What is covered by the Health Insurance Plan?
The majority of insurers of health insurance in India provides coverage for these medical costs as part of an insurance policy for health:
- Hospitalization Costs for In-PatientsThe hospitalization costs incurred in the treatment of injury or illness are covered as long as the hospitalization lasts longer than 24 hours.
- Pre-existing illnesses or diseases – Following the expiration of your waiting time, you are able to submit a claim to cover the costs incurred in the treatment of any disease or illness.
- Pre and Post-Hospitalization Costs The following are the costs. Medical expenses that are incurred as a result of blood tests, x-rays and other medical examinations which are necessary prior to hospitalization are covered through the insurer. The same goes for the cost of medications as well as preventive health checks which are performed to check your health following your discharge from the hospital are covered by an insurance program for health.
- Ambulance Costs While the amount of coverage is different between insurers but most medical insurance plans will cover ambulance costs.
- Maternity Cover Medical costs incurred during birth and pregnancy are covered, as well as the costs associated with a newborn baby.
- Healthy Checkups for Preventive Care Regular health check-ups are also available through some health insurance plans across India.
- Daycare ProceduresDaycare procedures in which hospitalization is not needed for longer than 24hrs are covered. It covers dialysis, eye surgery, and other daycare procedures according to your policy documents.
- Home Treatment Coverage The policy also pays costs associated with getting healthcare at the home, on the recommendation of a doctor.
- Ayush Benefit A medical insurance policy also covers medical expenses incurred during Ayurveda, Unani, Siddha, or Homeopathy treatment, up to a certain amount.
- Mental Health Insurance Coverage –Several insurance plans for health in India cover medical expenses associated with treating mental illnesses such as depression.
What is not covered in the Health Insurance Plan?
These medical costs and circumstances are not covered by an insurance policy for health:
- If there is no accidental incident, claims made within the first 30 days following the purchase of the health insurance plan do not qualify for coverage.
- Pre-existing illnesses are covered dependent on a wait time of between 2 and 4 years
- Critical illness coverage typically includes a 90-day waiting period
- The effects of war, terrorism, or nuclear activities
- Suicide attempts or self-inflicted injuries
- Terminal illness, AIDS, and other ailments of the same nature
- Cosmetic or plastic surgery, replacing hormones surgery, etc.
- Eye surgery or dental expenses
- Rehabilitation, bed rest Common illnesses, bed rest, etc.
- Post-care tests and diagnostic tests
- The claims arising out of injuries sustained in adventure sports
Important Factors to Take into Account Prior to Purchasing the Health Insurance Plan
There are some aspects that you must take into consideration to make the best decision when you purchase health insurance:
- Review the scope of Coverage: The policy coverage, as well as the amount of insurance, will determine the kind of ailments and surgeries you are able to claim within the term of your policy. Take a close look at the benefits provided such as hospitalization costs daily cash benefits COVID hospitalization coverage Critical illness coverage as well as maternity insurance. when choosing a health insurance plan.
- Affordable Sum Insured: The sum insured is an important deciding factor when selecting a health insurance plan. With regard to the rising inflation, it is recommended to purchase an insurance policy that has the minimum amount of 10 lakh, which could be increased to 1 crore. If it’s a family floater plan and senior citizen’s insurance the more the insurance premium is the greater the insurance coverage.
- Policy Type: Policy Type There are various types in medical insurance offered in India. According to your requirements, you may choose to purchase individual health insurance or seniors health insurance family floater, and critical health plans. Additionally, you can purchase top up and Super Top-up health insurance alongside your current health plan to expand the coverage. This can be advantageous in the event that the base amount insured is exhausted while you are undergoing treatment. This option can be selected when you make the purchase and renew.
- Waiting period: cause your medical insurance plan comes into effect once the waiting period has been completed. If a claim is made during the initial waiting time with the exception of accident-related hospitalization claims the insurer may deny the claim. Additionally, the waiting time clause is also applicable to pre-existing illnesses like thyroid, diabetes, blood pressure, etc. The same applies to certain illnesses as well as treatments and pregnant cover. You can pick an option with a short waiting time.
- Co-payment Clause: Your Medical insurance coverage might contain a copayment clause, that is, a specific portion of the amount claimed will be the responsibility of your (insured). The co-payment clause does not impact the amount of insurance. It permits you to lower the cost of insurance to an extent but definitely will increase your out-of-pocket costs. Make sure to select this option in the event that you are able to pay off the majority of your hospital bills which can be between 10% and 10% without incurring a financial burden.
- Room Rental Sub-limits: A health insurance policy could have a variety of sub-limits, and the most commonly used one is the sub-limit for room rent. For example, if your medical insurance policy has an amount insured of Rs 3 lakh, with an additional limit of 1% of the daily rent for your room, the cost of your room is covered up to Rs . 3,000 per day. Any additional sum for room rent has to be paid out of your personal account. Therefore, a health insurance plan that does not have any or very any sub-limits at all is recommended.
- Network of Cashless Hospitals Network of Cashless Hospitals: Look up the list of hospitals that are part of the network for an insurance company with cashless claims are accepted. The more network hospitals that are within your area, the better your chances of obtaining advantages of cashless hospitalization.
- Lifelong Renewability Option: Medical policy insurance is typically renewed each year. When the period of coverage is nearing its expiration and the insured wishes to keep the insurance coverage, the insured must to pay the cost at time renewal. When purchasing an insurance policy for health selecting a policy with the option of a lifetime renewal will benefit you over the long term.
- The Premium Loading Factor: Premium Loading refers to the extra amount due to the risk-prone policyholder as a premium, particularly for seniors in medical insurance policies. Selecting a medical insurance policy that does not charge a loading fee will spare you from having to pay an extra cost. Certain insurers also charge claim load. While this aspect is often ignored at first, generally will increase your out-of-pocket costs during the time of a claims.
- Verify the Claims Settlement Ratio: This is an essential measure to evaluate the reputation of an insurance company. Always choose an insurer with a solid claim settlement track record. A ratio of claim settlement that is higher than 80 percent could be the best option.