subject to the applicable terms and conditions.