Health insurance provides coverage for medical expenses through a contract between an insurer and an individual. It offers key benefits like cashless treatment at empaneled hospitals, coverage for pre- and post-hospitalization expenses, and ambulance fees. When buying a health insurance policy, it is important to consider the age criteria, appropriate premium and coverage amounts, waiting periods, cashless hospital networks, and other clauses. Health insurance offers tax benefits under Section 80D and can help cover unexpected medical costs.
2. Health Insurance
• Insurance that covers your medical expenses.
• A health insurance policy is a contract between an insurer and an individual
/group in which the insurer agrees to provide specified health insurance
cover at a particular “premium”
• Financial protection to meet the expenses incurred due to hospitalisation or
treatment of some disease
3.
4. Key benefits of Health Insurance
1.Cashless Medical Treatment: Empaneled hospitals
2.Coverage of Pre and Post Hospitalization Expenses
3.Ambulance fee
4.No Claim Bonus- Increment in sum assured or discount in premium
cost
5.Medical Check up Facility-Add on Benefit
6.Room Rent Sub limits in Insurance plan
7.Co Payment-Certain % to be beard by the Individual
8. Tax Benefit: Section 80D
5. Top 10 Things to Know Before Buying a
Health Insurance Policy
1. The Age Criteria:the cost of premium would depend on the age
2. The Right Combination of Premium and Coverage: buy a policy that
offers adequate coverage, without compromising on the benefits and at a
premium that you can afford.
3. The Waiting Period Clause :choose a plan that comes with a minimum
waiting period to be able to claim the benefits in case of a health
emergency.
4. Cashless Hospitalization Benefits:check with your insurer for the list of
empanelled hospitals and know what all network hospitals are there in
your vicinity.
6. Top 10 Things to Know Before Buying a
Health Insurance Policy
5.Pre and Post Hospitalization Coverage:Buy a plan that covers
expenses incurred before and after the hospitalization as well to save
expenses incurred on ambulance charges, medical tests, medicines,
doctor fees
6. Coverage of Maternity Expenses:it is better to buy a health plan that
covers maternity expenses as well.(2-4Years)
7. No-Claim-Bonus/No-Claim-Discount
7. Top 10 Things to Know Before Buying a Health Insurance
Policy
8. Preventive Health Check-up Facility
9. Co-Payment Clause
10.Claim Process
8.
9. FAQ
• Are there any tax benefits which can be availed through health
insurance plans?
• The premium paid towards the insurance policy can be claimed as a
tax-saving deduction under Section 80D. A taxpayer is permitted
deduct up to Rs 25,000 annually for a health insurance policy, where
the premium is paid for yourself. In case the premium is paid for a
parent, a deduction of Rs 30,000 can be claimed.
10. What is the claim settlement ratio?
• Claim settlement ratio would indicate the ratio of claims settled
against claims reported during the year. Always make sure to check the
ratios of your health insurer before you purchase the plan.
11. Is there a waiting period for claims under a
health insurance policy?
• Usually, there will be 30 days waiting period, starting from the policy
inception date. During this period any hospitalization charges will not
be payable by the insurance companies. However, emergency
hospitalization occurring due to an accident is excluded. There is no
waiting period applicable for subsequent policies under renewal.
12. What is a "health check" facility?
• Some health insurance policies pay for specified expenses towards
general health check up once in a few years. Usually, this is available
once in four years.
13. What are the factors that affect Health Insurance
premium?
• Age is a major factor that determines the premium. Previous medical
history is another major factor that determines the premium. Claim
free years can also be a factor in determining the cost of the premium
as it might benefit you with a certain percentage of the discount.
14. Can the policy be transferred from one insurance provider to
another provider without losing the benefits?
• The Insurance Regulatory and Development Authority (IRDA) has
issued a circular making it effective from 1st October, 2011, which
directs the insurance companies to allow portability from one
insurance company to another and from one plan to another, without
making the insured to lose the renewal credits for pre-existing
conditions, enjoyed in the previous policy. The sum insured under the
previous policy will continue.
15. What is a cashless facility?
• Health insurance companies have tie-up arrangements with several
hospitals all over the country. Through these tie-ups, the hospitals
become part of the network. If a health insurance policy offers the
cashless facility, a policyholder can take treatment in any of the
network hospitals without having to pay the hospital bills. The
payments to the hospital are made by a third-party administrator who
acts on behalf of the insurance company.
