Health Insurance
What is Health Insurance?
Health insurance is a contract between you and an insurance provider that covers medical expenses due to illness, accidents, or even preventive care, depending on the policy. You pay a premium, and in return, the insurer covers part or all of your healthcare costs.
Key Coverages in Health Insurance
Hospitalization Costs
Covers room rent, doctor fees, and treatment charges.
Pre & Post-Hospitalization
Pays for medical tests and follow-up care before and after hospitalization.
Daycare Procedures
Covers treatments like dialysis, chemotherapy, and cataract surgery that don’t require 24-hour hospitalization.
Ambulance Charges
Covers the cost of emergency medical transportation.
Cashless Treatment
Allows policyholders to receive treatment at network hospitals without upfront payments.
Domiciliary Care
Covers medical treatment received at home when hospitalization is not possible.
Organ Transplant Cover
Pays for transplant procedures, including donor expenses in some cases.
FAQS
- Individual Health Insurance Covers medical expenses for a single person.
- Family Floater Health Insurance A shared policy that covers all family members under a single sum insured.
- Group Health Insurance Provided by employers for employees and sometimes their families.
- Critical Illness Insurance Lump-sum payout upon diagnosis of serious diseases like cancer, stroke, or heart attack.
- Senior Citizen Health Insurance Designed for people aged 60+ with benefits for age-related medical conditions.
- Maternity & Newborn Cover Covers pregnancy-related expenses, delivery costs, and newborn care.
- Top-Up & Super Top-Up Plans Additional coverage beyond a base health insurance plan.
- Ayushman Bharat Scheme aims to provide free healthcare coverage to economically weaker sections of society.
- Wellness Programs focus on preventive healthcare, promoting fitness, mental well-being, disease screening, and lifestyle improvements for a healthier life.
- Protects against rising medical costs
- Ensures access to quality healthcare
- Covers critical illnesses & emergencies
- Reduces financial stress on families
- Offers tax benefits
- Pre-Existing Diseases – Covered after a waiting period (typically 2-4 years).
- Cosmetic & Dental Procedures – Unless needed due to an accident or illness.
- Self-Inflicted Injuries & Substance Abuse – Claims related to alcohol/drug use are not covered.
- Non-Allopathic Treatments – Ayurveda, Homeopathy, and other alternative medicines may not be covered unless specified.
- Waiting Periods for New Policies – Some benefits (like maternity or specific diseases) come with waiting periods.
- Age Factor – Older individuals pay higher premiums.
- Sum Insured – Higher coverage means a higher premium.
- Medical History – Pre-existing conditions may lead to higher costs.
- Lifestyle Factors – Smoking, alcohol use, and obesity can increase premiums.
- Policy Type – Individual, family, or corporate plans have different pricing models.
- Premiums paid for health insurance are often tax-deductible under income tax laws.
- Higher deductions for policies covering senior citizens.
- During the open enrollment period (typically once a year).
- During a special enrollment period if you experience a qualifying life event (e.g., marriage, job loss, having a baby).
- Check Sum Insured – Ensure the coverage amount is enough for major medical expenses.
- Compare Waiting Periods – Look for policies with shorter waiting times for pre-existing conditions.
- Network Hospitals – Choose a plan with extensive cashless hospitals.
- Claim Settlement Ratio – Select an insurer with a high claim approval rate.
- Check Co-Payment & Deductibles – Lower co-payments mean fewer out-of-pocket expenses.
- Get treatment at a network hospital.
- Submit policy details at the hospital insurance desk.
- The insurer directly settles the bill with the hospital.
- It depends on your plan. Some plans only cover in-network providers, while others offer out-of-network benefits.
- HMO (Health Maintenance Organization) – Requires you to use a network of doctors and get referrals for specialists.
- PPO (Preferred Provider Organization) – Offers flexibility to see any doctor but has lower costs for in-network providers.
- EPO (Exclusive Provider Organization) – Covers only in-network care except in emergencies.
- POS (Point of Service) – Requires a primary care doctor but allows out-of-network care at a higher cost.
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