Insurers refer to a clinic, hospital, doctor, laboratory, healthcare practitioner, or pharmacy that offers treatment for an individual’s disease as an “insurer”. The “insured” is the person covered by health insurance or is the owner of the policy.
Get to know more about health insurance, why it’s necessary, the different types of plans, and the laws that govern it in this article.
What is health insurance?
A contract allowing an insurer to pay all or most of a person’s healthcare bills in exchange for a premium is known as health insurance. In specifically, health insurance often covers the insured’s medical, surgical, prescription drug, and dental expenditures. Health insurance pays the care provider directly or pays the insured for expenses incurred due to illness or accident.
It’s frequently included in employee benefit packages as a way to attract the best talent, with premiums partly covered by the business but frequently taken from employee paychecks. With limited restrictions for company employees, the cost of health insurance premiums is taxable to the payers, and all the benefits received are tax-free.
Benefits of Health Insurance Plans
- Charges for Pre and Post Hospitalization –
- A health insurance plans may cover pre-hospitalization expenses such as diagnostic costs and doctor’s fees, among other things. Most insurance companies fund post-release expenses such as medicine, routine check-ups, injections, and so on. Compensation funds for the same might be obtained in a lump-sum payment or by issuing appropriate bills.
- Expenses of Hospitalization –
- Standard health insurance plans cover any medical issue that requires immediate hospitalization. However, claims will only be considered if the sickness has not been identified previously and the insurance plan has not been used.
Respectable insurance companies also cover hospitalization expenses involved in the following cases:
- Treatment for Critical Illness – Some insurance companies pay out large sums equal to or greater than the sum covered to cover all of the basic costs of treating critical illnesses. Most companies cover all medical expenditures, including hospitalization, diagnosis, and medication.
- Hospitalization Coverage for Accidents and Illnesses – Medical expenses incurred during hospitalization due to illnesses or accidental injuries are also covered. Major insurance companies give appropriate treatment rates equal to or greater than the sum insured. Such comprehensive coverage ensures that you are financially secure in the event of any unexpected events.
- Cover against Mental Illness – Such health insurance coverage also covers hospitalization for psychiatric therapy when necessary. With mental health issues on the rise in India and worldwide, this facility allows individuals to pursue professional care for a more satisfying life.
Mediclaim Health Insurance Policies
- Health insurance plans provide more flexibility : When a policyholder experiences difficulty, Health Insurance plans offer more flexible benefits. For example, when the sum covered is depleted, new coverage is offered at no additional cost. Benefits such as Automatic Restoration of Basic Sum Insured, Super Restoration of Basic Sum Insured, and Road Traffic Accident (RTA) on the Sum Insured is available in this situation.
- Health insurance plans cover Non-Hospitalization Expenses : Non-hospitalization charges are covered by the majority of the medical health insurance policies. Pre- and post-hospitalization costs, annual health check-ups, out-patient care treatments, diagnostics, and consultations are just a few examples.
Health Insurance Plans
Health Insurance for Individuals
The name implies that individual health insurance covers all the required treatment expenditures of an individual. This is also available for you, your parents, your mate, and your children. Every family member receives separate insurance coverage under this plan. For example, if your plan sum insured is Rs 10 lakhs, each family member is entitled to spend up to Rs 10 lakhs for the duration of the policy, i.e., if you buy an individual plan for three family members, the total sum insured is Rs 30 lakhs.
Because of the separate sum insured amount, if something were to happen to all/more than one of your family members simultaneously, this health insurance policy would be enough to cover them all.
Floater Health Insurance for Families
A single sum insured is offered for all individuals under one policy under such schemes. This entire money can be issued for the treatment of a single person, after which no further claims will be paid in the event of a medical emergency. Because their medical demands are more complicated, senior citizens are not eligible for family floater policies.
Senior Citizen Health Insurance
These plans are available to persons over the age of 60, and they are specially made to cover all medical expenses for the elderly. Comprehensive coverage is provided for various illnesses that may arise as a result of aging.
Reasons to choose Health Insurance
To keep your family safe
While looking for the best health insurance plans for your family and family members, you have the choice of securing your whole family under a single policy rather than buying separate policies.
Include your elderly parents, who are prone to illness, as well as your dependent children. If you have adequate health insurance, you will not have to worry about ensuring that they receive the best medical treatment possible if anything were to happen to them. Make sure you do your research, talk to specialists for an unbiased opinion, and get a plan covering everything.
To fight medical costs
As medical technological progresses and disease rates rise, so does the expense of treatment. It’s also important to note that medical expenses aren’t confined to hospitals. The cost of a doctor’s consultation, diagnostic tests, ambulance fees, operating room fees, medicines, lodging rent, and other expenses is rising. If you are not well prepared, all of them could put a significant burden on your finances.
By paying a low annual health insurance premium cost, you can avoid the burden of medical expenses while receiving high-quality care without worrying about the expense.
How to claim?
You can easily claim health insurance by following the simple steps.
- If you have a scheduled hospitalization, notify your insurance company before you are admitted; if you have an emergency hospitalization, you have 24 hours to notify your insurance company.
- Collect receipts, prescriptions, discharge papers, and copies of reports before leaving the hospital and provide hospital documentation to the insurance while processing the claim.
- When filling out the claim form on your insurer’s website, follow the processes exactly; make sure the hospital and doctors fill out all of the relevant sections completely.
- To avoid unnecessary delays, double-check your insurance documents to ensure that your bank information is up to date.
- After being released from the hospital, make sure you submit the form along with the required documents as soon as possible.
- The claim could take up to 45 days to be processed. During this time, the insurance company has the right to request additional paperwork.
Cashless Facility Procedures
The cashless health insurance claim option allows you to be admitted to a network hospital that has a contract with your insurer without having to pay out of pocket. To make use of the service, you must present your insurance documents to the hospital at the time of admission. The bills will be sent directly to the insurance provider by the hospital. If you’re planning on being admitted to the hospital, you’ll need to contact your insurer in advance to file a claim.
Reimbursement claim procedures
You will not be eligible for cashless treatment if you are treated in a hospital that is not linked with your insurance company. Before filing a reimbursement claim, you must pay the hospital bills out of your pocket. To claim it, you must provide all the hospital records to the insurance company, including bills, medications, reports, and other required documents. If your claim is accepted and correct, the insurer will process it and reimburse you.