health insurance benefits

What is Health Insurance? It’s Types & Benefits?

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What is Health Insurance?

Health insurance is a part of covering the medical expenses related to the person’s life and helps spread the risk among a large number of people. This is health insurance, a medical insurance policy which helps cover the medical expense financially for the hospitalized policyholder. With the facility of the cashless means of hospitalization at varied hospitals all over the city and country, people also get reimbursements for the hospitalization cost, treatment, injury, any other expenses including the surgeries.

Benefits of Health Insurance

Benefits of Health Insurance

The main purpose of health insurance is to offer hospitalized medical coverage including day Care procedures, pre and post hospitalization ambulance charges, and more. This insurance protects your savings from being used in case of serious health condition which leads to hospitalization during the policy period. The utility of your health insurance not only depends on its features but also on how well you use it. To understand it well, read the features given below.

1. Convalescence benefits

It is also known as recuperating or recovery benefits. Under this, the insurer takes care of the insured’s recovery expenses. This benefit is to cover all the supplementary costs that may arise due to hospitalization like loss of income. A lump sum amount is paid by the insurer in case of prolonged hospitalization for about 7 to 10 days. In some policies, the cost associated with a compassionate visit by the family members is also covered by the insurer.

2. Alternative treatment

The insurance companies under this cover treatment like Ayurveda, yoga, and homeopathy. the alternative treatment is covered by the company only if the treatment takes place in a government hospital or at an institute recognized by the quality council of India and the National Accreditation Board on health.

3. Expenses related to an organ donor

The cost of organ transplants is quite high but if you have proper health insurance you need not worry about your medical expenses before undergoing surgery. The general insurance companies cover organ transplant surgery as their regular health insurance plans. Under this only the cost of surgery for harvesting, the organ is covered by the insurer. While The other cost of donor hospitalization, post-surgical complication along with the cost of screening are not covered.

4. Domiciliary treatment

Many insurance companies have expanded their insurance coverage to include various treatments taken at home under medical supervision. The treatment is insured until the capped amount and the number of days fixed by the insurer.

5. Attendant Allowance

Most of their insurance companies even offer an attendant allowance to the adult accompanying the hospitalized person. This is applicable only if the hospitalized person is a child. However, the number of days the insurer pays the attendant allowance is fixed.

6. Free health check-up

Health insurance companies offer free periodic health checkups to their policyholders. This happens after every 4 or 5 claim-free years. The health checkups offered by the insurer are cashless if tests are done at impaneled hospitals or centers.

7. Dental treatment

Most of the insurance companies cover the dental treatment of the insured once in a few years with sub-limits. Like Apollo Munich’s Maxima Health care and easy health insurance plan covers the dental treatment after a waiting period of 3 to 4 years.

Types of health insurance

It is extremely important to have the right health insurance. To help you find the insurance that will fit in all your needs, we have discussed six types of health insurance plans below.

1. Individual health insurance plan

It is the type of health insurance that cover up the health expense of an incurred individual. They pay for the surgical and hospitalization expenses of an encoded individual. However, this happens to tell the cover limit is reached. Under this policy, the premium for an individual plan gets decided based on medical history and also as per the age of the person buying the plan.

2. Family floater health insurance plan

it is for those people who want to buy health insurance for the entire family under a single plan. Any of the member covered under the plan can claim for hospitalization and surgical expenses. The insured has to pay for premium here. The premium under this plan is decided based on the age of the eldest member covered under the policy.

3. Group health cover

This insurance is about by an employer for his employees. Here, the amount of premium is lower than the individual health insurance policy. They are usually standardized in nature and offers all the employees with the same benefits.

4. Senior citizen health insurance

As old age involves several expensive treatments and so health insurance plan becomes important. For meeting such high medical costs, specially designed health insurance plans for senior citizens are made available. Under this plan, anyone from the age of 65 and above can take the benefit. in this case, the premium is higher as compared to other policies.

5. Critical illness health cover

This health insurance plan covers the expense involved in treating life-threatening diseases like those of tumors, permanent paralysis, etc. Under this policy, the insured person gets a pay in lump sum amount on the diagnosis of serious diseases covered under the policy. For claiming the benefits here only the diagnosis of the disease is enough.

6. Super top-up policy

This policy offers additional coverage over the regular policy that will help to increase the amount of sum insured. However, this policy can only be used after one’s regular policy is exhausted.

How to select a health insurance plan?

It has become essential to buy health insurance in the present time for bearing the ever-soaring medical expenses. With so many options, the insurance plan binds you to be particular while choosing the best health insurance policy in India. As the market is flooded with thousands of insurance plans, purchasing the right and adequate health plan is not easy. To make this easy, the below pointers will prove to be relevant when you hunt for a health plan that meets your needs.

1. Smartly choose the coverage amount

Look for the plan that offers you maximum health coverage and also the maximum amount for the amount. The healthcare expenses are drastically going up with medical inflation and so you need a sufficient amount to deal with inflation. Just an example of a heart surgery which causes around 4 to 5 lakhs and for a middle-class family the amount is quite high. This matters a lot for them if the policy covers this amount.

2. Family floater heal plans to be a great option

The health plans are designed keeping in mind the needs of the individual but for your family, we will advise you to buy a family slaughter plant that will keep in mind the needs of your entire family. With this, you do not need to buy a separate policy for each member and keep their life secured. Here the premium is even less compared to other health policies. Anyone who needs to be hospitalized can utilize the amount during their treatment. Also, wiping a slightly higher premium you can cover your senior citizen parents.

3. Precisely choose the insured sum

Choose the sum insured according to your marital status and age. The risk factor at a young age is less compared to the age of more than 40. This age leads to a variety of problems like BP, diabetes, etc. Also, when you are married, select the insured sum of your health plan after checking the health status of your partner.

4. Plan the policy with a minimum waiting period

The health insurance plans come with their own set of terms and conditions regarding the pre-existing diseases. This means that if you have a disease before taking the plan then the claim made for taking treatment against the illness will be accepted after serving for a defined waiting period. Mostly the waiting period ranges from 2 to 4 years. Though there are some plants that have a less waiting period. Thus, while buying a health policy, opt for the one with less waiting period.

5. Maximum age renewal

Generally, there is no need for health policy at a young age but when one gets older, the possibilities of health issues increase. Thus, select a plan which can be renewed at the age of 75 or 80 years.

6. An insurer with a high claim settlement ratio

The number of claims that are settled by the insurer over the total claims received is the claim settlement ratio. Always choose the health plan from the insurance with a high claim settlement ratio. This ensures that your claim is not rejected until one gets a valid reason. Be careful while filling the form and attach all the relevant documents and proves to support your claim.

7. Choose the plan with sub-limits

The health insurance policies mostly come with sub-limits on per day medical expenses like room rent. Select those plans that offer the highest slab on room rent along with other Health care expenses. The best health insurance policy in India comes with maximum sub-limits. All you need to do is select the plan, compare, calculate the premium and get the best deal for you.

8. Consider network hospital

The health insurance in India entitles you to avail treatments from network hospitals which are a group of hospitals associated with a particular insurer. While purchasing a health plan for yourself or your partner or other family member living in rural areas, always consider a plan with a wide network of hospitals in those areas.

9. Compare the premium

It is important to compare the premium before taking a health plan. You can get help from mini online aggregators that will help you compare the insurance policies as per their benefits, features, premium, maximum return, etc. Compare all the plans and avail all the benefits at a comparatively cheaper premium rate.

10. Add on Rider/critical illness Rider/accidental Rider

If you have a critical illness Rider, make sure that your financial planning does not get disturbed, if any Sudden medical expense arises. Critical illness cover serves as an add on Rider which you can get by pain and extra premium. In return, you get to avail health coverage against life-threatening diseases.

Health insurance plan by the Indian Government

National health care schemes are the schemes initiated by the Indian government to help out the people. the scheme was launched to make health insurance accessible to the poor and destitute. The schemes aim to provide the poor and the disabled with some benefits so that they need not worry about their expensive health treatment or surgeries. With these schemes, they even get money in case of accidents or disability. Thus this makes their life a lot simpler. Check the details given below to know more about the schemes of the government.

1. Rashtriya Swathiya Bima Yojana

The yojana launched by the ministry of labor and employment, the government of India. The insurance scheme is for the families who are below the poverty line. The yojana aims to offer health insurance coverage to BPL families in an economical manner. Under the Yojana, the government has fixed the hospitalization cover limit to rupees 30000.The hospital package rates have been fixed by the government. The scheme also covers pre-existing illness without any age limit criteria. It covers five family members and the registration fees for the rest is only 30 rupees. Here, the premium is paid by the government to the insurance companies.

2. Employment State insurance scheme

It is a government scheme that has customized insurance for providing socio-economic security to the workers and their dependents. Along with full medical cover for self and dependents, the beneficiaries get to avail of cash benefits as well. However, this happens only if there is any health emergency, death due to occupation hazard, permanent or temporary disability, employment injury, etc. the scheme is valid for non-seasonal factory employees (the factory must have more than 10 employees). It is even applicable to restaurants, newspaper establishments, cinemas, shops, road motor transport, hotel enterprises employing more than 20 people. The scheme is implemented area wise in all the states of India except Sikkim, Manipur, Mizoram, Arunachal Pradesh, and union territories.

3. Central government health scheme

The scheme offers all-inclusive health care services to the Central government employees. It also includes the pensioners as well as their dependents living in specific cities. The scheme was launched in 1954 by the central government. The services of the healthcare are offered through wellness centers like CGHS dispensaries/ allopathic, Yoga/ Ayurveda, Siddha, Homeopathic centers and Unani.
The scheme has got various components some of them being-

  • Dispensary services
  • Domiciliary care
  • Consultation with a specialist at the hospital
  • Medical tests including ECG, X-Ray and laboratory test
  • Hospitalization cover
  • Medicines requirements
  • Health education

4. Aam Aadmi Bima Yojana

Aam Aadmi Bima Yojana was launched on October 2, 2007, for rural and landless households. The national health insurance scheme ensures the earning member of the household between the age group of 10 to 59 years. The compensation provided under the schemes is as follows.

  • Natural death, the compensation is rupees 30000
  • Accidental death partial or permanent disability is the compensation is of rupees 75000 ( loss of 2 limbs or 2 eyes)
  • Partial or permanent disability from an accident the compensation of rupees 37500.

5. The universal health insurance scheme

The scheme is implemented by four public insurers to provide health insurance coverage to poor families. Under the scheme, the insured sum limit is up to 30000 on a family floater basis. This is for the hospitalization expenses. While the accidental death cover offered by them is of rupees 25000. In case of loss of income, compensation of rupees 50 is provided daily. The premium subsidy for an individual is now increased to rupees 200 from 100 for 5 family members while for 7 family members it has been increased from 400 to 300.

6. Janashree Bima Yojana

Janashree Bima Yojana launched in August in the year 2000 by the government of India. The scheme covers people between the ages group of 18 and 59 years.

7. Ayushman Bharat national health protection mission

The scheme covers more than 10 crore valuable and poor families. They offer coverage of rupees 5 lakh per family every year for territory and secondary care hospitalization. It subsumes the schemes that are in progress and are sponsored by the central government like senior citizen health insurance scheme along with the Rashtriya Swasthya Bima Yojana. The scheme benefits can be avoided by the beneficiary at any impaneled private and public facilities.

The main aim of the scheme is to corporate flexibility and federalism to the states. For implementing the scheme, the state needs to have a state health agency.

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